Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care: a qualitative study of barriers and facilitators to adoption

OBJECTIVES: Point-of-care (POC) C reactive protein (CRP) is incorporated in National Institute of Health and Care Excellence (NICE) guidelines for the diagnosis of pneumonia, reduces antibiotic prescribing and is cost effective. AIM: To determine the barriers and facilitators to adoption of POC CRP testing in National Health Service (NHS) primary care for the diagnosis of lower respiratory tract infection. DESIGN: The study followed a qualitative methodology based on grounded theory. The study was undertaken in 2 stages. Stage 1 consisted of semistructured interviews with 8 clinicians from Europe and the UK who use the test in routine practice, and focused on their subjective experience in the challenges of implementing POC CRP testing. Stage 2 was a multidisciplinary-facilitated workshop with NHS stakeholders to discuss barriers to adoption, impact of adoption and potential adoption scenarios. Emergent theme analysis was undertaken. PARTICIPANTS: Participants included general practitioners (including those with commissioning experience), biochemists, pharmacists, clinical laboratory scientists and industry representatives from the UK and abroad. RESULTS: Barriers to the implementation of POC CRP exist, but successful adoption has been demonstrated abroad. Analysis highlighted 7 themes: reimbursement and incentivisation, quality control and training, laboratory services, practitioner attitudes and experiences, effects on clinic flow and workload, use in pharmacy and gaps in evidence. CONCLUSIONS: Successful adoption models from the UK and abroad demonstrate a distinctive pattern and involve collaboration with central laboratory services. Incorporating antimicrobial stewardship into quality improvement frameworks may incentivise adoption. Further research is needed to develop scaling-up strategies to address the resourcing, clinical governance and economic impact of widespread NHS implementation

Vulnerability in the classroom: how undergraduate business instructors\u27 ability to build trust impacts the student\u27s learning experience

Vulnerability is the ability to risk emotional exposure, chance making a mistake, or disclose personal information because the outcome is viewed as favorable. Vulnerability is a highly effective way to build trust with others. Trust is a valued leadership trait within corporate business because it encourages employees to take risks, share information, and ultimately become more effective and productive (Robbins & Judge, 2013). This paper explores the practicing of vulnerability in college-level business classrooms to appropriately prepare business students to become leaders who are able to build trust within the workplace. To further understand vulnerability in the classroom and develop a preliminary operational definition of the complex construct of vulnerability, a mixed methods research study was conducted at Sierra Nevada College that included a two-stage factor analysis followed by short interviews with instructors to gain further insight into the data collected. First, students from four randomly selected business classrooms were asked to participate in a study by completing a survey with 18 variables that describe vulnerable, productive teaching techniques. Then, the same survey was distributed to the five classrooms of instructors who were nominated for the 2014 or 2015 Nazir and Mary Ansari Excellence in Teaching Gold Medal award or Teacher of the Year award. The four Nazir and Mary Ansari Excellence in Teaching Gold Metal award candidates and the Teacher of the Year were interviewed for 30-minutes to provide insight and commentary on the findings from the first round of surveys. The goal of this study is to create a preliminary operational definition of the construct of “vulnerable teaching techniques” and to have an assessment tool to further understand vulnerability in a classroom setting

Molecular characterisation of the vibrio midae sy9 extra cellular alkaline serine protease and its role in the previously observed probiotic effect on the growth of Haliotis midae

