Economic evaluation of CPD activities for healthcare professionals: A scoping review.

CONTEXT: Continuing professional development (CPD) activities for healthcare professionals are central to the optimisation of patient safety and person-centred care. Although there is some evidence on the economics of healthcare professionals training, very little is known about the costs and benefits of CPD. METHODS: This study aimed to review the research evidence on economic evaluations of CPD activities for healthcare professionals. CINAHL, MEDLINE/PubMed, Scopus, Econlit and Web of Science databases were used to identify articles published between 2010 and 2021. RESULTS: Of the 6791 titles identified, 119 articles met the inclusion criteria and were included in this scoping review. The majority of articles were partial economic evaluations of CPD programmes (n = 70); half were from the USA. Studies that included multiple professions were most prevalent (n = 54), followed by nurses (n = 34) and doctors (n = 23). Patient outcomes were the most commonly reported outcome (n = 51), followed by change in clinical practice (n = 38) and healthcare professionals' knowledge gain (n = 19). CONCLUSIONS: There is an urgent call for more evidence regarding the economic evaluations of CPD. This is particularly important in view of the rising costs of healthcare globally. The majority of studies included in this review did not provide detailed information on the evaluations and many focused exclusively on the cost of CPD activities rather than outcomes.

Through the looking glass: the rabbit hole of reflective practice.

Reflective practice is a common feature of nurse education. Indeed, the development of nursing practice is associated with being a 'reflective practitioner'. However, how we see ourselves or interpret past events is often influenced by our own unconscious biases. While it is reasonable to hold favourable views of one's ability, biased or lack of self-insight might mean that one is actually unskilled and unaware of it. In the ambiguous clinical context where an act or omission can have potentially devastating consequences, the implications of this are significant. The questions of whether and how reflection addresses unconscious biases are relatively unexplored in the nursing literature. Given that accurate self-assessment is integral to reflective practice, this article attempts to explore the potential impact of unconscious bias on reflection. The authors conclude that while biases may limit our ability to learn from reflection, this is not a reason to dispense with reflective practice, but rather, is even more reason to critically engage with the process. Nurses of all levels must be encouraged to reflect on both their practice, and their reflection.

Transforming classroom questioning using emerging technology.

Classroom questioning is a common teaching and learning strategy in postgraduate nurse education. Technologies such as audience response systems (ARS) may offer advantage over traditional approaches to classroom questioning. However, despite being available since the 1960s, ARSs are still considered novel in many postgraduate nurse education classroom settings. This article aims to explicate the attitudes of postgraduate nursing students in an Irish academic teaching hospital towards classroom questioning (CQ) and the use of ARSs as an alternative to traditional CQ techniques. The results of this small-scale study demonstrate that ARSs have a role to play in CQ in the postgraduate setting, being regarded by students as beneficial to learning, psychological safety and classroom interaction.

Individual N-glycans added at intervals along the stalk of the Nipah virus G protein prevent fusion but do not block the interaction with the homologous F protein.

The promotion of membrane fusion by most paramyxoviruses requires an interaction between the viral attachment and fusion (F) proteins to enable receptor binding by the former to trigger the activation of the latter for fusion. Numerous studies demonstrate that the F-interactive sites on the Newcastle disease virus (NDV) hemagglutinin-neuraminidase (HN) and measles virus (MV) hemagglutinin (H) proteins reside entirely within the stalk regions of those proteins. Indeed, stalk residues of NDV HN and MV H that likely mediate the F interaction have been identified. However, despite extensive efforts, the F-interactive site(s) on the Nipah virus (NiV) G attachment glycoprotein has not been identified. In this study, we have introduced individual N-linked glycosylation sites at several positions spaced at intervals along the stalk of the NiV G protein. Five of the seven introduced sites are utilized as established by a retardation of electrophoretic mobility. Despite surface expression, ephrinB2 binding, and oligomerization comparable to those of the wild-type protein, four of the five added N-glycans completely eliminate the ability of the G protein to complement the homologous F protein in the promotion of fusion. The most membrane-proximal added N-glycan reduces fusion by 80%. However, unlike similar NDV HN and MV H mutants, the NiV G glycosylation stalk mutants retain the ability to bind F, indicating that the fusion deficiency of these mutants is not due to prevention of the G-F interaction. These findings suggest that the G-F interaction is not mediated entirely by the stalk domain of G and may be more complex than that of HN/H-F.

