Student nurses' experiences of discrimination and racism on work placements: What can higher education institutions do?

BACKGROUND: There is persistent interpersonal, institutional and structural racism within the health sector and higher education. Such anti-Black and anti-Brown racisms are experienced by nursing students, nursing apprentices and fully qualified nurses. This discrimination intersects with other characteristics, namely gender and student status, which can make the nursing profession an unsafe environment for many. OBJECTIVES: To understand student nurses' experiences of racism and intersecting oppressions, at university and on work placement. DESIGN: A qualitative descriptive study with individual interviews and focus groups. SETTINGS: A widening participation higher education institution in London, UK. PARTICIPANTS: Twenty-four student nurses and nurse apprentices studying on an adult nursing programme. METHODS: Students were recruited through purposive sampling. In-depth data relating to student nurses' perspectives and experiences were gathered through two focus groups and three individual interviews conducted by student nurse peers. Interviews were transcribed verbatim and open coding was used to analyse transcripts using comparison and thematic analysis. RESULTS: Three key themes arose: safety and support in the university space; hierarchical treatment in work placements due to intersecting race and 'student' identities, and; direct racism by patients and staff in work placements. CONCLUSIONS: Student nurses expressed their vulnerability to discrimination and racism whilst on placement in the National Health Service. More opportunities within university curricula are needed for student nurses to learn about, reflect on, and gain support for managing experiences of discrimination in the health system.

Exploring apprentice nursing associates' experiences of their home placements in primary care or social care.

BACKGROUND: An increasing number of apprentice nursing associates undertake their home placement in primary care or social care, but there is limited understanding of apprentice nursing associates' experiences in these settings. AIM: To explore apprentice nursing associates' experiences of a home placement in primary care or social care and provide initial insight into what may support or hinder their professional development in these settings. METHOD: A mixed-methods study design was used with qualitative interviews complemented by a quantitative survey. Participants were recruited among 27 current or former apprentice nursing associates studying at one London university. Eleven current or former apprentices were interviewed and 15 completed the survey. FINDINGS: Participants' motivations for applying to become nursing associates were to develop professionally and advance their careers. They experienced supportive learning environments where they felt part of the team, but also unsupportive learning environments where they were denied protected learning time and supervised practice. Several participants experienced unfair treatment and abuses of power, including non-payment for university days and external placements, sexual harassment and marginalisation. CONCLUSION: Apprentice nursing associates can have suboptimal experiences of home placements in primary care or social care and be subjected to unfair treatment and abuse. Urgent action is required from higher education institutions and employers to ensure apprentice nursing associates are adequately supported.

Depression Earlier on in Life Predicts Frailty at 50 Years: Evidence from the 1958 British Birth Cohort Study.

Frailty and depression in older ages have a bidirectional relationship, sharing some symptoms and characteristics. Most evidence for this has come from cross-sectional studies, or longitudinal studies with limited follow-up periods. We used data from the National Child Development Study (1958 Birth Cohort) to investigate the relationship between depression and early-onset frailty using a life course perspective. The primary outcome was frailty based on a 30-item inventory of physical health conditions, activities of daily living and cognitive function at 50 years. The main exposure was depression (based on a nine-item Malaise score ≥ 4) measured at 23, 33 and 42 years. We investigated this relationship using multiple logistic regression models adjusted for socio-demographic factors, early life circumstances and health behaviours. In fully adjusted models, when modelled separately, depression at each timepoint was associated with around twice the odds of frailty. An accumulated depression score showed increases in the odds of frailty with each unit increase (once: OR 1.92, 95%CI 1.65, 2.23; twice OR 2.33, 95%CI 1.85, 2.94; thrice: OR 2.95, 95%CI 2.11, 4.11). The public health significance of this finding is that it shows the potential to reduce the physical burden of disease later in life by paying attention to mental health at younger ages.

Synthesis of Dolutegravir Exploiting Continuous Flow Chemistry.

