Search

Background In response to the COVID-19 pandemic, the first vaccine was administered in December 2020 in England. However, vaccination uptake has historically been lower in London than in other English regions. Methods Mixed-methods: This comprised an analysis of cumulative percentage uptake across London between 8 December 2020 and 6 June 2021 by vaccine priority cohorts and ethnicity. We also undertook thematic analyses of uptake barriers, interventions to tackle these and key learning from a qualitative survey of 27 London local authority representatives, vaccine plans from London’s five Integrated Care Systems and interviews with 38 London system representatives. Results Vaccine uptake was lower in Black ethnic (57–65% uptake) compared with the White British group (90% uptake). Trust was a critical issue, including mistrust in the vaccine itself and in authorities administering or promoting it. The balance between putative costs and benefits of vaccination created uptake barriers for zero-hour and shift workers. Intensive, targeted and ‘hyper-local’ initiatives, which sustained community relationships and were not constrained by administrative boundaries, helped tackle these barriers. Conclusions The success of the national vaccination programme depended on conceding local autonomy, investing in responsive and long-term partnerships to engender trust through in-depth understanding of communities’ beliefs.

Debriefing is a key component of all simulation-based educational (SBE) activities and is an activity for which a multitude of approaches and models have been developed and implemented (Oriot & Alinier, 2016). To improve SBE practice in general, the International Nursing Association for Clinical Simulation and Learning (INACSL) has outlined a set of Simulation Standards of Best Practice first published in 2013. Revisions to these standards have occurred every few years, including expanding the topics covered as developments in this domain have occurred and the use of simulation has expanded.The aim of this study was to present the changes in the Simulation Debriefing Standard in comparison to those last published (INACSL Standards Committee, 2016).From 2019 to 2021, a group of simulation educators and researchers, the authors of this abstract, representing multiple specialities, simulation societies and geographic areas began meeting to review and revise the Simulation Debriefing Standard based on the latest literature. This group identified several items that would benefit from being updated, including expanding the terminology of this Standard to encompass Feedback, Debriefing and Guided reflection as distinct but integral components of this key phase of simulation-based experiences.An updated version of the Simulation Debriefing Standard of Best Practice will soon be published by INACSL in Clinical Simulation in Nursing. Some of the updates include expansion to understand and allow electronic systems to be recognized as components of the debriefing process and emphasizing the need for practice and review of the skill of facilitators in the techniques of debriefing. The new Simulation Debriefing Standard provides clear information and guidance to the simulationists. It includes four as opposed to the five criteria in the 2016 version (INACSL Standards Committee, 2016). The updated criteria can still be matched to those from the previous edition (see colour coding in Criteria of the 2016 and 2021 INACSL debriefing standards of best practiceIt is expected that the revised Simulation Debriefing Standard of Best Practice will be welcomed by the simulation community, which includes the healthcare educators and simulation technology developers, but also the learners. It has been designed as a guide to help educators in all the key aspects of debriefing, providing feedback and facilitating guided reflection conversations that will ultimately benefit learners. It includes an updated list of useful references readers can consult to find additional information.

