Measuring ligand efficacy at the mu-opioid receptor using a conformational biosensor.

The intrinsic efficacy of orthosteric ligands acting at G-protein-coupled receptors (GPCRs) reflects their ability to stabilize active receptor states (R*) and is a major determinant of their physiological effects. Here, we present a direct way to quantify the efficacy of ligands by measuring the binding of a R*-specific biosensor to purified receptor employing interferometry. As an example, we use the mu-opioid receptor (µ-OR), a prototypic class A GPCR, and its active state sensor, nanobody-39 (Nb39). We demonstrate that ligands vary in their ability to recruit Nb39 to µ-OR and describe methadone, loperamide, and PZM21 as ligands that support unique R* conformation(s) of µ-OR. We further show that positive allosteric modulators of µ-OR promote formation of R* in addition to enhancing promotion by orthosteric agonists. Finally, we demonstrate that the technique can be utilized with heterotrimeric G protein. The method is cell-free, signal transduction-independent and is generally applicable to GPCRs

The management of poor performance in nursing and midwifery: a case for concern.

Aim(s) - To examine the evidence of how poorly performing nurses and midwives are managed in the UK NHS Background – There is little evidence about poor performance and its management in nursing and midwifery literature. Method(s) – The scoping study comprised a literature search, analysis of recent Nursing and Midwifery Council data and a day’s observation at NMC fitness to practice hearings. Results – Nurses and midwives are the clinical groups most likely to be suspended from work in the NHS; NHS Trusts do not report data on suspensions therefore no statistics exist on numbers, reasons for suspensions, managerial processes, gender, area of work, or ethnicity of those suspended; the few major research projects identify variable management practices regarding poor performance, the significant financial cost to the NHS and the personal cost to those suspended; there is some evidence that inexperienced, poorly trained, or poorly supported managers use suspension inappropriately. Our day of observation supported this. Conclusion(s) – There is a need for more robust data gathering and research in the field of NHS managerial practice. Implications for Nursing Management – Managers should refrain from adopting punitive forms of performance management. Both frontline staff and management need better training and support for dealing with poor performance

An evaluation of the Islington community education provider network super hub.

‘Super Hubs’ are novel initiatives which have arisen in order to aid various workforce developments and service improvements for promoting creative thinking and practice. The Islington Super Hub is a workstream of the Islington Community Education Provider Network (CEPN) which aids the learning and development of community nursing and new apprenticeships (Health Education North Central and East London 2015). In this paper we report on the findings from a realist evaluation of the Islington Super Hub (Pawson and Tilley 1997) using data from a range of provider organisations. The following areas of direct relevance to the Super Hub’s activity will be analysed: i) the factors enabling nursing staff to transfer between sectors; ii) the variety of current preceptorship and induction programmes supporting newly registered nurses moving into community roles; iii) the current links between primary/secondary care for strengthening inter-sectoral working and the core training needed for hospital-based nurses to support patient journeys; iv) the practice learning experiences of specialist practice community nurses, such as General Practice Nurses, District Nurses and Health Visitors as well as non-specialist practitioners and health care assistants; v) the current approaches for sustaining practice-based learning for enhanced learning/development; vi) the current approaches to multi-professional education across localities which contribute to establishing robust community focussed multi-professional collaborative educational approaches; vii) the availability of student nurse placements in community settings and the associated mentorship capacity. Our analysis concludes with critical reflection on the relative merits of the Super Hub’s programme of learning and development which aims to promote creative thought/practice and the contextual factors surrounding the newly emerging apprenticeship roles. References Health Education North Central and East London (2015) Nursing and Midwifery Education Strategy. London: Health Education North Central and East London. Pawson R, Tilley N (1997) Realistic Evaluation. London: Sag

Disciplinary processes and the management of poor performance among UK nurses: bad apple or systemic failure? A scoping study

The rise of managerialism within healthcare systems has been noted globally. This paper uses the findings of a scoping study to investigate the management of poor performance among nurses and midwives in the United Kingdom within this context. The management of poor performance among clinicians in the NHS has been seen as a significant policy problem. There has been a profound shift in the distribution of power between professional and managerial groups in many health systems globally. We examined literature published between 2000 and 10 to explore aspects of poor performance and its management. We used Web of Science, CINAHL, MEDLINE, British Nursing Index, HMIC, Cochrane Library and PubMed. Empirical data are limited but indicate that nurses and midwives are the clinical groups most likely to be suspended and that poor performance is often represented as an individual deficit. A focus on the individual as a source of trouble can serve as a distraction from more complex systematic problems