An efficient continuous flow process for the synthesis of dolutegravir, an active pharmaceutical ingredient (API) for HIV treatment, was investigated. The synthetic procedure starts from a readily available benzyl-protected pyran via six chemical transformations using continuous flow reactors. The significant advantage of this flow process includes the reduction of the overall reaction time from 34.5 h in batch to 14.5 min. The overall yield of each reaction step improved dramatically upon flow optimization. Another key feature of this synthesis is telescoping multiple steps.

Using multimedia technology to enhance self-advocacy of people with intellectual disabilities: Introducing a theoretical framework for 'Multimedia Advocacy'.

BACKGROUND: Multimedia Advocacy is the use of digital technology for people with intellectual disabilities as means of developing identities, being heard, connecting to family and care networks and, advocating for change. METHODS: We explore principles and theories that underpin Multimedia Advocacy, mapping disciplinary approaches that have influenced the concept and praxis. RESULTS: We describe relevant theories from cultural and media studies, personal therapeutic practices, communication, universal design, and systemic adoption of technology. We discuss new ways of achieving person-centred working with digital technology. We aim to develop a stronger theory/practice dialogue between these disciplines. CONCLUSIONS: The theories described highlight the importance of embedding access and use of digital technology within everyday settings. Long-term implementation plans and buy-in from all organisational levels are required for Multimedia Advocacy tools to be embraced by health and social care systems so the voice of an individual is included and genuine person-centred practice is achieved.

A model of behavioural response to risk accurately predicts the statistical distribution of COVID-19 infection and reproduction numbers.

One clear aspect of behaviour in the COVID-19 pandemic has been people's focus on, and response to, reported or observed infection numbers in their community. We describe a simple model of infectious disease spread in a pandemic situation where people's behaviour is influenced by the current risk of infection and where this behavioural response acts homeostatically to return infection risk to a certain preferred level. This homeostatic response is active until approximate herd immunity is reached: in this domain the model predicts that the reproduction rate R will be centred around a median of 1, that proportional change in infection numbers will follow the standard Cauchy distribution with location and scale parameters 0 and 1, and that high infection numbers will follow a power-law frequency distribution with exponent 2. To test these predictions we used worldwide COVID-19 data from 1st February 2020 to 30th June 2022 to calculate [Formula: see text] confidence interval estimates across countries for these R, location, scale and exponent parameters. The resulting median R estimate was [Formula: see text] (predicted value 1) the proportional change location estimate was [Formula: see text] (predicted value 0), the proportional change scale estimate was [Formula: see text] (predicted value 1), and the frequency distribution exponent estimate was [Formula: see text] (predicted value 2); in each case the observed estimate agreed with model predictions.

An exploration of social participation in Caribbean student nurses' use of social media in their learning journey.

AIMS: To identify how social participation facilitates pre-registration student nurses learning and professional development using social media. DESIGN: A social survey using thematic analysis to explore Caribbean student nurses' views of social media usage from an open-ended question in a survey. METHODS: A qualitative analysis of student nurses from Jamaica and Trinidad and Tobago, who completed an open-ended question in a survey. Data were analysed using thematic analysis. RESULTS/FINDINGS: The three themes identified were: (1) Social media and communication; (2) Social media and self-care; and (3) Social media and learning. CONCLUSION: This paper used qualitative evidence to identify and report a new way of viewing SoMe in nursing education as a student-centred educational learning tool. SoMe can improve the effectiveness of student nurses learning, while developing fundamental skills (open-mindedness, critical thinking, professionalism and decision-making) for nursing practice. Social participation and connectivism theory are embedded in student nurses' learning journey. However, it has been used by student nurses outside the traditional university teaching and their capacity to own their personal learning. To meet the new generation of student nurses' learning needs, it is important that higher education institutions develop guidance, support and use of social media for learning to support student nurses in their education as students and also future professionals. IMPACT: This study addresses how social participation is used in social media to contribute to Caribbean student nurses' education. The main finding is the introduction of a new learning theory supporting learning using social media. This study has an impact on using social media for learning. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Racial and Ethnic Differences in Falls Among Older Adults: a Systematic Review and Meta-analysis.