© 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc. We aimed to report the first genomewide association study (GWAS) meta-analysis of dual-energy X-ray absorptiometry (DXA)-derived hip shape, which is thought to be related to the risk of both hip osteoarthritis and hip fracture. Ten hip shape modes (HSMs) were derived by statistical shape modeling using SHAPE software, from hip DXA scans in the Avon Longitudinal Study of Parents and Children (ALSPAC; adult females), TwinsUK (mixed sex), Framingham Osteoporosis Study (FOS; mixed), Osteoporotic Fractures in Men study (MrOS), and Study of Osteoporotic Fractures (SOF; females) (total N = 15,934). Associations were adjusted for age, sex, and ancestry. Five genomewide significant (p < 5 × 10−9, adjusted for 10 independent outcomes) single-nucleotide polymorphisms (SNPs) were associated with HSM1, and three SNPs with HSM2. One SNP, in high linkage disequilibrium with rs2158915 associated with HSM1, was associated with HSM5 at genomewide significance. In a look-up of previous GWASs, three of the identified SNPs were associated with hip osteoarthritis, one with hip fracture, and five with height. Seven SNPs were within 200 kb of genes involved in endochondral bone formation, namely SOX9, PTHrP, RUNX1, NKX3-2, FGFR4, DICER1, and HHIP. The SNP adjacent to DICER1 also showed osteoblast cis-regulatory activity of GSC, in which mutations have previously been reported to cause hip dysplasia. For three of the lead SNPs, SNPs in high LD (r2 > 0.5) were identified, which intersected with open chromatin sites as detected by ATAC-seq performed on embryonic mouse proximal femora. In conclusion, we identified eight SNPs independently associated with hip shape, most of which were associated with height and/or mapped close to endochondral bone formation genes, consistent with a contribution of processes involved in limb growth to hip shape and pathological sequelae. These findings raise the possibility that genetic studies of hip shape might help in understanding potential pathways involved in hip osteoarthritis and hip fracture. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.

Background Evidence from outside surgery suggests that meritocracy-based processes around selection tend to reduce, rather than increase, diversity. In recent years, the surgical training boards have gone to considerable effort to achieve greater transparency and fairness in their selection processes, and to identify those attributes that are believed to best predict future success as a surgeon. This is consistent with the Royal Australasian College of Surgeons Diversity and Inclusion Plan, which places emphasis on gender equity and has goals that include increasing the attractiveness of surgery as a vocation for women, removing impediments to them applying to the surgical training programmes and removing any biases that might disadvantage them during the selection process. Methods This study uses the Female Opportunity Index and rate ratio metrics to measure the level of female disadvantage in surgical selection, whether it be by the perception of its attractiveness to women which influences their application rates, or by the likelihood of successful selection for those who have applied, compared with their male counterparts. Results There are marked differences between the nine surgical specialties and 13 specialty training boards in both the proportion of women who apply, and the proportion who are successful in gaining entry onto the Surgical Education and Training programmes. The Female Opportunity Index ranged from 0.21 to 0.87, which represents a wide variation between surgical specialties. Conclusion These data raise the question as to whether unconscious bias is occurring in an apparently meritocracy-based selection process in some specialties. The data also suggest that some specialties are relatively unattractive to women, for which the reasons are likely to be complex.

Evidence from outside surgery suggests that meritocracy-based processes around selection tend to reduce, rather than increase, diversity. In recent years, the surgical training boards have gone to considerable effort to achieve greater transparency and fairness in their selection processes, and to identify those attributes that are believed to best predict future success as a surgeon. This is consistent with the Royal Australasian College of Surgeons Diversity and Inclusion Plan, which places emphasis on gender equity and has goals that include increasing the attractiveness of surgery as a vocation for women, removing impediments to them applying to the surgical training programmes and removing any biases that might disadvantage them during the selection process.This study uses the Female Opportunity Index and rate ratio metrics to measure the level of female disadvantage in surgical selection, whether it be by the perception of its attractiveness to women which influences their application rates, or by the likelihood of successful selection for those who have applied, compared with their male counterparts.There are marked differences between the nine surgical specialties and 13 specialty training boards in both the proportion of women who apply, and the proportion who are successful in gaining entry onto the Surgical Education and Training programmes. The Female Opportunity Index ranged from 0.21 to 0.87, which represents a wide variation between surgical specialties.These data raise the question as to whether unconscious bias is occurring in an apparently meritocracy-based selection process in some specialties. The data also suggest that some specialties are relatively unattractive to women, for which the reasons are likely to be complex.

