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'Diversity' is a heavily freighted and multivalent keyword in the global digital media environment. The recommender systems used by platforms are particularly acute sites of development and debate around the political, cultural and technical issues 'diversity' signifies. Drawing on a review of computer science publications on recommender systems in media and entertainment as well as a survey of recent advances in media and cultural policy scholarship, this short article performs a pragmatic close reading of diversity in these intersecting fields. We note that attention must be paid to the specific challenges and politics of diversity not only in particular cultural fields but also in local cultural contexts, drawing on examples from music and SVOD platforms to flesh out these questions and the practical possibilities that arise from them. [ABSTRACT FROM AUTHOR]

As social media platforms adapt their rules to limit the presence, spread, and amplification of harmful content on their services, users develop strategies to circumvent content moderation policies. To better understand cultures of content moderation circumvention, including the types of rules that Facebook users seek to circumvent, we analysed a sample of YouTube videos and Reddit threads in which users discuss content moderation circumvention. We show how Facebook users turn to others across platforms to obtain information about circumvention methods. We observe that these users often discuss overcoming Facebook's content moderation policies in terms that downplay the significance of their intended actions. We suggest that where Facebook's policies and enforcement measures fail to deter rule violations that may facilitate harm, Facebook should consider new culture-driven approaches to platform governance that foster prosocial environments and engender compliance with platform rules. [ABSTRACT FROM AUTHOR]

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Background: Surgical intervention for thoracic aortic aneurysms is high risk. Understanding changes in health-related quality of life before and after endovascular stent grafting and open surgical repair can aid treatment decision-making. Methods: The Effective Treatments for Thoracic Aortic Aneurysms ('ETTAA') study (ISRCTN04044627) was a longitudinal, observational study. Adults with new/existing arch or descending thoracic aortic aneurysms greater than or equal to 4 cm in diameter were followed from 2014 to 2022. Five domains of health-related quality of life (Mobility, Self-Care, Usual Activities, Pain/Discomfort, and Anxiety/Depression) were recorded using the EuroQoL, five dimensions, five levels ('EQ-5D-5L') questionnaire and analysed using a range of longitudinal mixed models. Results: Of 886 thoracic aortic aneurysm participants, 824 completed at least 2 questionnaires. Patients had slightly worse health-related quality of life than age-matched norms. Without surgery, deterioration occurred over time in Mobility (0.072/year (95% c.i. 0.042 to 0.101), P < 0.001) and Self-Care (0.039/year (95% c.i. 0.018 to 0.061), P < 0.001) in both sexes and Pain/Discomfort in women (0.069/year (95% c.i. 0.020 to 0.118), P = 0.005). For 6 weeks after endovascular stent grafting, there was a significant impairment in Self-Care (0.214 (95% c.i. 0.112 to 0.316), P < 0.001) and (for women only) in Usual Activities (0.625 (95% c.i. 0.338 to 0.911), P < 0.001), which then returned to pre-endovascular stent grafting levels. Six weeks after open surgical repair, the impairment in health-related quality of life was greater (Mobility 0.492 (95% c.i. 0.314 to 0.669), Self-Care 0.474 (95% c.i. 0.364 to 0.583), Usual Activities 1.469 (95% c.i. 1.042 to 1.896), and Pain/Discomfort 0.561 (95% c.i. 0.363 to 0.760), all P < 0.001) and took longer to return to pre-open surgical repair levels, partly due to increased complications and longer hospitalization. Anxiety/Depression decreased after open surgical repair (−0.214 (95% c.i. −0.326 to −0.101), P < 0.001). Age, sex, frailty, smoking, New York Heart Association class, and chronic obstructive pulmonary disease were significantly associated with health-related quality of life. Conclusion: Without intervention, health-related quality of life declines as age increases. Changes in health-related quality of life should contribute to surgical treatment decision-making. Understanding changes in health-related quality of life before and after endovascular stent grafting and open surgical repair can aid treatment decision-making. For 6 weeks after endovascular stent grafting, there was a significant impairment in Self-Care (0.214 (95% c.i. 0.112 to 0.316), P < 0.001) and (for women only) in Usual Activities (0.625 (95% c.i. 0.338 to 0.911), P < 0.001), which then returned to pre-endovascular stent grafting levels. Six weeks after open surgical repair, the impairment in health-related quality of life was greater (Mobility 0.492 (95% c.i. 0.314 to 0.669), Self-Care 0.474 (95% c.i. 0.364 to 0.583), Usual Activities 1.469 (95% c.i. 1.042 to 1.896), and Pain/Discomfort 0.561 (95% c.i. 0.363 to 0.760), all P < 0.001) and took longer to return to pre-open surgical repair levels. Anxiety/Depression decreased after open surgical repair (−0.214 (95% c.i. −0.326 to −0.101), P < 0.001). [ABSTRACT FROM AUTHOR]

This article explores the parallels between the Responsibility to Protect (R2P) framework and the regulation of online harms. It highlights the challenges faced by both initiatives due to Western-centric perspectives and values. The R2P framework has been criticized for its Western-centric decision-making processes and inaction in certain conflicts, while current online harms regulation led by Western states may not be applicable or effective in other contexts. The article emphasizes the need for policymakers to consider the experiences and perspectives of all states and avoid imposing Western values on global norms and standards for online harm protection. It also discusses the challenges of defining and translating harms across different states and platforms, leading to exclusion and insecurity for certain societies and individuals. The article calls for a more inclusive and globally-minded approach to online harms regulation that considers diverse perspectives and experiences beyond the Western moral threshold. [Extracted from the article]