Teaching and learning modalities for continuing professional development in the long-term care: A rapid synthesis review.

AIM: To describe the various teaching and learning modalities for the delivery of Continuing Professional Development activities for health care professionals in the long-term care sector. BACKGROUND: Continuing Professional Development is a key activity that organisations undertake to achieve effective workforce planning, recruitment, retention and upskilling strategies in long-term care settings. During the Covid-19 pandemic there was a rapid move to online modalities of Continuous Professional Development, but there is a paucity of evidence in relation to their effectiveness compared with face-to-face, or in-class learning. DESIGN: A rapid synthesis review. METHODS: MEDLINE, CINAHL and HEALTH BUSINESS ELITE databases were used to identify relevant articles that were published between 2016 and 2022. Original studies of any design investigating Continuing Professional Development activities, with or without a comparison between interventions or activities were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. The Kirkpatrick model was adopted as a globally recognised method for evaluating training programmes. RESULTS: After a full text analysis, 34 papers were included in the review. Face to face was the most common method of delivery followed by online, while blended (a mix of face-to-face and online delivery) was the least common method used. The teaching modalities were not associated with specific learning contents, but were used for a range of content. Most studies obtained positive outcomes following implementation of the educational interventions. Kirkpatrick Level 4 (results) was the most commonly measured outcome. CONCLUSIONS: While blended learning was the least common method of delivery, it was found to be more beneficial for learners than face-to-face or online exclusively. There are now new spaces to learn and new technologies that allow us to 'reimagine' where, when and how we teach. This requires Continuing Professional Development providers to design and tailor their courses according to health professionals' learning needs and the clinical contexts where they work. We recommend that Continuing Professional Development providers involve employers when designing teaching and learning activities for Long Term Care workers, to decide which modalities enable effective knowledge translation.

Triggering of the newcastle disease virus fusion protein by a chimeric attachment protein that binds to Nipah virus receptors.

The fusion (F) proteins of Newcastle disease virus (NDV) and Nipah virus (NiV) are both triggered by binding to receptors, mediated in both viruses by a second protein, the attachment protein. However, the hemagglutinin-neuraminidase (HN) attachment protein of NDV recognizes sialic acid receptors, whereas the NiV G attachment protein recognizes ephrinB2/B3 as receptors. Chimeric proteins composed of domains from the two attachment proteins have been evaluated for fusion-promoting activity with each F protein. Chimeras having NiV G-derived globular domains and NDV HN-derived stalks, transmembranes, and cytoplasmic tails are efficiently expressed, bind ephrinB2, and trigger NDV F to promote fusion in Vero cells. Thus, the NDV F protein can be triggered by binding to the NiV receptor, indicating that an aspect of the triggering cascade induced by the binding of HN to sialic acid is conserved in the binding of NiV G to ephrinB2. However, the fusion cascade for triggering NiV F by the G protein and that of triggering NDV F by the chimeras can be distinguished by differential exposure of a receptor-induced conformational epitope. The enhanced exposure of this epitope marks the triggering of NiV F by NiV G but not the triggering of NDV F by the chimeras. Thus, the triggering cascade for NiV G-F fusion may be more complex than that of NDV HN and F. This is consistent with the finding that reciprocal chimeras having NDV HN-derived heads and NiV G-derived stalks, transmembranes, and tails do not trigger either F protein for fusion, despite efficient cell surface expression and receptor binding.

Role of the two sialic acid binding sites on the newcastle disease virus HN protein in triggering the interaction with the F protein required for the promotion of fusion.