The aim of this systematic review and meta-analysis was to determine whether differences in reported fall rates exist between different ethnic groups. Searches were carried out on four databases: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science. Only English language studies with community-dwelling participants aged 60 + years were included. Studies also needed to compare fall prevalence for at least two or more ethnic groups. Two reviewers independently screened all articles and evaluated study quality. Twenty-three articles were included for systematic review, and meta-analyses were carried out on the 16 retrospective studies that reported falls in the previous 12 months. The Asian group demonstrated significantly lower fall prevalence than all other ethnic groups at 13.89% (10.87, 16.91). The Hispanic group had a fall prevalence of 18.54% (12.95, 24.13), closely followed by the Black group at 18.60% (13.27, 23.93). The White group had the highest prevalence at 23.77% (18.66, 28.88). Some studies provided adjusted estimates of effect statistics for the odds/risk of falls, which showed that differences still existed between some ethnic groups even after adjusting for other risk factors. Overall, differences in fall prevalence do appear to exist between different ethnic groups, although the reasons for these differences currently remain undetermined and require further investigation. These findings highlight the need to provide more ethnically tailored responses to public health challenges, which could potentially increase the adherence to prevention interventions, and allow for a more targeted use of resources.

Demographic profiling of Caribbean and United Kingdom student nurses' use of social media for professional development.

BACKGROUND: Most students are adept in using technology and have developed skills and confidence utilising SoMe for professional purposes. SoMe is used by both registered nurses and student nurses. PURPOSE: The purpose of this study was to investigate the professional use of SoMe by student nurses in Trinidad and Tobago, Jamaica and the UK to guide, support and develop implementation of effective and appropriate use of SoMe for professional development. METHODS: An online cross-sectional survey was completed by student nurses from the three countries. Data were analysed using descriptive statistics. RESULTS: The main reason for using social media among Caribbean participants was to watch videos or short clips whereas in UK it was downloading articles. Over 75% participants of all ages believed that social media was likely to help their career. There is no social media guidance for student nurses in Trinidad and Tobago and Jamaica. CONCLUSION: Our study demonstrated that social media is embedded in student nurses' professional development throughout their education, with some variation in their use by country. Despite the fundamental place that social media plays in student nurses' professional development, there is no national or international guidance on how student nurses should use social media for professional development.

Total Synthesis of Glipizide and Glibenclamide in Continuous Flow.

Glipizide and glibenclamide remain some of the widely prescribed antidiabetic sulfonylurea drugs for the treatment of type 2 diabetes mellitus. Herein the authors report on an isocyanate-free synthetic procedure towards the preparation of these on demand drugs at multigram scale using continuous flow technology. The safety concern over the use of isocyanates in most of the existing synthetic routes was dealt with in this present work by using N-carbamates synthesised in situ from activation of amines with chloroformates as safer alternatives. An overall yield of 80-85 % was obtained for the semi-telescoped steps within 10 min total residence time.

International student nurses' use of social media for learning: A cross sectional survey.

BACKGROUND: Students use social media for sharing information and connecting with their friends, also for peer support, peer learning and student engagement. Research indicates that approximately twice the number of students were using social media for educational purposes compared to academic staff and almost all students discuss academic issues on social media. However, little is known about how diverse cohorts of student nurses use social media for specific purposes at different stages of their learning. OBJECTIVES: Identify how student nurses in each country of study use social media for learning. Identify how each generation of student nurses use social media for learning. Identify how student nurses use social media as their education progresses. DESIGN: A cross-sectional survey. SETTINGS: The study was undertaken across three countries Jamaica, Trinidad and Tobago and the UK. PARTICIPANTS: Student nurses from each of the countries that consented to participate met the inclusion criteria. METHODS: 1050 student nurses across the three countries self-completed the cross-sectional survey between March and September 2019. Data was analysed using descriptive and inferential statistics. RESULTS: WhatsApp® was the most used platform for learning amongst participants. Watching videos and downloading articles represented two-thirds of social media usage for learning. Smart phones were the most used device to access social media. Kruskal-Wallis tests were significant (≤0.001) for checking social media and messaging in lecture, use of social media for studies and classroom activities by country, generation (except classroom activities) and year of education. Use of social media for classroom activities had no significance by generation. CONCLUSION: Country, generation and year of education are factors that influence the use of social media in student nurses' learning. These should be considered by Universities in curriculum development and in teaching and learning delivery. From a pragmatic approach, social media is available and used by a majority of student nurses and can be widely assimilated into the nursing curriculum.

