The lived experiences of racial bias for Black,Asian and Minority Ethnic students in practice: A hermeneutic phenomenological study

AimThis study explored the lived experiences of racial bias for Black, Asian and Minority Ethnic students undertaking an undergraduate or post-graduate degree in nursing, midwifery and allied health courses in the United Kingdom.BackgroundPrevious research indicates that students from Black, Asian and Minority Ethnic groups have fewer opportunities to succeed at university and this has brought about a race awarding gap in their degree attainment. The reasons for this awarding gap are complex and multi-factorial and it is crucial that the lived experiences of racial bias are explored from the student perspective.DesignA hermeneutic phenomenological approach was adopted to elicit individual and collective experiences in the practice environment, a mandatory component of the student’s degree.MethodsA focus group and individual semi-structured interviews were conducted to collect data from sixteen participants and analysed using thematic analysisResultsThree encompassing themes were identified which included a sense of not belonging, trauma impact on mental health and understanding covert and overt racism. Participants reported incidences of racism and appeared to be traumatised by their experiences within practice and the university. They also reported poor mental health and well-being as shared experiences and a lack of confidence in the university and practice to mitigate racial issues.ConclusionsMeaningful action must be taken by universities and practice partners to advance racial inequality initiatives by having robust anti-racism action plans and processes. These should be co-created with students and staff to reduce the race awarding gap.     

Widening the participation gap: The effect of educational track on reported voting in England

This article explores the effect of tracked education in upper secondary on voting behaviour. It discusses two causal mechanisms that link tracked education to greater disparities of political participation: the curriculum and peer socialization. Data of Waves 1, 2, 5 and 7 of the Longitudinal Study of Young People in England (LSYPE) is used to assess the hypothesis that educational track has an independent effect on voting. Controlling for several pre- and post-track influences, the paper shows that students who have taken vocational courses in less prestigious schools indeed have lower reported voting levels at age 20 than those who have pursued an academic qualification (A levels) in prestigious schools. It is proposed that the effect of tracked education on political participation is likely to vary across Europe and that this variation may well be explained by differences across Europe in the extent to which the academic and vocational tracks are integrated, both in terms of the curriculum and in their social intake.     

3D打印个性化髋臼接骨板设计生物力学研究与分析

目的 应用三维有限元方法研究接骨板内固定疗法治疗髋臼后壁骨折,探讨接骨板与骨面不同间隙对髋臼应力分布的影响。方法 基于真实人体髋关节CT扫描数据,设计出适用于髋臼后壁骨折内固定的个性化接骨板,利用Mimics、Geomagic、Abaqus等软件构建接骨板内固定髋关节三维有限元模型,选择成人缓慢行走时单脚承重的受力状态对模型加载,分析接骨板与骨面不同间隙（0 mm、0.25 mm、0.5 mm、0.75 mm）对髋臼生物力学的影响。结果 随着接骨板与骨界面间隙的增大,接骨板与髋臼后壁碎片上所受最大应力随着间隙的增大而略微减小,但应力分布情况并没有太大的变化。结论 将本文有限元仿真结果结合临床骨治疗生物固定理念,可以发现个性化接骨板与骨界面间隙并不是越小越好,在允许范围内,应将接骨板与骨界面之间留有一定间隙。     

Qualitative cross-cultural exploration of vaginal bleeding/spotting symptoms and impacts associated with hormone therapy in post-menopausal women to inform the development of new patient-reported measurement tools

Objectives

To understand the vaginal bleeding/spotting experiences of postmenopausal (PM) women taking estrogen plus progestin therapies (EPT) and develop measures to assess these symptoms and their impact on women's daily lives in four countries.

Design

(1) Concept elicitation interviews were conducted with PM women in the US (n = 14), Italy (n = 15), Mexico (n = 15) and China (n = 15) to explore vaginal bleeding/spotting symptoms associated with EPT. The Post-Menopausal Bleeding Questionnaire (PMBQ) was also debriefed to evaluate understanding and comprehensiveness. (2) Based on concept elicitation, a single item electronic daily diary was developed and the PMBQ modified to form a 12-item impact measure. (3) The measures were pilot-tested and then cognitively debriefed with US women receiving EPT. All qualitative data was subject to thematic analysis.

Main outcome measures

The Vaginal Bleeding/Spotting Daily Diary, (VBS-DD) and Post-Menopausal Bleeding Impact Questionnaire (PMBIQ) were developed in this study.

Results

Concept elicitation identified vaginal bleeding and spotting as important symptoms for women taking EPT, impacting their emotional wellbeing, social life, ability to move freely, clothing and sexual activity. Based on pilot testing and cognitive debriefing, women demonstrated good understanding of the VBS-DD and the PMBQ was reduced to 10 items due to conceptual redundancy.

Conclusions

Women taking EPT in the US, China, Mexico and Italy reported vaginal bleeding/spotting symptoms that have a detrimental impact on their quality of life. Two new measures were developed to assess the severity and impact of vaginal bleeding/spotting specific to EPT. This work highlights the need for EPT-related symptoms to be a part of treatment decision-making.     

Difficult esophageal atresia: Trick and treat

Although most patients with esophageal atresia (EA) and tracheo-esophageal fistula (TEF) may benefit from “standard” management, which is deferred emergency surgery, some may present unexpected elements that change this paradigm. Birth weight, associated anomalies, and long gap can influence the therapeutic schedule of the patients with EA/TEF and can make their treatment tricky. As a consequence, detailed information on these aspects gives the power to develop a decision-making process as correct as possible. In this article, we will review the most important factors influencing the treatment of patients with EA/TEF and will share our experience on the diagnostic and therapeutic tips that may provide pivotal help in the management of such patients.     