Abalone are marine gastropods that command a very high market price, particularly in the Far East where they are a highly sought after sea food delicacy. South Africa has a rapidly developing abalone aquaculture industry, based on the cultivation of Haliotis midae in landbased race-way systems. The relatively slow growth rates of abalone represent a major constraint on the abalone aquaculture industry. However, there is mounting experimental evidence showing that the health and physiology of aquacultured species can be improved through the prophylactic use of probiotic bacteria. Previous research by Macey and Coyne (2005) showed that H. midae fed a high protein artificial diet, ABFEED(R) S34, supplemented with the bacterium Vibrio midae SY9 have enhanced digestion, growth and immune responses. Probiotic microorganisms are thought to function in a variety of ways, which include the secretion of extracellular enzymes that may enhance digestion in the host organism. However, most of the investigations conducted on probiotic microorganisms for aquacultured species have failed to elucidate the exact mode of action. In this study, the predominant V. midae SY9 extracellular alkaline protease, VmproA, was investigated in an attempt to determine the role of VmproA in the growth enhancing probiotic effect observed by Macey and Coyne (2005) for abalone fed V. midae SY9 supplemented feed. The V. midae SY9 gene, vmproA, encoding the protease was cloned from a previously constructed genomic library and characterised. Nucleotide sequencing and analysis indicated that vmproA encodes a protein, VmproA, which has high similarity to a Vibrio alginolyticus extracellular detergent resistant alkaline serine protease. Furthermore, during the course of this investigation it became apparent that VmproA may represent an extracellular alkaline detergent-stable, member of the proteinase K-like subfamily of the subtilase superfamily of serine proteases. The detergent-stable protease gene, vmproA, was targeted for gene mutagenesis through vmproA gene duplication and disruption, resulting in the construction of the mutant strains V. midae SY9Pro2 and V. midae SY9Mut2, respectively. VmproA gene duplication and disruption did not significantly influence the growth of the mutant strains in batch culture in comparison to V. midae SY9. V. midae SY9Pro2 produced and secreted VmproA and had equivalent levels of extracellular protease activity to V. midae SY9 when cultivated in a high protein medium. However, insertional inactivation of vmproA resulted in a loss of VmproA production and secretion. This also resulted in a significant reduction in the extracellular protease levels produced by V. midae SY9Mut2 in comparison with that of V. midae SY9. The effect of dietary supplementation with either V. midae SY9, V. midae SY9Pro2 or V. midae SY9Mut2 on H. midae growth performance was investigated in a growth trial. The basal diet of ABFEED(R) S34 weaning chips was separately supplemented with the V. midae SY9 strains by vacuum impregnation so as to achieve a viable cell concentration of greater than 108 CFU g-1 ABFEED(R). After 180 days, H. midae receiving either the V. midae SY9Pro2 or V. midae SY9Mut2 supplemented diets displayed significantly (P0.05) between animals fed the V. midae SY9 supplemented diet or the control diet. In situ alkaline protease levels within the crop/stomach and intestinal digestive tract regions were significantly enhanced (P<0.05) in H. midae fed V. midae SY9 supplemented ABFEED(R) S34 compared to animals fed the basal diet or the basal diet supplemented with either V. midae SY9Pro2 or V. midae SY9Mut2. In situ hybridization and immunohistochemistry were employed to examine the in vivo localisation of dietary supplemented V. midae SY9 cells and VmproA within the H. midae digestive tract. V. midae SY9 was chromosomally tagged with the mini-Tn10-gfp-kan transposon and the resulting strain, V. midae SY

A research protocol for developing a Point-Of-Care Key Evidence Tool 'POCKET': a checklist for multidimensional evidence reporting on point-of-care in vitro diagnostics.

INTRODUCTION: Point-of-care in vitro diagnostics (POC-IVD) are increasingly becoming widespread as an acceptable means of providing rapid diagnostic results to facilitate decision-making in many clinical pathways. Evidence in utility, usability and cost-effectiveness is currently provided in a fragmented and detached manner that is fraught with methodological challenges given the disruptive nature these tests have on the clinical pathway. The Point-of-care Key Evidence Tool (POCKET) checklist aims to provide an integrated evidence-based framework that incorporates all required evidence to guide the evaluation of POC-IVD to meet the needs of policy and decisionmakers in the National Health Service (NHS). METHODS AND ANALYSIS: A multimethod approach will be applied in order to develop the POCKET. A thorough literature review has formed the basis of a robust Delphi process and validation study. Semistructured interviews are being undertaken with POC-IVD stakeholders, including industry, regulators, commissioners, clinicians and patients to understand what evidence is required to facilitate decision-making. Emergent themes will be translated into a series of statements to form a survey questionnaire that aims to reach a consensus in each stakeholder group to what needs to be included in the tool. Results will be presented to a workshop to discuss the statements brought forward and the optimal format for the tool. Once assembled, the tool will be field-tested through case studies to ensure validity and usability and inform refinement, if required. The final version will be published online with a call for comments. Limitations include unpredictable sample representation, development of compromise position rather than consensus, and absence of blinding in validation exercise. ETHICS AND DISSEMINATION: The Imperial College Joint Research Compliance Office and the Imperial College Hospitals NHS Trust R&D department have approved the protocol. The checklist tool will be disseminated through a PhD thesis, a website, peer-reviewed publication, academic conferences and formal presentations