Objective— Deletion of Akt1 leads to severe atherosclerosis and occlusive coronary artery disease. Vascular smooth muscle cells (VSMCs) are an important component of atherosclerotic plaques, responsible for promoting plaque stability in advanced lesions. Fibrous caps of unstable plaques contain less collagen and ECM components and fewer VSMCs than caps from stable lesions. Here, we investigated the role of Akt1 in VSMC proliferation, migration, and oxidative stress–induced apoptosis. In addition, we also characterized the atherosclerotic plaque morphology and cardiac function in an atherosclerosis-prone mouse model deficient in Akt1. Methods and Results— Absence of Akt1 reduces VSMC proliferation and migration. Mechanistically, the proliferation and migratory phenotype found in Akt1-null VSMCs was linked to reduced Rac-1 activity and MMP-2 secretion. Serum starvation and stress-induced apoptosis was enhanced in Akt1 null VSMCs as determined by flow cytometry using Annexin V/PI staining. Immunohistochemical analysis of atherosclerotic plaques from Akt1 −/− ApoE −/− mice showed a dramatic increase in plaque vulnerability characteristics such as enlarged necrotic core and reduced fibrous cap and collagen content. Finally, we show evidence of myocardial infarcts and cardiac dysfunction in Akt1 −/− ApoE −/− mice analyzed by immunohistochemistry and echocardiography, respectively. Conclusion— Akt1 is essential for VSMC proliferation, migration, and protection against oxidative stress–induced apoptosis. Absence of Akt1 induces features of plaque vulnerability and cardiac dysfunction in a mouse model of atherosclerosis.

Two studies are reported that investigated the processes involved in stopping worry. Study 1 found that the use of “as many as can” stop rules was significantly related to measures of trait worry and beliefs about the positive and negative consequences of worrying, and Study 2 demonstrated that the reported use of “as many as can” stop rules significantly predicted perseveration on behavioral measures of catastrophic worrying. Reported use of “feel like continuing” stop rules was unrelated to any measures of worry in both studies. These results indicate that the use of “as many as can” stop rules is a highly significant predictor of worry frequency and perseveration, and that beliefs about the positive and negative consequences of worry also independently predict the use of “as many as can” stop rules. These findings are consistent with (1) the view that the stop rules used by worriers are closely associated with, or directly derived from, the more stable, global beliefs that worriers hold about the utility of the worry process, and (2) predictions from the mood-as-input model of catastrophic worrying (H. M. Startup & G. C. L. Davey, 2001).

Data concerning self-reported driving after drinking or using other drugs were collected from 3,382 junior and senior high school students in rural central and southern Illinois. Drinking, drug use, and driving increased steadily with age, with 42% of the 12th grade class indicating they had driven a car at least one time in the past six months after drinking or using other drugs. Riding with a driver who had been drinking also increased with age; 20% of the seventh grade sample had ridden in a car with a drinking driver, while 58% of the 12th grade sample reported having done so. Slightly more females had ridden in a car with a driver who had been drinking than males, while males reported higher rates of driving after drinking or using other drugs than females. Correlation analyses indicated 22 variables related significantly to drinking, drug use, and driving. Forward stepwise multiple regression analysis showed that 11 variables related significantly to riding as a passenger with a drinking driver. Thirteen variables were related significantly to driving after drinking or using other drugs. Frequency of alcohol use variables were the most powerful indicators of self-reported driving after drinking or using other drugs in this sample. Language: en

Delirium in the elderly attracts sporadic attention in the literature yet constitutes a major challenge to health services, complicating many illnesses and procedures in elderly patients, associated with high rates of mortality, cutting across disciplinary boundaries and posing theoretical difficulties for the organic/functional distinction that pervades medicine. In this review the importance of delirium in the elderly is emphasized, drawing attention to the suffering caused to the patient and the excess mortality. Problems of nomenclature (why use one word when three will do?) are discussed, the conclusion being that the oldest term is probably the best, provided that the concept of a ‘syndrome’ is preserved. Difficulties in research assessment are identified, and aetiology and the relationship of the delirium syndrome to dementia syndromes are discussed. Deficiencies in past approaches to management are identified and a definition of delirium is suggested. Finally, a proposal for a research programme is outlined.