Newcastle disease virus (NDV)-induced membrane fusion requires an interaction between the hemagglutinin-neuraminidase (HN) attachment and the fusion (F) proteins, triggered by HN's binding to receptors. NDV HN has two sialic acid binding sites: site I, which also mediates neuraminidase activity, and site II, which straddles the membrane-distal end of the dimer interface. By characterizing the effect on receptor binding avidity and F-interactive capability of HN dimer interface mutations, we present evidence consistent with (i) receptor engagement by site I triggering the interaction with F and (ii) site II functioning to maintain high-avidity receptor binding during the fusion process.

Paramyxoviruses: different receptors - different mechanisms of fusion.

Paramyxovirus-mediated membrane fusion usually requires an interaction between the viral-attachment and -fusion proteins. The mechanism by which this interaction regulates fusion differs between paramyxoviruses that bind to sialic acid-containing receptors and those that recognize specific proteins. The recently solved structure of the globular head of the measles virus hemagglutinin suggests that this difference might be related to the location of the receptor-binding sites on the attachment proteins of the two classes of paramyxoviruses.

Engineered intermonomeric disulfide bonds in the globular domain of Newcastle disease virus hemagglutinin-neuraminidase protein: implications for the mechanism of fusion promotion.

The promotion of membrane fusion by Newcastle disease virus (NDV) requires an interaction between the viral hemagglutinin-neuraminidase (HN) and fusion (F) proteins, although the mechanism by which this interaction regulates fusion is not clear. The NDV HN protein exists as a tetramer composed of a pair of dimers. Based on X-ray crystallographic studies of the NDV HN globular domain (S. Crennell et al., Nat. Struct. Biol. 7:1068-1074, 2000), it was proposed that the protein undergoes a significant conformational change from an initial structure having minimal intermonomeric contacts to a structure with a much more extensive dimer interface. This conformational change was predicted to be integral to fusion promotion with the minimal interface form required to maintain F in its prefusion state until HN binds receptors. However, no evidence for such a conformational change exists for any other paramyxovirus attachment protein. To test the NDV model, we have engineered a pair of intermonomeric disulfide bonds across the dimer interface in the globular domain of an otherwise non-disulfide-linked NDV HN protein by the introduction of cysteine substitutions for residues T216 and D230. The disulfide-linked dimer is formed both intracellularly and in the absence of receptor binding and is efficiently expressed at the cell surface. The disulfide bonds preclude formation of the minimal interface form of the protein and yet enhance both receptor-binding activity at 37 degrees C and fusion promotion. These results confirm that neither the minimal interface form of HN nor the proposed drastic conformational change in the protein is required for fusion.

Respiratory Syncytial Virus Preterm (32-36 Completed Weeks of Gestation) Risk Estimation Measure for RSV Hospitalization in Ireland: A Prospective Study.

BACKGROUND: In several countries, respiratory syncytial virus prophylaxis is offered to late preterm infants who are at escalated risk of respiratory syncytial virus hospitalization (RSVH). However, targeted prophylaxis should be informed by country-specific data. This study, which uniquely includes 36 weeks of gestational age (GA) infants, aims to establish the risk factors for RSVH in 32-36 weeks of GA infants in Ireland. METHODS: A prospective observational study at 13 hospitals of laboratory-confirmed RSVH in nonprophylaxed 32-36 weeks of GA infants was conducted from July 2011 to February 2014. Baseline and first-year clinical data were analyzed by using SPSS software Version 22 (IBM Corp, Armonk, NY). Significant (P < 0.05) variables were entered into multiple logistic regression to determine the independent risk factors for RSVH. RESULTS: Sixty-three percent of eligible infants (1825 of 2877) were recruited. The RSVH rate was 3.6% (65 of 1807 analyzed infant records). There was no RSV-attributable mortality. Twelve infants required intensive care. Of the 15 variables correlating to RSVH, 5 independent risk factors were identified: older siblings [odds ratio (OR): 3.8; 95% confidence interval (CI): 1.97-7.41], being Caucasian (OR: 2.3; 95% CI: 1.04-5.29), neonatal respiratory morbidity (OR: 2.2; 95% CI: 1.28-3.94); birth July 15 to December 15 (OR: 2.1; 95% CI: 1.09-3.92) and family history of asthma (OR: 1.9; 95% CI: 1.01-3.39). Birth from 36 weeks to 36 + 6 days mitigated RSVH risk (relative risk: 0.58; 95% CI: 0.34-0.99); however, risk factors were similar to the 32-35 weeks of GA cohort. CONCLUSION: Neonatal respiratory morbidity or being Caucasian were the population-specific independent risk factors for RSVH in 32-36 weeks of GA in Ireland, whereas the other identified independent risk factors mirrored those established in previous studies.