Promoting a Growth Mindset in CS1: Does One Size Fit All? A Pilot Study

This paper describes a pilot intervention conducted in CS1, in theacademic year of 2016-2017. The intervention was based on thework of Dweck, promoting a growth Mindset in an effort to in-crease performance in introductory programming. The study alsoexamined data from a previous year (as a control group) to compareand contrast the results. Multiple factors related to programmingperformance were recorded with the control and treatment group,which were measured at multiple intervals throughout the course,to monitor changes as the pilot intervention was implemented.This study found a significant increase in programming perfor-mance when the intervention was deployed. However, althoughperformance increased for the treatment group, the average Mindsetdid not significantly change towards a growth Mindset (replicatingthe findings of Cutts et al, 2010). To further explore this finding,a preliminary deeper investigation using k-means clustering wascarried out. The investigation found that the intervention promoteda growth Mindset for some student profiles and a fixed Mindset forothers. This finding is important for educators considering interven-tion development or implementation of Mindset, and demonstratesthat a Mindset intervention may not be suitable for all learners

An evaluation of the Islington community education provider network super hub

‘Super Hubs’ are novel initiatives which have arisen in order to aid various workforce developments and service improvements for promoting creative thinking and practice. The Islington Super Hub is a workstream of the Islington Community Education Provider Network (CEPN) which aids the learning and development of community nursing and new apprenticeships (Health Education North Central and East London 2015). In this paper we report on the findings from a realist evaluation of the Islington Super Hub (Pawson and Tilley 1997) using data from a range of provider organisations. The following areas of direct relevance to the Super Hub’s activity will be analysed: i) the factors enabling nursing staff to transfer between sectors; ii) the variety of current preceptorship and induction programmes supporting newly registered nurses moving into community roles; iii) the current links between primary/secondary care for strengthening inter-sectoral working and the core training needed for hospital-based nurses to support patient journeys; iv) the practice learning experiences of specialist practice community nurses, such as General Practice Nurses, District Nurses and Health Visitors as well as non-specialist practitioners and health care assistants; v) the current approaches for sustaining practice-based learning for enhanced learning/development; vi) the current approaches to multi-professional education across localities which contribute to establishing robust community focussed multi-professional collaborative educational approaches; vii) the availability of student nurse placements in community settings and the associated mentorship capacity. Our analysis concludes with critical reflection on the relative merits of the Super Hub’s programme of learning and development which aims to promote creative thought/practice and the contextual factors surrounding the newly emerging apprenticeship roles

Thalamotemporal impairment in temporal lobe epilepsy: A combined MRI analysis of structure, integrity and connectivity

Objective Thalamic abnormality in temporal lobe epilepsy (TLE ) is well known from imaging studies, but evidence is lacking regarding connectivity profiles of the thalamus and their involvement in the disease process. We used a novel multisequence magnetic resonance imaging (MRI ) protocol to elucidate the relationship between mesial temporal and thalamic pathology in TLE . Methods For 23 patients with TLE and 23 healthy controls, we performed T 1‐weighted (for analysis of tissue structure), diffusion tensor imaging (tissue connectivity), and T 1 and T 2 relaxation (tissue integrity) MRI across the whole brain. We used connectivity‐based segmentation to determine connectivity patterns of thalamus to ipsilateral cortical regions (occipital, parietal, prefrontal, postcentral, precentral, and temporal). We subsequently determined volumes, mean tractography streamlines, and mean T 1 and T 2 relaxometry values for each thalamic segment preferentially connecting to a given cortical region, and of the hippocampus and entorhinal cortex. Results As expected, patients had significant volume reduction and increased T 2 relaxation time in ipsilateral hippocampus and entorhinal cortex. There was bilateral volume loss, mean streamline reduction, and T 2 increase of the thalamic segment preferentially connected to temporal lobe, corresponding to anterior, dorsomedial, and pulvinar thalamic regions, with no evidence of significant change in any other thalamic segments. Left and right thalamotemporal segment volume and T 2 were significantly correlated with volume and T 2 of ipsilateral (epileptogenic), but not contralateral (nonepileptogenic), mesial temporal structures. Significance These convergent and robust data indicate that thalamic abnormality in TLE is restricted to the area of the thalamus that is preferentially connected to the epileptogenic temporal lobe. The degree of thalamic pathology is related to the extent of mesial temporal lobe damage in TLE

Defining Levels of Learning for Strengths Development Programs in Pharmacy

The Clifton StrengthsFinder® is an online measure of personal talent that identifies where an individual’s greatest potential for building strengths exists. This paper describes a framework for strengths education in pharmacy which includes introductory, intermediate and advanced levels of learning. The use of the StrengthsFinder® assessment and supporting workshops aids student pharmacists, pharmacy residents and practitioners in identifying and refining their talents and connecting talents to roles in the profession. Additional learning strategies support a learner’s progression to intermediate and advanced levels of learning, which focus on the application of strengths in teams, leadership, and organizational development. By articulating and recognizing levels of learning around strengths-related content and skills, strong instructional design is fostered. Optimal design includes development of a sequence of learning opportunities delivered over time, a roll-out plan and consideration of the instructional resources required