The article discusses the concept of data sovereignty and its implications for internet policy. Data sovereignty refers to the rights of nations or regions to govern the flow and management of data within their borders. It has far-reaching implications for sectors such as economics, law, security, privacy, and technology. Data sovereignty can enhance control, autonomy, and security over data, protect privacy rights, promote inclusivity and diversity, foster economic growth, and enhance trust and transparency in data governance. However, implementing data sovereignty poses challenges, such as balancing national sovereignty with the global nature of the internet and harmonizing regulations across jurisdictions. The article also highlights a case study in Aotearoa New Zealand, where data sovereignty is of concern to Indigenous users. The Te Mana Raraunga network advocates for Māori rights and interests in data and supports the development of Māori data infrastructure and digital businesses. The article concludes by discussing other articles in the issue that explore various aspects of infrastructure, policy, and participation in the digital realm. [Extracted from the article]

With an ageing population, comes an increase in our working lives, so the necessity to motivate and retain older workers becomes more pertinent. Lower turnover intentions and successful ageing at work have been linked to being proactive, but what drives this behaviour amongst older workers is less understood. This research explores the values and motives stimulating proactivity amongst working professionals aged 50–60 (seven males and seven females). Semi-structured interviews were analysed using template analysis. Understanding these motivational factors enables organisations to create conditions that promote proactive behaviour among older workers. The study identifies four distinct clusters that elucidate how proactivity is triggered among older workers. The findings indicate that both achievement motives and intrinsically driven proactivity were present among all participants. However, the value orientations that inform proactive endeavours diverged across the different clusters. Implications for theory and practice are provided. [ABSTRACT FROM AUTHOR]

Background: The onset of disability in bathing is particularly important for older adults as it can be rapidly followed by disability in other daily activities; this may represent a judicious time point for intervention in order to improve health, well-being and associated quality of life. An important environmental and preventative intervention is housing adaptation, but there are often lengthy waiting times for statutory provision. In this randomised controlled trial (RCT), we aim to evaluate the effectiveness and cost-effectiveness of bathing adaptations compared to no adaptations and to explore the factors associated with routine and expedited implementation of bathing adaptations. Methods: BATH-OUT-2 is a multicentre, two-arm, parallel-group RCT. Adults aged 60 and over who are referred to their local authority for an accessible level access shower will be randomised, using pairwise randomisation, 1:1, to receive either an expedited provision of an accessible shower via the local authority or a usual care control waiting list. Participants will be followed up for a maximum of 12 months and will receive up to four follow-ups in this duration. The primary outcome will be the participant's physical well-being, assessed by the Physical Component Summary score of the Short Form-36 (SF-36), 4 weeks after the intervention group receives the accessible shower. The secondary outcomes include the Mental Component Summary score of the SF-36, self-reported falls, health and social care resource use, health-related quality of life (EQ-5D-5L), social care-related quality of life (Adult Social Care Outcomes Toolkit (ASCOT)), fear of falling (Short Falls Efficacy Scale), independence in bathing (Barthel Index bathing question), independence in daily activities (Barthel Index) and perceived difficulty in bathing (0–100 scale). A mixed-methods process evaluation will comprise interviews with stakeholders and a survey of local authorities with social care responsibilities in England. Discussion: The BATH-OUT-2 trial is designed so that the findings will inform future decisions regarding the provision of bathing adaptations for older adults. This trial has the potential to highlight, and then reduce, health inequalities associated with waiting times for bathing adaptations and to influence policies for older adults. Trial registration: ISRCTN Registry ISRCTN48563324. Prospectively registered on 09/04/2021. [ABSTRACT FROM AUTHOR]

Background: Repair of thoracic aortic aneurysms with either endovascular repair (TEVAR) or open surgical repair (OSR) represents major surgery, is costly and associated with significant complications. The aim of this study was to establish accurate costs of delivering TEVAR and OSR in a cohort of UK NHS patients suitable for open and endovascular treatment for the whole treatment pathway from admission and to discharge and 12-month follow-up. Methods: A prospective study of UK NHS patients from 30 NHS vascular/cardiothoracic units in England aged ≥18, with distal arch/descending thoracic aortic aneurysms (CTAA) was undertaken. A multicentre prospective cost analysis of patients (recruited March 2014–July 2018, follow-up until July 2019) undergoing TEVAR or OSR was performed. Patients deemed suitable for open or endovascular repair were included in this study. A micro-costing approach was adopted. Results: Some 115 patients having undergone TEVAR and 35 patients with OSR were identified. The mean (s.d.) cost of a TEVAR procedure was higher £26 536 (£9877) versus OSR £17 239 (£8043). Postoperative costs until discharge were lower for TEVAR £7484 (£7848) versus OSR £28 636 (£23 083). Therefore, total NHS costs from admission to discharge were lower for TEVAR £34 020 (£14 301), versus OSR £45 875 (£43 023). However, mean NHS costs for 12 months following the procedure were slightly higher for the TEVAR £5206 (£11 585) versus OSR £5039 (£11 994). Conclusions: Surgical procedure costs were higher for TEVAR due to device costs. Total in-hospital costs were higher for OSR due to longer hospital and critical care stay. Follow-up costs over 12 months were slightly higher for TEVAR due to hospital readmissions. Detailed micro-costing of endovascular stent grafting (TEVAR) and open surgical repair (OSR) in a cohort of UK NHS patients for whole of treatment pathway up to 12 months follow-up. Overall costs are higher for OSR, driven by length of stay and critical care post-procedure, compared to TEVAR, with costs driven by stent graft devices. These detailed micro-costing estimates exceed current NHS tariffs for reimbursement. [ABSTRACT FROM AUTHOR]

