Putting on a show : educator experiences of facilitating interprofessional simulation

This doctoral report presents a grounded theory Putting on a Show, illuminating how educators describe their practice of providing healthcare simulation for more than one professional group. Interprofessional simulation, describes occasions when more than one professional group through simulation-based approaches, learn with, from and about each other to improve patient outcomes. Simulation based approaches, originating in the aviation industry are now regularly applied in healthcare education (Hellaby, 2013). Simulation is frequently used to explore team dynamics, processes and outcomes and is described as a method that can support interprofessional learning outcomes (Gough, Hellaby, Jones & MacKinnon, 2012; Zhang, Thompson & Miller, 2011). In this study a constructionist grounded theory approach was used to explore the experience of educators when providing this type of simulation. Data collection for this research took place in England over a one-year period with seven participants. Grounded theory is used to generate a theoretical understanding of previously unexplained basic social processes, to ask 'why' questions (Charmaz, 2014). Grounded theory explores participant constructions of experience and is a method of construction throughout the inquiry process, using open, focussed coding and constant comparative methods alongside memos, reflective journals and diagrams (Charmaz, 2008). The conceptual theory generated in this study describes the utility of theatrical practices in simulation including a dramaturg role that resonates with the role of an interprofessional simulation educator. Educators, when adopting this role, can challenge taken for granted practice using an interprofessional gaze to reshape their default views of team approaches to clinical practice to facilitate the interprofessional potential of team-based simulation. The study contributes to describing features of simulation educator development and proposes ways to harness sociological authenticity when providing team-based simulation to more than one professional group

Multi-sector mitigation strategies at the neighbourhood scale

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The fatal trajectory of pulmonary COVID-19 is driven by lobular ischemia and fibrotic remodelling

Background: COVID-19 is characterized by a heterogeneous clinical presentation, ranging from mild symptoms to severe courses of disease. 9-20% of hospitalized patients with severe lung disease die from COVID-19 and a substantial number of survivors develop long-COVID. Our objective was to provide comprehensive insights into the pathophysiology of severe COVID-19 and to identify liquid biomarkers for disease severity and therapy response. Methods: We studied a total of 85 lungs (n = 31 COVID autopsy samples; n = 7 influenza A autopsy samples; n = 18 interstitial lung disease explants; n = 24 healthy controls) using the highest resolution Synchrotron radiation-based hierarchical phase-contrast tomography, scanning electron microscopy of microvascular corrosion casts, immunohistochemistry, matrix-assisted laser desorption ionization mass spectrometry imaging, and analysis of mRNA expression and biological pathways. Plasma samples from all disease groups were used for liquid biomarker determination using ELISA. The anatomic/molecular data were analyzed as a function of patients' hospitalization time. Findings: The observed patchy/mosaic appearance of COVID-19 in conventional lung imaging resulted from microvascular occlusion and secondary lobular ischemia. The length of hospitalization was associated with increased intussusceptive angiogenesis. This was associated with enhanced angiogenic, and fibrotic gene expression demonstrated by molecular profiling and metabolomic analysis. Increased plasma fibrosis markers correlated with their pulmonary tissue transcript levels and predicted disease severity. Plasma analysis confirmed distinct fibrosis biomarkers (TSP2, GDF15, IGFBP7, Pro-C3) that predicted the fatal trajectory in COVID-19. Interpretation: Pulmonary severe COVID-19 is a consequence of secondary lobular microischemia and fibrotic remodelling, resulting in a distinctive form of fibrotic interstitial lung disease that contributes to long-COVID. Funding: This project was made possible by a number of funders. The full list can be found within the Declaration of interests / Acknowledgements section at the end of the manuscript

Pharmacological profiling of the hemodynamic effects of cannabinoid ligands: a combined in vitro and in vivo approach.

The receptors mediating the hemodynamic responses to cannabinoids are not clearly defined due to the multifarious pharmacology of many commonly used cannabinoid ligands. While both CB1 and TRPV1 receptors are implicated, G protein-coupled receptor 55 (GPR55) may also mediate some of the hemodynamic effects of several atypical cannabinoid ligands. The present studies attempted to unravel the pharmacology underlying the in vivo hemodynamic responses to ACEA (CB1 agonist), O-1602 (GPR55 agonist), AM251 (CB1 antagonist), and cannabidiol (CBD; GPR55 antagonist). Agonist and antagonist profiles of each ligand were determined by ligand-induced GTPcS binding in membrane preparations expressing rat and mouse CB1 and GPR55 receptors. Blood pressure responses to ACEA and O-1602 were recorded in anesthetized and conscious mice (wild type, CB1 / and GPR55 / ) and rats in the absence and presence of AM251 and CBD. ACEA demonstrated GTPcS activation at both receptors, while O-1602 only activated GPR55. AM251 exhibited antagonist activity at CB1 and agonist activity at GPR55, while CBD demonstrated selective antagonist activity at GPR55. The depressor response to ACEA was blocked by AM251 and attenuated by CBD, while O-1602 did not induce a depressor response. AM251 caused a depressor response that was absent in GPR55 / mice but enhanced by CBD, while CBD caused a small vasodepressor response that persisted in GPR55 / mice. Our findings show that assessment of the pharmacological profile of receptor activation by cannabinoid ligands in in vitro studies alongside in vivo functional studies is essential to understand the role of cannabinoids in hemodynamic control