A Meta-Analytic Review of Cooperative Learning Practices in Higher Education: A Human Communication Perspective

The phrase cooperative learning refers to a pedagogical learning and teaching technique in use in schools from kindergarten through higher education. The technique involves the structuring of an active classroom environment with students working in groups to discover, solve, and at its basic, provide a framework for dialogue and conversation. Cooperative learning is grounded in the development of a theory of social interdependence (Morton Deutsch) which states that individuals, working in groups, can in most cases provide for greater productivity and ideas than individuals working alone. The development of cooperative learning was greatly expanded in the late 1960’s and early 1970’s with the invention of specific group learning techniques led by researchers David and Robert Johnson (Learning Together), Elliot Aronson (Jigsaw), and Robert Slavin (STAD). These researchers established guidelines (rules) and taxonomies that provided a basis for research in the area of cooperative learning. At the center of all of these techniques is an element of human communication, most often through the oral/aural communication channel, where group learning and discovery takes place. Cooperative learning and collaborative learning techniques differ in the amount and implementation of teaching guidelines required in the methodology. This study (a metaanalysis) weaves through more than 14-hundred published pieces of literature in a variety of disciplines, narrowing it down to 19 published articles which investigate (through experiments) the effectiveness through learning outcomes of cooperative learning in higher education (college and university level). With studies including more than 2-thousand student-participants in the research, data indicates no significant difference between those classrooms utilizing a cooperative learning format, and those using a traditional lecture/discussion format (d =0.05, 95%, C1:-05 to .14, p\u3e.05, k = 21, N = 2,052). Though there is no statistical difference between the two teaching techniques, researchers do offer a list of positive classroom observations/variables, which provides a launching point for future research into the use of cooperative learning techniques in higher education

Nationalist citizens are more likely to be Eurosceptic – but patriotism appears to increase support for the EU

Citizens with a strong attachment to their country are often assumed to be more likely to express opposition to the European Union. But is this always the case? Drawing on a new study, Leonie Huddy and Alessandro Del Ponte identify a clear difference between citizens with ‘nationalist’ attitudes and those who are ‘patriotic’. While nationalism is associated with an increase in Euroscepticism, patriotism appears to increase support for the EU

The left-right divide remains a powerful indicator of voting behaviour

The increasing salience of issues such as immigration and the environment has altered the nature of party competition in Europe. But do these changes mean that left-right ideologies are no longer a powerful indicator of the choices voters make at the ballot box? Drawing on data from Israel, Odelia Oshri, Omer Yair and Leonie Huddy show that in the absence of partisan attachment, a left-right identity continues to provide an anchor for voters’ political decision-making

Protocol for deposition of conductive oxides onto 3D-printed materials for electronic device applications

Additively manufactured (AM) three-dimensional (3D) mesostructures can be designed to enhance mechanical, thermal, or optical properties, driving future device applications at the micron to millimeter scale. We present a protocol for transforming AM mesostructures into 3D electronics by growing nanoscale conducting films on 3D-printed polymers. In this generalizable approach, we describe steps to utilize precision thermal atomic layer deposition (ALD) of conducting, semiconducting, and dielectric metal oxides. This can be applied to ultrasmooth, customizable photopolymer lattices printed by high-resolution microstereolithography. For complete details on the use and execution of this protocol, please refer to Huddy et al. (2022)