Gonzales proposes a multi-solving innovations model - under which policies are designed to have beneficial outcomes across sectors - for approaching this complex policy problem. Building on these studies, this issue of I Policy & Internet i provides a range of new contributions that probe and evaluate different dimensions of the problems of democracy in the digital age. Keywords: digital democracy; media policy; misinformation; participatory culture; public interest EN digital democracy media policy misinformation participatory culture public interest 158 161 4 06/19/23 20230601 NES 230601 As Yochai Benkler identified almost two decades ago, the internet radically transformed "how we make the information environment we occupy as autonomous individuals, citizens and members of cultural and social groups" (Benkler, [2], p. 1). [Extracted from the article]

The digital environment is dominated by monopolistic companies who possess and exercise substantial economic, political and social power to varying degrees. Globally, policymakers are striving to regulate these digital platform companies to address monopoly issues. Through a content analysis of publicly available policy and government documents, company reports, trade press and news media, we investigate key moments in the evolution of anti-monopoly/oligopoly actions taken by the Chinese government against its dominant digital platforms. We then compare this analysis with a brief overview of the European Union's (EU) digital sovereignty agenda, focusing on the discourse regarding greater digital economy competition in the region. Our analysis suggests that in both jurisdictions digital sovereignty is not simply an issue of geopolitics, that is, contests between nation states, but it is also a response to the excessive power wielded by digital platform companies. We argue that in an international digital policy landscape increasingly characterised by digital sovereignty agendas, the issue of monopoly in digital platform economies is a small but potentially overlooked and undervalued point of convergence between the EU and China. [ABSTRACT FROM AUTHOR]

Aims To observe, describe, and evaluate management and timing of intervention for patients with untreated thoracic aortic aneurysms. Methods and results Prospective study of UK National Health Service (NHS) patients aged ≥18 years, with new/existing arch or descending thoracic aortic aneurysms of ≥4 cm diameter, followed up until death, intervention, withdrawal, or July 2019. Outcomes were aneurysm growth, survival, quality of life (using the EQ-5D-5L utility index), and hospital admissions. Between 2014 and 2018, 886 patients were recruited from 30 NHS vascular/cardiothoracic units. Maximum aneurysm diameter was in the descending aorta in 725 (82%) patients, growing at 0.2 cm (0.17–0.24) per year. Aneurysms of ≥4 cm in the arch increased by 0.07 cm (0.02–0.12) per year. Baseline diameter was related to age and comorbidities, and no clinical correlates of growth were found. During follow-up, 129 patients died, 64 from aneurysm-related events. Adjusting for age, sex, and New York Heart Association dyspnoea index, risk of death increased with aneurysm size at baseline [hazard ratio (HR): 1.88 (95% confidence interval: 1.64–2.16) per cm, P < 0.001] and with growth [HR: 2.02 (1.70–2.41) per cm, P < 0.001]. Hospital admissions increased with aneurysm size [relative risk: 1.21 (1.05–1.38) per cm, P = 0.008]. Quality of life decreased annually for each 10-year increase in age [–0.013 (–0.019 to –0.007), P < 0.001] and for current smoking [–0.043 (–0.064 to –0.023), P = 0.004]. Aneurysm size was not associated with change in quality of life. Conclusion International guidelines should consider increasing monitoring intervals to 12 months for small aneurysms and increasing intervention thresholds. Individualized decisions about surveillance/intervention should consider age, sex, size, growth, patient characteristics, and surgical risk. [ABSTRACT FROM AUTHOR]

YouTube's "up next" feature algorithmically selects, suggests, and displays videos to watch after the one that is currently playing. This feature has been criticized for limiting users' exposure to a range of diverse media content and information sources; meanwhile, YouTube has reported that they have implemented various technical and policy changes to address these concerns. However, there is little publicly available data to support either the existing concerns or YouTube's claims of having addressed them. Drawing on the idea of "platform observability," this article combines computational and qualitative methods to investigate the types of content that the algorithms underpinning YouTube's "up next" feature amplify over time, using three keyword search terms associated with sociocultural issues where concerns have been raised about YouTube's role: "coronavirus," "feminism," and "beauty." Over six weeks, we collected the videos (and their metadata, including channel IDs) that were highly ranked in the search results for each keyword, as well as the highly ranked recommendations associated with the videos. We repeated this exercise for three steps in the recommendation chain and then examined patterns in the recommended videos (and the channels that uploaded the videos) for each query and their variation over time. We found evidence of YouTube's stated efforts to boost "authoritative" media outlets, but at the same time, misleading and controversial content continues to be recommended. We also found that while algorithmic recommendations offer diversity in videos over time, there are clear "winners" at the channel level that are given a visibility boost in YouTube's "up next" feature. However, these impacts are attenuated differently depending on the nature of the issue. [ABSTRACT FROM AUTHOR]

Background: Ventilator-associated pneumonia (VAP) is an important diagnosis in critical care. VAP research is complicated by the lack of agreed diagnostic criteria and reference standard test criteria. Our aim was to review which reference standard tests are used to evaluate novel index tests for suspected VAP.Methods: We conducted a comprehensive search using electronic databases and hand reference checks. The Cochrane Library, MEDLINE, CINHAL, EMBASE, and web of science were searched from 2008 until November 2018. All terms related to VAP diagnostics in the intensive treatment unit were used to conduct the search. We adopted a checklist from the critical appraisal skills programme checklist for diagnostic studies to assess the quality of the included studies.Results: We identified 2441 records, of which 178 were selected for full-text review. Following methodological examination and quality assessment, 44 studies were included in narrative data synthesis. Thirty-two (72.7%) studies utilised a sole microbiological reference standard; the remaining 12 studies utilised a composite reference standard, nine of which included a mandatory microbiological criterion. Histopathological criteria were optional in four studies but mandatory in none.Conclusions: Nearly all reference standards for VAP used in diagnostic test research required some microbiological confirmation of infection, with BAL culture being the most common reference standard used. [ABSTRACT FROM AUTHOR]