Exploring the physical activity of Iranian migrant women in the United Kingdom: a qualitative study.

PURPOSE: This article explores the role migration has on the physical activity of Iranian migrant women living in the United Kingdom. METHOD: This qualitative study includes 22 first-generation Iranian migrant women, aged 24-64, residing in London. Data was collected through in-depth, semi-structured, individual interviews and was analyzed thematically. RESULTS: The findings show that for those women from traditional backgrounds, migration corresponds with liberation from social and cultural pressures experienced in Iran and greater motivation to adopt a physically active lifestyle. However, for Iranian women who had arrived in the UK more recently and had a higher social standing in Iran, migration was associated with the loss of their careers, sources of income, and social networks. These issues were compounded by a lack of cohesion in Iranian migrant communities and poor access to local physical activity resources. This resulted in diminishing motivation and the subsequent de-prioritisation of the women's physical activity, even though they had regularly engaged in physical activity in Iran. CONCLUSION: Despite migration leading to improving physical activity for some Iranian women, for others, migration leads to marginality in Britain. Local authorities and Iranian community organizations need to adopt innovative strategies to reach out to recent Iranian migrant women.

Multistep Continuous Flow Synthesis of Stavudine.

Herein, we demonstrate an elegant multistep continuous flow synthesis for stavudine (d4T), a potent nucleoside chemotherapeutic agent for human immunodeficiency virus, acquired immunodeficiency syndrome (AIDS) and AIDS-related conditions. This was accomplished via six chemical transformations in five sequential continuous flow reactors from an affordable starting material, 5-methyluridine. In the first instance, single step continuous flow synthesis was demonstrated with an average of 97% yield, 21.4 g/h throughput per step, and a total of 15.5 min residence time. Finally, multistep continuous flow synthesis of d4T in 87% total yield with a total residence time of 19.9 min and 117 mg/h throughput without intermediate purification was demonstrated.

Demographic profiling of Caribbean and United Kingdom student nurses' use of social media for professional development

Background: Most students are adept in using technology and have developed skills and confidence utilising SoMe for professional purposes. SoMe is used by both registered nurses and student nurses. Purpose: The purpose of this study was to investigate the professional use of SoMe by student nurses in Trinidad and Tobago, Jamaica and the UK to guide, support and develop implementation of effective and appropriate use of SoMe for professional development. Methods: An online cross-sectional survey was completed by student nurses from the three countries. Data were analysed using descriptive statistics. Results: The main reason for using social media among Caribbean participants was to watch videos or short clips whereas in UK it was downloading articles. Over 75% participants of all ages believed that social media was likely to help their career. There is no social media guidance for student nurses in Trinidad and Tobago and Jamaica. Conclusion: Our study demonstrated that social media is embedded in student nurses' professional development throughout their education, with some variation in their use by country. Despite the fundamental place that social media plays in student nurses' professional development, there is no national or international guidance on how student nurses should use social media for professional development.

