South African primary health care in the era of HIV/AIDS treatment and care : understanding the organisation and delivery of nursing care

The integration of Antiretroviral Treatment (ART) for HIV in to South African primary health care (PHC) and task shifting are increasing nurses' role in ART and H/V care. There is evidence this role is motivating nurses to adopt more patient-centred care. This study explored this potential emergence of more patient centred care in PHC in the Free State province, South Africa. A multi-site, mixed-method observational approach was used, building on ethnographic principles. A purposive sample of four clinics, two providing ART and two not, were the focus for observation and interviews through four phases of data collection. Emerging findings were explored in an additional six clinics in later phases of data collection. 34 professional nurses, 6 members of clinic staff and 21 patients were interviewed. A thematic analysis that aimed to develop theory grounded in the study contexts through integrating existing theory with inductively identified themes was used. The study found care is patient centred and integrated to a limited extent, while ART and HIV care are more likely to be patient centred than other aspects of PHC. These care routines are then shown to emerge from nurses' agency mediating different levels of structure: the rules of clinic interaction and then the clinic context. Further analysis of nurses' agency explores how it is shaped by a complex identity and a health system context of constant change. The study provides in-depth understanding of a little explored health services issue, and is the basis for recommendations to support patient centred and integrated care. The analysis supports the reconceptualisation of patient centred care to consider Issues of convenience, as a response to the specific context of nurse-led PHC in South Africa. The study also introduces a structure-agency theoretical framework that can be applied to the context of nurse-led PHC

A biochemical engineering study of lysozyme refolding

Available from British Library Document Supply Centre-DSC:DXN010371 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

"They accept me, because I was one of them": formative qualitative research supporting the feasibility of peer-led outreach for people who use drugs in Dakar, Senegal.

BACKGROUND: Peer outreach harm reduction initiatives are being developed with and for people who use drugs in Dakar, Senegal. This is in response to growing injecting drug use across the West Africa region and linked emerging epidemics of HIV and hepatitis C. We undertook formative qualitative research to explore the feasibility and potential of peer outreach in this context and in particular how outreach could be linked to fostering community-level processes of change. METHODS: We undertook a total of 44 semi-structured qualitative interviews. Thirty-four interviews were with people who used drugs (comprised of 25 participants who had injected at least once in their life) and included 11 peer educators who delivered "awareness-raising" harm reduction activities. We also interviewed 10 service providers involved in the planning and monitoring of peer outreach initiatives. We used thematic analysis to identify key characteristics of how peer-led outreach is being delivered, beneficiary need, and the nature of the social networks in which the awareness-raising activities operate. RESULTS: Through interviews with peer educators, people who use drugs, and service providers, four main overlapping themes are identified as follows: peer educators as a bridge to responsibilization through awareness-raising activities, awareness-raising activities as an enactment of recovery, awareness raising through social network diffusion, and the contexts and constraints of peer outreach engagement through awareness-raising activities. CONCLUSIONS: The study results suggest that peer education is on a trajectory to develop into a central role for harm reduction interventions in Dakar, Senegal. This research shows how peer education is bound in processes of responsibilization and self-change, which link to varying possibilities for risk reduction or recovery. For peer education to achieve a range of significant goals, broader structural and system changes should be implemented in the region. We caution that without such changes, awareness-raising activities and the role of peer educators may instead become part of state- and agency-sponsored processes of seeking to responsibilize individuals for health and harm reduction

Artificial intelligence and medical education: a global mixed-methods study of medical students’ perspectives

Objective: Medical students, as clinicians and healthcare leaders of the future, are key stakeholders in the clinical roll-out of artificial intelligence-driven technologies. The authors aim to provide the first report on the state of artificial intelligence in medical education globally by exploring the perspectives of medical students. Methods: The authors carried out a mixed-methods study of focus groups and surveys with 128 medical students from 48 countries. The study explored knowledge around artificial intelligence as well as what students wished to learn about artificial intelligence and how they wished to learn this. A combined qualitative and quantitative analysis was used. Results: Support for incorporating teaching on artificial intelligence into core curricula was ubiquitous across the globe, but few students had received teaching on artificial intelligence. Students showed knowledge on the applications of artificial intelligence in clinical medicine as well as on artificial intelligence ethics. They were interested in learning about clinical applications, algorithm development, coding and algorithm appraisal. Hackathon-style projects and multidisciplinary education involving computer science students were suggested for incorporation into the curriculum. Conclusions: Medical students from all countries should be provided teaching on artificial intelligence as part of their curriculum to develop skills and knowledge around artificial intelligence to ensure a patient-centred digital future in medicine. This teaching should focus on the applications of artificial intelligence in clinical medicine. Students should also be given the opportunity to be involved in algorithm development. Students in low- and middle-income countries require the foundational technology as well as robust teaching on artificial intelligence to ensure that they can drive innovation in their healthcare settings

Frequency-dependent drag from quantum turbulence produced by quartz tuning forks in superfluid He4