Background: Rapid evaluation was at the heart of National Health Service England's evaluation strategy of the new models of care vanguard programme. This was to facilitate the scale and spread of successful models of care throughout the health & social care system. The aim of this paper is to compare the findings of the two evaluations of the Enhanced health in Care Homes (EHCH) vanguard in Gateshead, one using a smaller data set for rapidity and one using a larger longitudinal data set and to investigate the implications of the use of rapid evaluations using interrupted time series (ITS) methods.Methods: A quasi-experimental design study in the form of an ITS was used to evaluate the impact of the vanguard on secondary care use. Two different models are presented differing by timeframes only. The short-term model consisted of data for 11 months data pre and 20 months post vanguard. The long-term model consisted of data for 23 months pre and 34 months post vanguard.Results: The cost consequences, including the cost of running the EHCH vanguard, were estimated using both a single tariff non-elective admissions methodology and a tariff per bed day methodology. The short-term model estimated a monthly cost increase of £73,408 using a single tariff methodology. When using a tariff per bed day, there was an estimated monthly cost increase of £14,315. The long-term model had, using a single tariff for non-elective admissions, an overall cost increase of £7576 per month. However, when using a tariff per bed-days, there was an estimated monthly cost reduction of £57,168.Conclusions: Although it is acknowledged that there is often a need for rapid evaluations in order to identify "quick wins" and to expedite learning within health and social care systems, we conclude that this may not be appropriate for quasi-experimental designs estimating effect using ITS for complex interventions. Our analyses suggests that care must be taken when conducting and interpreting the results of short-term evaluations using ITS methods, as they may produce misleading results and may lead to a misallocation of resources. [ABSTRACT FROM AUTHOR]

Objectives To understand approaches to priority setting for healthcare service resource allocation at an operational level in a nationally commissioned but regionally delivered service. Design Qualitative study using semistructured interviews and a Framework analysis. Setting National Health Service dentistry commissioning teams within subregional offices in England. Participants All 31 individuals holding the relevant role (dental lead commissioner in subregional offices) were approached directly and from this 14 participants were recruited, with 12 interviews completed. Both male and female genders and all regions were represented in the final sample. Results Three major themes arose. First, 'Methods of priority setting and barriers to explicit approaches' was a common theme, specifically identifying the main methods as: perpetuating historical allocations, pressure from politicians and clinicians and use of needs assessments while barriers were time and skill deficits, a lack of national guidance and an inflexible contracting arrangements stopping resource allocation. Second, 'Relationships with key stakeholders and advisors' were discussed, showing the important nature of relationships with clinical advisors but variation in the quality of these relationships was noted. Finally, 'Tensions between national and local responsibilities' were illustrated, where there was confusion about where power and autonomy lay. Conclusions Commissioners recognised a need for resource allocation but relied on clinical advice and needs assessment in order to set priorities. More explicit priority setting was prevented by structure of the commissioning system and standard national contracts with providers. Further research is required to embed and simplify adoption of tools to aid priority setting. [ABSTRACT FROM AUTHOR]

Background: Visually impaired older people (VIOP) have a higher risk of falling than their sighted peers, and are likely to avoid physical activity. The aim was to adapt the existing Falls Management Exercise (FaME) programme for VIOP, delivered in the community, and to investigate the feasibility of conducting a definitive randomised controlled trial (RCT) of this adapted intervention.Methods: Two-centre randomised mixed methods pilot trial and economic evaluation of the adapted group-based FaME programme for VIOP versus usual care. A one hour exercise programme ran weekly over 12 weeks at the study sites (Newcastle and Glasgow), delivered by third sector (voluntary and community) organisations. Participants were advised to exercise at home for an additional two hours over the week. Those randomised to the usual activities group received no intervention. Outcome measures were completed at baseline, 12 and 24 weeks. The potential primary outcome was the Short Form Falls Efficacy Scale - International (SFES-I). Participants' adherence was assessed by reviewing attendance records and self-reported compliance to the home exercises. Adherence with the course content (fidelity) by instructors was assessed by a researcher. Adverse events were collected in a weekly phone call.Results: Eighteen participants, drawn from community-living VIOP were screened; 68 met the inclusion criteria; 64 participants were randomised with 33 allocated to the intervention and 31 to the usual activities arm. 94% of participants provided data at the 12 week visit and 92% at 24 weeks. Adherence was high. The intervention was found to be safe with 76% attending nine or more classes. Median time for home exercise was 50 min per week. There was little or no evidence that fear of falling, balance and falls risk, physical activity, emotional, attitudinal or quality of life outcomes differed between trial arms at follow-up.Conclusions: The intervention, FaME, was implemented successfully for VIOP and all progression criteria for a main trial were met. The lack of difference between groups on fear of falling was unsurprising given it was a pilot study but there may have been other contributory factors including suboptimal exercise dose and apparent low risk of falls in participants. These issues need addressing for a future trial.Trial Registration: Current Controlled Trials ISRCTN ID: 16949845 Registered: 21 May 2015. [ABSTRACT FROM AUTHOR]