International student nurses' use of social media for learning: A cross sectional survey

Background: Students use social media for sharing information and connecting with their friends, also for peer support, peer learning and student engagement. Research indicates that approximately twice the number of students were using social media for educational purposes compared to academic staff and almost all students discuss academic issues on social media. However, little is known about how diverse cohorts of student nurses use social media for specific purposes at different stages of their learning. Objectives: Identify how student nurses in each country of study use social media for learning. Identify how each generation of student nurses use social media for learning. Identify how student nurses use social media as their education progresses. Design: A cross-sectional survey. Settings: The study was undertaken across three countries Jamaica, Trinidad and Tobago and the UK. Participants: Student nurses from each of the countries that consented to participate met the inclusion criteria. Methods: 1050 student nurses across the three countries self-completed the cross-sectional survey between March and September 2019. Data was analysed using descriptive and inferential statistics. Results: WhatsApp® was the most used platform for learning amongst participants. Watching videos and downloading articles represented two-thirds of social media usage for learning. Smart phones were the most used device to access social media. Kruskal-Wallis tests were significant (≤0.001) for checking social media and messaging in lecture, use of social media for studies and classroom activities by country, generation (except classroom activities) and year of education. Use of social media for classroom activities had no significance by generation. Conclusion: Country, generation and year of education are factors that influence the use of social media in student nurses' learning. These should be considered by Universities in curriculum development and in teaching and learning delivery. From a pragmatic approach, social media is available and used by a majority of student nurses and can be widely assimilated into the nursing curriculum

Proof-of-Concept Study: a Mobile Application to Derive Clinical Outcome Measures from Expression and Speech for Mental Health Status Evaluation.

This proof-of-concept study aimed to assess the ability of a mobile application and cloud analytics software solution to extract facial expression information from participant selfie videos. This is one component of a solution aimed at extracting possible health outcome measures based on expression, voice acoustics and speech sentiment from video diary data provided by patients. Forty healthy volunteers viewed 21 validated images from the International Affective Picture System database through a mobile app which simultaneously captured video footage of their face using the selfie camera. Images were intended to be associated with the following emotional responses: anger, disgust, sadness, contempt, fear, surprise and happiness. Both valence and arousal scores estimated from the video footage associated with each image were adequate predictors of the IAPS image scores (p < 0.001 and p = 0.04 respectively). 12.2% of images were categorised as containing a positive expression response in line with the target expression; with happiness and sadness responses providing the greatest frequency of responders: 41.0% and 21.4% respectively. 71.2% of images were associated with no change in expression. This proof-of-concept study provides early encouraging findings that changes in facial expression can be detected when they exist. Combined with voice acoustical measures and speech sentiment analysis, this may lead to novel measures of health status in patients using a video diary in indications including depression, schizophrenia, autism spectrum disorder and PTSD amongst other conditions.

The evolution of Tamiflu synthesis, 20 years on: Advent of enabling technologies the last piece of the puzzle?

Influenza is a serious respiratory disease responsible for significant morbidity and mortality due to both annual epidemics and pandemics; its treatment involves the use of neuraminidase inhibitors. (-)-Oseltamivir phosphate (Tamiflu) approved in 1999, is one of the most potent oral anti-influenza neuraminidase inhibitors. Consequently, more than 70 Tamiflu synthetic procedures have been developed to date. Herein, we highlight the evolution of Tamiflu synthesis since its discovery over 20 years ago in the quest for a truly efficient, safe, cost-effective and environmentally benign synthetic procedure. We have selected a few representative routes to give a clear account of the past, present and the future with the advent of enabling technologies.

The long-term health and wellbeing impacts of Healthy New Towns (HNTs): protocol for a baseline and feasibility study of HNT demonstrator sites in England.