Eikonal phase retrieval: Unleashing the fourth generation sources potential for enhanced propagation based tomography on biological samples

The evolution of synchrotrons towards higher brilliance beams has increased the possible sample-to-detector propagation distances for which the source confusion circle does not lead to geometrical blurring. This makes it possible to push near-field propagation driven phase contrast enhancement to the limit, revealing low contrast features which would otherwise remain hidden under an excessive noise-to-signal ratio. Until today this possibility was hindered, in most objects of scientific interest, by the simultaneous presence of strong phase gradient regions and low contrast features. The strong gradients, when enhanced with the now possible long propagation distances, induce such strong phase effects that the linearisation assumptions of current state-of-the-art single-distance phase retrieval filters are broken, and the resulting image quality is jeopardized. Our work provides an innovative algorithm which efficiently performs the phase retrieval task over the entire near-field range, producing images of exceptional quality for mixed objects

Do school closures and school reopenings affect community transmission of COVID-19? A systematic review of observational studies

Objectives: To systematically reivew the observational evidence of the effect of school closures and school reopenings on SARS-CoV-2 community transmission. Setting: Schools (including early years settings, primary schools and secondary schools). Intervention: School closures and reopenings. Outcome measure: Community transmission of SARS-CoV-2 (including any measure of community infections rate, hospital admissions or mortality attributed to COVID-19). Methods: On 7 January 2021, we searched PubMed, Web of Science, Scopus, CINAHL, the WHO Global COVID-19 Research Database, ERIC, the British Education Index, the Australian Education Index and Google, searching title and abstracts for terms related to SARS-CoV-2 AND terms related to schools or non-pharmaceutical interventions (NPIs). We used the Cochrane Risk of Bias In Non-randomised Studies of Interventions tool to evaluate bias. Results: We identified 7474 articles, of which 40 were included, with data from 150 countries. Of these, 32 studies assessed school closures and 11 examined reopenings. There was substantial heterogeneity between school closure studies, with half of the studies at lower risk of bias reporting reduced community transmission by up to 60% and half reporting null findings. The majority (n=3 out of 4) of school reopening studies at lower risk of bias reported no associated increases in transmission. Conclusions: School closure studies were at risk of confounding and collinearity from other non-pharmacological interventions implemented around the same time as school closures, and the effectiveness of closures remains uncertain. School reopenings, in areas of low transmission and with appropriate mitigation measures, were generally not accompanied by increasing community transmission. With such varied evidence on effectiveness, and the harmful effects, policymakers should take a measured approach before implementing school closures; and should look to reopen schools in times of low transmission, with appropriate mitigation measures

Why do some women choose to freebirth in the UK? An interpretative phenomenological study

Background Freebirthing or unassisted birth is the active choice made by a woman to birth without a trained professional present, even where there is access to maternity provision. This is a radical childbirth choice, which has potential morbidity and mortality risks for mother and baby. While a number of studies have explored women’s freebirth experiences, there has been no research undertaken in the UK. The aim of this study was to explore and identify what influenced women’s decision to freebirth in a UK context. Methods An interpretive phenomenological approach was adopted. Advertisements were posted on freebirth websites, and ten women participated in the study by completing a narrative (n = 9) and/or taking part in an in-depth interview (n = 10). Data analysis was carried out using interpretative methods informed by Heidegger and Gadamer’s hermeneutic-phenomenological concepts. Results Three main themes emerged from the data. Contextualising herstory describes how the participants’ backgrounds (personal and/or childbirth related) influenced their decision making. Diverging paths of decision making provides more detailed insights into how and why women’s different backgrounds and experiences of childbirth and maternity care influenced their decision to freebirth. Converging path of decision making, outlines the commonalities in women’s narratives in terms of how they sought to validate their decision to freebirth, such as through self-directed research, enlisting the support of others and conceptualising risk. Conclusion The UK based midwifery philosophy of woman-centred care that tailors care to individual needs is not always carried out, leaving women to feel disillusioned, unsafe and opting out of any form of professionalised care for their births. Maternity services need to provide support for women who have experienced a previous traumatic birth. Midwives also need to help restore relationships with women, and co-create birth plans that enable women to be active agents in their birthing decisions even if they challenge normative practices. The fact that women choose to freebirth in order to create a calm, quiet birthing space that is free from clinical interruptions and that enhances the physiology of labour, should be a key consideration