Background: Previous models of Hospital at Home (HAH) for COPD exacerbation (ECOPD) were limited by the lack of a reliable prognostic score to guide patient selection. Approximately 50% of hospitalised patients have a low mortality risk by DECAF, thus are potentially suitable.Methods: In a non-inferiority randomised controlled trial, 118 patients admitted with a low-risk ECOPD (DECAF 0 or 1) were recruited to HAH or usual care (UC). The primary outcome was health and social costs at 90 days.Results: Mean 90-day costs were £1016 lower in HAH, but the one-sided 95% CI crossed the non-inferiority limit of £150 (CI -2343 to 312). Savings were primarily due to reduced hospital bed days: HAH=1 (IQR 1-7), UC=5 (IQR 2-12) (P=0.001). Length of stay during the index admission in UC was only 3 days, which was 2 days shorter than expected. Based on quality-adjusted life years, the probability of HAH being cost-effective was 90%. There was one death within 90 days in each arm, readmission rates were similar and 90% of patients preferred HAH for subsequent ECOPD.Conclusion: HAH selected by low-risk DECAF score was safe, clinically effective, cost-effective, and preferred by most patients. Compared with earlier models, selection is simpler and approximately twice as many patients are eligible. The introduction of DECAF was associated with a fall in UC length of stay without adverse outcome, supporting use of DECAF to direct early discharge.Trial Registration Number: Registered prospectively ISRCTN29082260. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim was to measure the predictive value of a termination of resuscitation guideline that allows for pre-hospital termination of adult cardiac arrests of presumed cardiac aetiology where the patient did not present in a shockable cardiac rhythm and did not achieve return of spontaneous circulation on-scene. The secondary objective was to compare the effectiveness of that guideline with existing basic life support and advanced life support guidelines. Methods: A retrospective review of 2139 adult out-of-hospital primary cardiac arrest patients transported to hospital by a single ambulance trust during a 12-month period between 1 April 2014 and 31 March 2015. Results: Application of the new guideline identified 832 for termination, from which three (0.4%) survived, resulting in a specificity of 99.1% (95% CI: 97.4% to 99.8%), PPV of 99.6% (95% CI: 99% to 99.9%), sensitivity of 46.5% (95% CI: 44.1% to 48.8%) and NPV of 25.6% (95% CI: 23.2% to 28.1%). The transport rate was 60.7%, compared to 72.8% for the basic life support guideline and 95.2% for the advanced life support guideline. Conclusions: Within the tested cohort, a reduction of 39.3% in transport of adult out-of-hospital primary cardiac arrest of presumed cardiac aetiology could have been achieved if using a termination of resuscitation guideline that allows for termination on-scene when the patient presented in a non-shockable rhythm and there has been no return of spontaneous circulation. These guidelines require prospective validation, but may identify more futile transportations than other previously validated guidelines. [ABSTRACT FROM AUTHOR]

Like other Westernised countries, Australia’s history of colonisation, racism and oppression has impacted upon Indigenous Peoples’ health and well-being. It is also evident that institutional racism and ongoing colonisation are present in the Australian health system. Better preparation of health professionals to work in a culturally respectful way can contribute to addressing health disparities and prejudices. One approach to enabling the development of cultural respect is through embedding an Indigenous graduate attribute (IGA) across curricula and ensuring the process is thoughtfully developed and assessed. This paper describes and discusses the process of developing an assessment criteria template (ACT) to assess Indigenous cultural respect in an undergraduate nursing degree programme. Critical to the project was meaningful engagement with Indigenous stakeholders and Indigenous leadership to inform the development and implementation process. Although the context will vary globally due to the diversity of Indigenous Peoples and each country’s history of colonisation, by publishing this work, we intend to provide transparency into the process we undertook to embed and assess an IGA ACT in an undergraduate nursing curriculum. We hope this is helpful for other tertiary institutions internationally who are also engaging in this space. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine sheltered housing tenants' views of health and well-being, the strategies they adopted to support their well-being, and their use of health and social care services through a Health Needs Assessment. Sheltered housing in the UK is a form of service-integrated housing for people, predominantly over 60. The study used a parallel, three-strand mixed method approach to encompass the tenants' perceptions of health and well-being ( n = 96 participants), analysis of the service's health and well-being database, and analysis of emergency and elective hospital admissions ( n = 978 tenant data sets for the period January to December 2012). Tenants' perceptions of well-being were seen to reinforce much of the previous work on the subject with strategies required to sustain social, community, physical, economic, environmental, leisure, emotional and spiritual dimensions. Of the tenants' self-reported chronic conditions, arthritis, heart conditions and breathing problems were identified as their most common health concerns. Hospital admission data indicated that 43% of the tenant population was admitted to hospital (886 admissions) with 53% emergency and 47% elective admissions. The potential cost of emergency as opposed to elective admissions was substantial. The mean length of stay for emergency admissions was 8.2 days (median 3.0 days). While elective hospital admission had a mean length of stay of 1.0 day (median 0.0 days). These results suggest the need for multi-professional health, social care and housing services interventions to facilitate sheltered housing tenants' aspirations and support their strategies to live well and independently in their own homes. Equally there is a need to increase tenants' awareness of health conditions and their management, the importance of services which offer facilitation, resources and support, and the key role played by prevention and reablement. [ABSTRACT FROM AUTHOR]