An oligosaccharide at the C-terminus of the F-specific domain in the stalk of the human parainfluenza virus 3 hemagglutinin-neuraminidase modulates fusion.

The promotion of membrane fusion by the fusion (F) protein of human parainfluenza virus 3 (hPIV3) is dependent on a virus-specific contribution from the hemagglutinin-neuraminidase (HN) protein. By evaluation of chimeric hPIV3-Newcastle disease virus (NDV) HN proteins, we have previously shown that hPIV3-F-specificity is determined by a domain that extends from the middle of the membrane anchor to the 82nd residue in the ectodomain [Virology 209, (1995) 457; Arch. Virol. 13 (1997) 115]. If the corresponding NDV-derived residues replace the two C-terminal residues in this domain, no fusion is detected. However, these substitutions restore a glycosylation site present in NDV HN, but not in hPIV3 HN. Deletion of this site from a nested set of chimeras with hPIV3-derived N-terminal portions of decreasing length partially restores fusion, suggesting that an oligosaccharide near the top of hPIV3 HN stalk modulates fusion. In addition, further mutational analyses show that a chimera with only 125 N-terminal hPIV3-derived residues (72 in the stalk) actually promotes fusion more efficiently than the wt protein. These findings localize the C-terminus of the F-specific domain in hPIV3 HN a full 10 residues closer to the membrane than previously shown.

Population dynamics of two species of dragon lizards in arid Australia: the effects of rainfall.

The population dynamics of two species of agamid (dragon) lizards were studied in the Simpson Desert, central Australia, over a period of 7 years, and modelled in relation to rainfall. Both species have annual life cycles, with adults predominating during the breeding season in spring and summer and juveniles predominating in other seasons. Within years, juvenile abundance in both species in autumn and winter was related most strongly to rainfall in the preceding summer and autumn. This pattern suggests that rainfall enhances survival, growth and possibly clutch size and hatching success. Between years, however, rainfall drove successional change in the dominant plant species in the study area, spinifex Triodia basedowii, causing in turn a shift in the relative abundance of the two species. Thus, the central netted dragon Ctenophorus nuchalis was most numerous in 1990 when vegetation cover was <10%, but declined dramatically in abundance after heavy rainfall at the end of that year. In contrast, the military dragon C. isolepis achieved greatest abundance following heavy rains in the summers of 1990 and 1994, when spinifex cover increased to >20%, and remained numerically dominant for much of the study. We suggest that drought-wet cycles periodically reverse the dominance of the two species of Ctenophorus, and perhaps of other lizard species also, thus enhancing local species diversity over time. Further long-term studies are needed to document the population dynamics of other species, and to identify the factors that influence them.

Glycoprotein interactions in paramyxovirus fusion.

The Paramyxoviridae are enveloped, negative-stranded RNA viruses, some of which recognize sialic acid-containing receptors, while others recognize specific proteinaceous receptors. The major cytopathic effect of paramyxovirus infection is membrane fusion-induced syncytium formation. Paramyxoviruses are unusual in that the receptor-binding and fusion-promoting activities reside on two different spike structures, the attachment and fusion glycoproteins, respectively. For most paramyxoviruses, this distribution of functions requires a mechanism by which the two processes can be linked for the promotion of fusion. This is accomplished by a virus-specific interaction between the two proteins. An increasing body of evidence supports the notion that members of this family of viruses utilize this glycoprotein interaction in different ways in order to mediate the regulation of the fusion protein activation, depending on the type of receptor utilized by the virus.