We have measured the drag force from quantum turbulence on a series of quartz tuning forks in superfluid helium. The tuning forks were custom made from a 75-μm-thick wafer. They have identical prong widths and prong spacings, but different lengths to give different resonant frequencies. We have used both the fundamental and overtone flexure modes to probe the turbulent drag over a broad range of frequencies f=ω/2π from 6.5 to 300 kHz. Optical measurements show that the velocity profiles of the flexure modes are well described by a cantilever beam model. The critical velocity for the onset of quantum turbulence at low temperatures is measured to be vc≈0.7κω−−−−−√ where κ is the circulation quantum. The drag from quantum turbulence shows a small frequency dependence when plotted against the scaled velocity v/v

A quasiparticle detector for imaging quantum turbulence in superfluid 3He-B

We describe the development of a two-dimensional quasiparticle detector for use in visualising quantum turbulence in superfluid 3He-B at ultra-low temperatures. The detector consists of a 5×5 matrix of pixels, each a 1mm diameter hole in a copper block containing aminiature quartz tuning fork. The damping on each fork provides a measure of the local quasiparticle flux. The detector is illuminated by a beam of ballistic quasiparticles generated from a nearby black-body radiator. A comparison of the damping on the different forks provides a measure of the cross-sectional profile of the beam. Further, we generate a tangle of vortices (quantum turbulence) in the path of the beam using a vibrating wire resonator. The vortices cast a shadow onto the face of the detector due to the Andreev reflection of quasiparticles in the beam. This allows us to image the vortices and to investigate their dynamics. Here we give details of the design and construction of the detector and show some preliminary results for one row of pixels which demonstrates its successful application tomeasuring quasiparticle beams and quantum turbulence

Prevention of COVID-19 among populations experiencing multiple social exclusions.

Despite the development of effective vaccines against SARS-CoV-2 and an encouraging start to its roll out in many countries, in the coming months and years targeted prevention strategies will still be vital for socially marginalised groups. People experiencing multiple levels of exclusion related to homelessness, drug use, sex work, migration and their intersection can be particularly vulnerable to infection and morbidity with SARS-CoV-2 and will be less likely to benefit from population-wide prevention approaches such as contact tracing and mass vaccination. The recommendation by the Joint Committee on Vaccine and Immunisation in the UK to prioritise vaccination of people experiencing homelessness and rough sleepers is welcome, but will require ongoing vaccination programmes to ensure optimal coverage as well as targeted testing in coming years. There is a high risk that individuals who are homeless or otherwise socially excluded will be unable to be vaccinated and remain vulnerable to COVID-19 infection, limiting the potential for overall UK population coverage of COVID-19 vaccination to remain below the herd immunity threshold. In this editorial, we consider existing evidence on ‘what works’ in vaccine provision and contact tracing among socially excluded populations, as well as learning from the response so far including the provision of emergency accommodation and vaccine delivery. We set out strategies for interventions and priority research questions, emphasising the importance of co-production in research and service delivery, to prevent ongoing transmission of SARS-CoV-2 and future infectious disease outbreaks.</p

Peer advocacy and access to healthcare for people who are homeless in London, UK: a mixed method impact, economic and process evaluation protocol.

INTRODUCTION: People who are homeless experience higher morbidity and mortality than the general population. These outcomes are exacerbated by inequitable access to healthcare. Emerging evidence suggests a role for peer advocates-that is, trained volunteers with lived experience-to support people who are homeless to access healthcare. METHODS AND ANALYSIS: We plan to conduct a mixed methods evaluation to assess the effects (qualitative, cohort and economic studies); processes and contexts (qualitative study); fidelity; and acceptability and reach (process study) of Peer Advocacy on people who are homeless and on peers themselves in London, UK. People with lived experience of homelessness are partners in the design, execution, analysis and dissemination of the evaluation. ETHICS AND DISSEMINATION: Ethics approval for all study designs has been granted by the National Health Service London-Dulwich Research Ethics Committee (UK) and the London School of Hygiene and Tropical Medicine's Ethics Committee (UK). We plan to disseminate study progress and outputs via a website, conference presentations, community meetings and peer-reviewed journal articles

Excess TGF-β mediates muscle weakness associated with bone metastases in mice

Cancer-associated muscle weakness is a poorly understood phenomenon, and there is no effective treatment. Here we find that seven different mouse models of human osteolytic bone metastases-representing breast, lung and prostate cancers, as well as multiple myeloma-exhibited impaired muscle function, implicating a role for the tumor-bone microenvironment in cancer-associated muscle weakness. We found that transforming growth factor (TGF)-β, released from the bone surface as a result of metastasis-induced bone destruction, upregulated NADPH oxidase 4 (Nox4), resulting in elevated oxidization of skeletal muscle proteins, including the ryanodine receptor and calcium (Ca(2+)) release channel (RyR1). The oxidized RyR1 channels leaked Ca(2+), resulting in lower intracellular signaling, which is required for proper muscle contraction. We found that inhibiting RyR1 leakage, TGF-β signaling, TGF-β release from bone or Nox4 activity improved muscle function in mice with MDA-MB-231 bone metastases. Humans with breast- or lung cancer-associated bone metastases also had oxidized skeletal muscle RyR1 that is not seen in normal muscle. Similarly, skeletal muscle weakness, increased Nox4 binding to RyR1 and oxidation of RyR1 were present in a mouse model of Camurati-Engelmann disease, a nonmalignant metabolic bone disorder associated with increased TGF-β activity. Thus, pathological TGF-β release from bone contributes to muscle weakness by decreasing Ca(2+)-induced muscle force production