BACKGROUND: Increasing levels of non-communicable diseases (NCDs), mental health problems, high rates of unhealthy behaviours and health inequalities remain major public health challenges worldwide. In the context of increasing urbanisation, there is an urgent need to understand how evidence that living environments shape health, wellbeing and behaviour can be used to design and deliver healthy environments in local urban settings. The Healthy New Town (HNT) programme implemented in England from 2015 consists of ten major housing developments that aim to improve population health through healthy design principles, new models for integrating health and social care and the creation of strong and connected communities. The programme provides a natural experiment in which to investigate the effects on health, wellbeing and inequalities of large-scale interventions targeting the wider social determinants of health. METHODS: The research described in this protocol aims to examine the feasibility of a larger study to assess the longer-term health impacts of HNTs, by addressing two research questions: (1) what are the similarities and differences in the HNT programme developments, processes, contexts and expected impacts and outcomes across HNT sites? and (2) how feasible is the use of data from routine sources and existing HNT evaluations and as the baseline for a definitive study to assess impact on health, wellbeing, behavioural and economic outcomes and programme processes? The research will consist of (a) participatory systems mapping with stakeholders to produce a theoretical framework for a longer-term study on the HNT programme, (b) synthesis of existing qualitative data from local HNT evaluations to understand local processes and intervention mechanisms, (c) scoping local and routinely available data to establish a baseline and feasibility for a longer-term study of health and economic outcomes, and (d) building relationships and recruiting HNT sites into the proposed research. DISCUSSION: The proposed research will produce a theoretical framework and assess the feasibility of a definitive study of outcomes of the HNT programme. This research is necessary to understand how longer-term health, wellbeing, behavioural and economic outcomes can be measured, and to inform a definitive study to generate evidence on the effectiveness of the HNT programme.

3D printing and continuous flow chemistry technology to advance pharmaceutical manufacturing in developing countries.

The realization of a downward spiralling of diseases in developing countries requires them to become self-sufficient in pharmaceutical products. One of the ways to meet this need is by boosting the local production of active pharmaceutical ingredients and embracing enabling technologies. Both 3D printing and continuous flow chemistry are being exploited rapidly and they are opening huge avenues of possibilities in the chemical and pharmaceutical industries due to their well-documented benefits. The main barrier to entry for the continuous flow chemistry technique in low-income settings is the cost of set-up and maintenance through purchasing of spare flow reactors. This review article discusses the technical considerations for the convergence of state-of-the-art technologies, 3D printing and continuous flow chemistry for pharmaceutical manufacturing applications in developing countries. An overview of the 3D printing technique and its application in fabrication of continuous flow components and systems is provided. Finally, quality considerations for satisfying regulatory requirements for the approval of 3D printed equipment are underscored. An in-depth understanding of the interrelated aspects in the implementation of these technologies is crucial for the realization of sustainable, good quality chemical reactionware.

The Therapeutic Engagement Questionnaire (TEQ): a service user-focused mental health nursing outcome metric.

BACKGROUND: Therapeutic engagement (TE) has been described as the crux of mental health nursing but despite its perceived importance, to date, there is no measurement tool that captures it. As a result, there is no way of determining the contribution of mental health nursing interaction to service user recovery, in acute inpatient mental health settings or the wider care quality agenda. METHODS: To develop and validate a TE measurement tool in partnership with Service Users (SUs) and Registered Mental Health Nurses (RMHNs). The TEQ was developed in 3 stages: 1) item generation (and pre-testing), 2) item reduction using Principal Component Analysis (PCA), and 3) validation across Mental Health Trusts in England. RESULTS: The final questionnaire has two versions, (SU and RMHN version), each scored within two contexts (1-1 SU-RMHN interactions and overall environment and atmosphere of the ward) and includes 20 items with two sub-scales (care interactions and care delivery). Psychometric evaluation of the TEQ shows high inter-scale correlations (0.66-0.95 SU; 0.57-0.90 RMHN), sound sub-scale internal consistency (> 0.95), concurrent validity (> 0.60) and adequate score variability for both versions of the TEQ. In summary, the TEQ behaves well as a measurement tool. CONCLUSIONS: The TEQ can determine the collaborative and empathic nature of RMHN-SU interactions, capture if SUs are treated with dignity and respect and recognise that the principles of the recovery approach are being respected. The TEQ can also provide robust monitoring of nursing activity, offer opportunity for transparency of activity, feed into healthcare organizations' key performance indicators and provide reassurance about the nature and quality of nurses' work.