The well-documented health disparities between the Australian Indigenous and non-Indigenous population mandates a comprehensive response from health professionals. This article outlines the approach taken by one faculty of health in a large urban Australian university to enhance cultural competence in students from a variety of fields. Here we outline a collaborative and deeply respectful process of Indigenous and non-Indigenous university staff collectively developing a model that has framed the embedding of a common faculty Indigenous graduate attribute across the curriculum. Through collaborative committee processes, the development of the principles of “Respect; Engagement and sharing; Moving forward” (REM) has provided both a framework and way of “being and doing” our work. By drawing together the recurring principles and qualities that characterize Indigenous cultural competence the result will be students and staff learning and bringing into their lives and practice, important Indigenous cultural understanding. [ABSTRACT FROM AUTHOR]

Introduction: In the UK, 1 in 5 people aged 75 and over live with sight loss. Visually impaired older people (VIOP) have an above average incidence of falls and 1.3-1.9 times more likely to experience hip fractures, than the general population. Older people with eye diseases are ~3 times more likely than those with good vision, to limit activities due to fear of falling. This feasibility study aims to adapt the group-based Falls Management Exercise (FaME) programme to the needs of VIOP and carry out an external pilot trial to inform the design of a future definitive randomised controlled trial. Methods and design: A UK based 2-centre mixed methods, randomised, feasibility study will be conducted over 28 months. Stakeholder panels, including VIOP, will make recommendations for adaptations to an existing exercise programme (FaME), to meet the needs of VIOP, promoting uptake and adherence, while retaining required effective components of the exercise programme. 80 VIOP aged 60 and over, living at home, ambulant with or without a walking aid, will be recruited in Newcastle (n=40) and Glasgow (n=40) through National Health Service (NHS) Trusts and third sector partners. Participants randomised into the intervention arm will receive the adapted FaME programme. Participants randomised into the control arm will continue with usual activity. Outcomes are, recruitment rate, adherence and validated measures including fear of falling and quality of life. Postintervention in-depth qualitative interviews will be conducted with a purposive sample of VIOP (N=10). Postural stability instructors will be interviewed, before trial-specific training and following the intervention. Ethics and dissemination: Ethics approval was secured through the National Research Ethics Service (NRES) Committee North East, Newcastle and North Tyneside 2. Glasgow Caledonian University was approved as a non-NHS site with local ethics approval. Findings will be disseminated through peer-reviewed journals, national and international conferences. [ABSTRACT FROM AUTHOR]

Aim To explore the perceptions of early career nursing academics on leadership in academia. Background There is growing emphasis on leadership capacity building across all domains of nursing. However, there is limited evidence on leadership capacity in early career academics. This study tested an intervention to develop leadership capacity amongst early career nursing academics in two Australian universities. Methods A sequential mixed methods design, using online surveys and semi-structured interviews, was used to collect data. Results Twenty-three early career nursing academics participated. Most had experience of formal leadership roles and were aware of its importance to them as they developed their academic careers. Participants were able to discuss their own views of themselves as leaders; their perceptions of their own needs for leadership development, and ways in which they could seek to develop further as leaders. Conclusion There is a need to provide initial and ongoing opportunities for leadership development amongst nurse academics. These opportunities should be contextualised and recognise factors such as gender, and the effects of structural oppression. Implications for nursing management Nurse academics are involved in the preparation of the next generation of clinical leaders and it is imperative that they are able to articulate a clear view of leadership. [ABSTRACT FROM AUTHOR]

Background: Congenital cytomegalovirus (cCMV) is an important cause of childhood deafness, which is modifiable if diagnosed within the first month of life. Targeted screening of infants who do not pass their newborn hearing screening tests in England is a feasible approach to identify and treat cases to improve hearing outcome.Aims: To conduct a cost analysis of targeted screening and subsequent treatment for cCMV-related sensorineural hearing loss (SNHL) in an, otherwise, asymptomatic infant, from the perspective of the UK National Health Service (NHS).Methods: Using data from the newborn hearing screening programme (NHSP) in England and a recent study of targeted screening for cCMV using salivary swabs within the NHSP, we estimate the cost (in UK pounds (£)) to the NHS. The cost of screening (time, swabs and PCR), assessing, treating and following up cases is calculated. The cost per case of preventing hearing deterioration secondary to cCMV with targeted screening is calculated.Results: The cost of identifying, assessing and treating a case of cCMV-related SNHL through targeted cCMV screening is estimated to be £6683. The cost of improving hearing outcome for an infant with cCMV-related SNHL through targeted screening and treatment is estimated at £14 202.Conclusions: The costs of targeted screening for cCMV using salivary swabs integrated within NHSP resulted in an estimate of cost per case that compares favourably with other screening programmes. This could be used in future studies to estimate the full economic value in terms of incremental costs and incremental health benefits. [ABSTRACT FROM AUTHOR]

Purpose: This study explores the experiences and perceptions of academic nurse mentors supporting early career nurse academics (ECNAs). Methods: Interviews were undertaken with mentors following a mentoring partnership with ECNAs. Data were transcribed verbatim and analysed using a process of thematic analysis. Findings: Four themes emerged from the data, namely; motivation for mentoring; constructing the relationship; establishing safe boundaries and managing expectations. Conclusions: This study provides a unique insight into the experiences of mentoring within the context of an academic leadership programme for nurses. Such insights highlight the issues facing academics from professional disciplines and can inform strategies to support their career development. Clinical relevance: A sustainable academic nursing workforce is crucial to ensure that effective preparation of future generations of expert clinical nurses. Therefore, it is important to consider strategies that could strengthen the academic nursing workforce. [ABSTRACT FROM AUTHOR]