A comparative study of gold UCLA-type and CAD/CAM titanium implant abutments

PURPOSE

The aim of this study was to evaluate the interface accuracy of computer-assisted designed and manufactured (CAD/CAM) titanium abutments and implant fixture compared to gold-cast UCLA abutments.

MATERIALS AND METHODS

An external connection implant system (Mark III, n=10) and an internal connection implant system (Replace Select, n=10) were used, 5 of each group were connected to milled titanium abutment and the rest were connected to the gold-cast UCLA abutments. The implant fixture and abutment were tightened to torque of 35 Ncm using a digital torque gauge, and initial detorque values were measured 10 minutes after tightening. To mimic the mastication, a cyclic loading was applied at 14 Hz for one million cycles, with the stress amplitude range being within 0 N to 100 N. After the cyclic loading, detorque values were measured again. The fixture-abutment gaps were measured under a microscope and recorded with an accuracy of ±0.1 µm at 50 points.

RESULTS

Initial detorque values of milled abutment were significantly higher than those of cast abutment (P<.05). Detorque values after one million dynamic cyclic loadings were not significantly different (P>.05). After cyclic loading, detorque values of cast abutment increased, but those of milled abutment decreased (P<.05). There was no significant difference of gap dimension between the milled abutment group and the cast abutment group after cyclic loading.

CONCLUSION

In conclusion, CAD/CAM milled titanium abutment can be fabricated with sufficient accuracy to permit screw joint stability between abutment and fixture comparable to that of the traditional gold cast UCLA abutment.     

移植的间充质干细胞与宿主心肌匹配整合实验研究

目的 探索间充质干细胞(MSCs)分化的心肌样细胞与宿主心肌匹配的解剖结构基础.方法 采用成年近交系Wistar大鼠,经左冠状动脉前降支结扎1 h建立心肌缺血再灌模型.术后1周,将来自同种供体、经体外扩增和Rt-GFP转染MSCs后植入梗死区.移植后4周测定心脏功能.随后取材、连续冰冻切片,观察心肌组织形态学的变化及MSCs分化的心肌样细胞缝隙连接(Connexin-43)的表达.结果 植入梗死区中的MSCs表达Connexin-43.移植组梗死区面积缩小,左心室壁厚度增加,心脏功能改善.结论 移植的MSCs通过分化为心肌样细胞,并与宿主心肌细胞形成电机械匹配结构即缝隙连接(Connexin-43),使新增加的心肌细胞能够与宿主心肌同步收缩,从而更有效改善心脏功能.     

Cell-to-cell communication and expression of gap junctional proteins in human diabetic and nondiabetic skin fibroblasts

Wound healing involves the interactions of many cell types, and is controlled in part by growth factors. Intercellular communication mediated by gap junctions is considered to play an important role in the coordination of cellular metabolism during the growth and development of tissues and organs. Basic fibroblast growth factor (bFGF), known to be important in wound healing, has been found to increase Cx43 expression and intercellular communication in endothelial cells and cardiac fibroblasts. It has been proposed that an increased coupling is necessary for the coordination of these cells in wound healing and angiogenesis, and that one of the actions of bFGF is to modulate intercellular communication. The aim of our study was to evaluate the effects of bFGF on gap junctional intercellular communication (GJIC) in vitro, and the presence of gap junctional proteins connexin (Cx) 26, Cx32, and Cx43 in fibroblasts of diabetic and nondiabetic individuals. Fibroblast cell lines (n=10) were cultured for 3 d in serum-free media with or without bFGF (3 ng/mL). Cells were evaluated for the rate of GJIC by using laser cytometry, and for the presence of Cx26, Cx32, and Cx43 by immunohistochemical and Western analyses. All cell types communicated via contact-dependent mechanisms. The rate of GJIC was greater (p<0.01) for diabetic than for nondiabetic fibroblasts (4.1±0.01 vs 3.3±0.01 %/min). bFGF increased (p<0.01) the rate of GJIC for diabetic (4.9±0.01 vs 4.1±0.01%) and nondiabetic (4.1±0.01 vs 3.3±0.01%) fibroblasts. Immunohistochemistry identified Cx26 in the cytoplasm, Cx32 was not detected, and Cx43 was present on the cellular borders in all cultures. Image analysis of immunofluorescent staining demonstrated that bFGF increased (p<0.05) Cx43 expression in diabetic and nondiabetic fibroblasts. Western immunoblot analysis revealed bands at 43–46 kD that were similar in volume for diabetic and nondiabetic fibroblasts. Thus, gap junctions involving Cx43 and GJIC among fibroblasts appear to be targets for bFGF. Fibroblasts of diabetic individuals appear to have an increased rate of cell-cell coupling, correlating with a decreased rate of proliferation.     

山东省卫生健康行业网络安全调查与分析

目的/意义调查分析山东省卫生健康行业网络安全现状,精确定位行业网络安全短板,提升风险管理决策能力。方法/过程以问卷方式采集数据,从医疗机构等级和地域分布两个维度进行网络安全差距分析。结果/结论针对当前山东省基层医疗卫生机构信息化建设管理和技术防护层面的问题,提出卫生健康行业网络安全治理具体措施。