Introduction: Chronic thoracic aortic aneurysm (CTAA) affecting the arch or descending aorta is an indolent but life-threatening condition with a rising prevalence as the UK population ages. Treatment may be in the form of open surgical repair (OSR) surgery, endovascular stent grafting (ESG) or best medical therapy (BMT). Currently, there is no consensus on the best management strategy, and no UK-specific economic studies that assess outcomes beyond the chosen procedure, but this is required in the context of greater demand for treatment and limited National Health Service (NHS) resources. Methods and analysis: This is a prospective, multicentre observational study with statistical and economic modelling of patients with CTAA affecting the arch or descending aorta. We aim to gain an understanding of how treatments are currently chosen, and to determine the clinical effectiveness and cost-effectiveness of the three available treatment strategies (BMT, ESG and OSR). This will be achieved by: (1) following consecutive patients who are referred to the teams collaborating in this proposal and collecting data regarding quality of life (QoL), medical events and hospital stays over a maximum of 5 years; (2) statistical analysis of the comparative effectiveness of the three treatments; and (3) economic modelling of the comparative costeffectiveness of the three treatments. Primary study outcomes are: aneurysm growth, QoL, freedom from reintervention, freedom from death or permanent neurological injury, incremental cost per qualityadjusted life year gained. Ethics and dissemination: The study will generate an evidence base to guide patients and clinicians to determine the indications and timing of treatment, as well as informing healthcare decision-makers about which treatments the NHS should provide. The study has achieved ethical approval and will be disseminated primarily in the form of a Health Technology Assessment monograph at its completion. Trial registration number: ISRCTN04044627. [ABSTRACT FROM AUTHOR]

Background To explore whether stroke health state descriptions used in preference elicitation studies reflect patients’ experiences by comparing published descriptions with qualitative studies exploring patients’ lived experience. Methods Two literature reviews were conducted: on stroke health state descriptions used in direct preference elicitation studies and the qualitative literature on patients’ stroke experience. Content and comparative thematic analysis was used to identify characteristics of stroke experience in both types of study which were further mapped onto health related quality of life (HRQOL) domains relevant to stroke. Two authors reviewed the coded text, categories and domains. Results We included 35 studies: seven direct preference elicitation studies and 28 qualitative studies on patients’ experience. Fifteen coded categories were identified in the published health state descriptions and 29 in the qualitative studies. When mapped onto domains related to HRQOL, qualitative studies included a wider range of categories in every domain that were relevant to the patients’ experience than health state descriptions. Conclusions Variation exists in the content of health state descriptions for all levels of stroke severity, most critically with a major disjuncture between the content of descriptions and how stroke is experienced by patients. There is no systematic method for constructing the content/scope of health state descriptions for stroke, and the patient perspective is not incorporated, producing descriptions with major deficits in reflecting the lived experience of stroke, and raising serious questions about the values derived from such descriptions and conclusions based on these values. [ABSTRACT FROM AUTHOR]

Introduction: In patients with large abdominal aortic aneurysm (AAA), open surgical or endovascular aneurysm repair procedures are often used to minimise the risk of aneurysm-related rupture and death; however, aneurysm repair itself carries a high risk. Low cardiopulmonary fitness is associated with an increased risk of early post-operative complications and death following elective AAA repair. Therefore, fitness should be enhanced before aneurysm repair. High-intensity interval exercise training (HIT) is a potent, time-efficient strategy for enhancing cardiopulmonary fitness. Here, we describe a feasibility study for a definitive trial of a pre-operative HIT intervention to improve post-operative outcomes in patients undergoing elective AAA repair. Methods and analysis: A minimum of 50 patients awaiting elective repair of a 5.5-7.0 cm infrarenal AAA will be allocated by minimisation to HIT or usual care control in a 1:1 ratio. The patients allocated to HIT will complete three hospital-based exercise sessions per week, for 4 weeks. Each session will include 2 or 4 min of high-intensity stationary cycling followed by the same duration of easy cycling or passive recovery, repeated until a total of 16 min of high-intensity exercise is accumulated. Outcomes to be assessed before randomisation and 24-48 h before aneurysm repair include cardiopulmonary fitness, maximum AAA diameter and health-related quality of life. In the postoperative period, we will record destination (ward or critical care unit), organ-specific morbidity, mortality and the durations of critical care and hospital stay. Twelve weeks after the discharge, participants will be interviewed to reassess quality of life and determine post-discharge healthcare utilisation. The costs associated with the exercise intervention and healthcare utilisation will be calculated. Ethics and dissemination: Ethics approval was secured through Sunderland Research Ethics Committee. The findings of the trial will be disseminated through peer-reviewed journals, and national and international presentations. Trial registration: Current Controlled Trials ISRCTN09433624. [ABSTRACT FROM AUTHOR]

Previously there has been commitment to the idea that Indigenous curricula should be taught by Indigenous academic staff, whereas now there is increasing recognition of the need for all academic staff to have confidence in enabling Indigenous cultural competency for nursing and other health professional students. In this way, Indigenous content can be threaded throughout a curriculum and raised in many teaching and learning situations, rather than being siloed into particular subjects and with particular staff. There are many sensitivities around this change, with potential implications for Indigenous and non-Indigenous students and staff, and for the quality of teaching and learning experiences. This paper reports on a collaborative process that was used to reconceptualise how Indigenous health care curricula would be positioned throughout a programme and who would or could work with students in this area. Effective leadership, establishing a truly collaborative environment, acknowledging fears and perceived inadequacies, and creating safe spaces for sharing and learning were crucial in effecting this change. [ABSTRACT FROM AUTHOR]

Aim and objectives. The study explored the experiences of newly qualified midwives and described the factors that facilitated or constrained their development during the transition from student to registered midwife. Background. Knowledge of the transition to midwifery practice remains limited. Design and Method. A qualitative descriptive approach was used. Sixteen graduates from one Australian University participated in a tape-recorded interview. Thematic analysis was used to analyse the data set. Results. The metaphor of 'The Pond', an environment that consists of layers of life and can be both clear and peaceful or murky and infested, was used to describe new midwives perceptions of the context and culture of hospital-based maternity care. For some, 'The Pond' was a harsh environment that often became toxic. The 'Life-raft' metaphor was used to describe the importance of midwife-to-midwife relationships. The theme of 'Swimming' captured the consequence of positive interactions with colleagues and a supportive environment, whilst 'Sinking' described the consequence of poor relationships with midwives and a difficult working environment. Conclusion. The study highlights the importance of positive midwife-to-midwife relationships on the transition from student to registered midwife. There was also evidence that continuity with women and midwifery colleagues enhanced confidence and restored faith in normal birth. At the same time, it was clear that the midwifery culture of some institutions remains highly contested with midwives struggling to provide woman-centred care and often challenged by the risk-averse nature of maternity care. Relevance to Clinical Practice. Whilst further work is required, the findings provide a deeper understanding of individual midwives' transition period. The importance of forming longitudinal relationships not only with women but with midwifery colleagues is highlighted. Developing continuity models that adequately support graduates and student's needs are likely to assist in addressing practices issues in both the academic and clinical setting. [ABSTRACT FROM AUTHOR]

The formulation of evidence-based policy necessitates rigorous, objective evaluation of policy initiatives and, consequently, there has been a significant growth in evaluation of social policy over the last ten years. Alongside this, there is a recognition that the application of new policy initiatives needs to be flexible in order to be relevant to local populations. As a result, pilots and pathfinders are encouraged to undertake local evaluations in addition to national evaluations commissioned by central government. These dual evaluations are seen as a vehicle to provide evidence on effectiveness whilst accommodating heterogeneity of needs and provision. We suggest that without clear delineation of roles, dual evaluations are inefficient, likely to put additional pressure on busy practitioners (and the recipients of new services) to comply with varying data demands, and present policy makers with confusing messages. In this article we focus on the potential for local and national evaluations to reach different conclusions by demonstrating how a simplistic application of quantitative techniques at local level can lead to inappropriate conclusions which contradict national findings. We make a number of recommendations that might facilitate better coordination of local and national evaluations. [ABSTRACT FROM PUBLISHER]

dignam d., duffield c., stasa h., gray j., jackson d. & daly j. (2012) Journal of Nursing Management 20, 65-71 Management and leadership in nursing: an Australian educational perspective Aim In this article, we present an Australian perspective on issues influencing management and leadership education in nursing. Background Nurse leaders and managers work in a context of high pressure, uncertainty and rapid change, and face unprecedented challenges on a daily basis. Evaluation and Key Issues In the present paper, we reflect on the issues and challenges facing providers of management education for nursing, and consider these challenges in relationship to current trends and imperatives. Conclusions Collaborative approaches between educational and clinical settings are needed to ensure quality, relevant educational support for managers and leaders, and enhance curriculum integrity. Implications for Nursing Management There is a need for contemporaneous and relevant research to inform innovative models of collaborative education. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on the job perceptions of graduates from two different courses in midwifery in Australia. According to the authors, graduates from two midwifery courses, one for registered nurses at a postgraduate level and the other for non-nurses at an undergraduate level, revealed philosophical differences on concepts of job satisfaction and ways their jobs could be improved. They also mention differences in graduates age and intention to work as part time.

Background: As part of an ongoing service improvement project, a digital 'joint school' (DJS) was developed to provide education and support to patients undergoing total hip (THR) and total knee (TKR) replacement surgery. The DJS allowed patients to access personalised care plans and educational resources using web-enabled devices, from being listed for surgery until 12 months post-operation. The aim of this study was to compare a cohort of patients enrolled into the DJS with a cohort of patients from the same NHS trust who received a standard 'non-digital' package of education and support in terms of Health-Related Quality of Life (HRQoL), functional outcomes and hospital length of stay (LoS).Methods: A retrospective comparative cohort study of all patients undergoing primary TKR/THR at a single NHS trust between 1st Jan 2018 and 31st Dec 2019 (n = 2406) was undertaken. The DJS was offered to all patients attending the clinics of early adopting surgeons and the remaining surgeons offered their patient's standard written and verbal information. This allowed comparison between patients that received the DJS (n = 595) and those that received standard care (n = 1811). For each patient, demographic data, LoS and patient reported outcome measures (EQ-5D-3L, Oxford hip/knee scores (OKS/OHS)) were obtained. Polynomial regressions, adjusting for age, sex, Charlson Comorbidity Index (CCI) and pre-operative OKS/OHS or EQ-5D, were used to compare the outcomes for patients receiving DJS and those receiving standard care.Findings: Patients that used the DJS had greater improvements in their EQ-5D, and OKS/OHS compared to patients receiving standard care for both TKR and THR (EQ-5D difference: TKR coefficient estimate (est) = 0.070 (95%CI 0.004 to 0.135); THR est = 0.114 (95%CI 0.061 to 0.166)) and OKS/OHS difference: TKR est = 5.016 (95%CI 2.211 to 7.820); THR est = 4.106 (95%CI 2.257 to 5.955)). The DJS had a statistically significant reduction on LoS for patients who underwent THR but not TKR.Conclusion: The use of a DJS was associated with improved functional outcomes when compared to a standard 'non-digital' method. The improvements between pre-operative and post-operative outcomes in EQ-5D and OKS/OHS were higher for patients using the DJS. Furthermore, THR patients also had a shorter LoS. [ABSTRACT FROM AUTHOR]