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Pharmacogenomics (PGx)‐based personalized medicine (PM) is increasingly utilized to guide treatment decisions for many drug‐disease combinations. Notably, London Health Sciences Centre (LHSC) has pioneered a PGx program that has become a staple for London‐based specialists. Although implementational studies have been conducted in other jurisdictions, the Canadian healthcare system is understudied. Herein, the multistakeholder perspectives on implementational drivers and barriers are elucidated. Using a mixed‐method qualitative model, key stakeholders, and patients from LHSC’s PGx‐based PM clinic were interviewed and surveyed, respectively. Interview transcripts were thematically analyzed in a stepwise process of customer profiling, value mapping, and business model canvasing. Value for LHSC located specialist users of PGx was driven by the quick turnaround time, independence of the PGx clinic, and the quality of information. Engagement of external specialists was only limited by access and awareness, whereas other healthcare nonusers were limited by education and applicability. The major determinant of successful adoption at novel sites were institutional champions. Patients valued and approved of the service, expressed a general willingness to pay, but often traveled far to receive genotyping. This paper discusses the critical pillars of education, awareness, advocacy, and efficiency required to address implementation barriers to healthcare service innovation in Canada. Further adoption of PGx practices into Canadian hospitals is an important factor for advancing system‐level changes in care delivery, patient experiences, and outcomes. The findings in this paper can help inform efforts to advance clinical PGx practices, but also the potential adoption and implementation of other innovative healthcare service solutions.

Background The burden of knee replacement prosthetic joint infection (KR PJI) is increasing. KR PJI is difficult to treat, outcomes can be poor and it is financially expensive and limited evidence is available to guide treatment decisions. Aim To provide guidelines for surgeons and units treating KR PJI. Methods Guideline formation by consensus process undertaken by BASK's Revision Knee Working Group, supported by outputs from UK-PJI meetings. Results Improved outcomes should be achieved through provision of care by revision centres in a network model. Treatment of KR PJI should only be undertaken at specialist units with the required infrastructure and a regular infection MDT. This document outlines practice guidelines for units providing a KR PJI service and sets out: • The necessary infrastructure required to provide a high-quality KR PJI service • The MDT composition — who and when • The KR PJI care pathway • Medical and surgical treatment strategies • The indications for referral to tertiary units (Major Revision Centres) • Outcome metrics and auditable standards Conclusions KR PJI patients treated within the NHS should be provided the best care possible. This report sets out guidance and support for surgeons and units to achieve this.

Although friendship as a social behaviour is an evolved trait that shares many similarities with kinship, there is a key difference: to choose friends, one must select few from many. Homophily, i.e., a similarity-based friendship choice heuristic, has been shown to be the main factor in selecting friends. Its function has been associated with the efficiency of collective action via synchronised mental states. Recent empirical results question the general validity of this explanation. Here I offer an alternative hypothesis: similarity-based friendship choice is an individual-level adaptive response to falling clustering coefficient of the social network typical during urbanisation, falling fertility, increased migration. The mathematical model shows how homophily as a friend-choice heuristic affects the network structure: (1) homophilic friendship choice increases the clustering coefficient; (2) network proximity-based and similarity-based friendship choices have additive effects on the clustering coefficient; and (3) societies that face falling fertility, urbanisation, and migration, are likely go through a u-shaped transition period in terms of clustering coefficient. These findings suggest that social identity can be seen as an emergent phenomenon and is the consequence, rather than the driver of, homophilic social dynamics, and offer an alternative explanation for the rise of “fake news” as a societal phenomenon.

One of the characteristics of the COVID-19 pandemic is that much of what is published about it quickly becomes outdated. Such is the rate of change in the pandemic’s course—whether due to the roll-out of the vaccine program globally or the evolution of new variants—that the context in which articles are written may be very different by the time of publication. Given that, it’s perhaps important to ‘time-stamp’ this editorial and outline the context at the time of writing. We’re writing this in the late summer of 2021; the UK is experiencing a third wave of the pandemic, while simultaneously removing almost all COVID-19 restrictions (such as limits on public gatherings), having fully vaccinated three-quarters of the adult population and partially vaccinated almost 9 out of 10 adults. Although there are differences, the situation is similar within other countries in Europe and North America, with vaccines seemingly weakening the link between infection, serious illness and death, thereby allowing for loosening of social restrictions. Though the situation at the time you are reading this will no doubt be different, there are some things of which we can be sure. First, COVID-19 has already ‘ … killed millions, affected billions and cost trillions.’1 impacting all parts of the globe over a prolonged period. Second, the impact on healthcare services has been immense, whether through the acute pressures on hospital capacity during each wave of the pandemic, the need to redesign service delivery in order to …

EBN Perspectives brings together key issues from the commentaries in one of our nursing topic themes

This article identifies, compares, and assesses residential models of care to treat infectious complications among people who inject drugs (PWID) through intravenous antibiotic (IV) therapy. Database searches in Ovid MEDLINE, Embase, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature Studies were performed. A Google web search was also performed. Studies published in English between 2000 and May 2017 that presented data on an out-of-hospital residential program for IV antibiotic treatment of infectious complications among PWID were included. Of the 2355 unique articles screened, 218 were reviewed in their entirety and three were included. Across the three included studies, no mortalities were reported during the study. Each study reported similar outcomes compared to in-hospital care. In the two studies reporting costs, residential care was substantially less expensive. This review indicates that residential treatment appears to be beneficial to PWID, hospitals, and the health care system.

The anterior cruciate ligament tear is a common medical condition that is treated using arthroscopy by pulling a tissue graft through a tunnel opened with a drill. The correct anatomical position and orientation of this tunnel are crucial for knee stability, and drilling an adequate bone tunnel is the most technically challenging part of the procedure. This paper presents the first guidance system based solely on intra-operative video for guiding the drilling of the tunnel. Our solution uses small, easily recognizable visual markers that are attached to the bone and tools for estimating their relative pose. A recent registration algorithm is employed for aligning a pre-operative image of the patient’s anatomy with a set of contours reconstructed by touching the bone surface with an instrumented tool. Experimental validation using ex-vivo data shows that the method enables the accurate registration of the pre-operative model with the bone, providing useful information for guiding the surgeon during the medical procedure. Experiments also demonstrate that the guided drilling of the tunnel leads to errors as low as 2.5 mm in the footprint and $$1.8^\circ $$ in orientation, which compares favourably to other works in the field. The high accuracy and short time overhead evinced by the experimental validation combined with no additional incisions or capital equipment make this video-based computer-aided arthroscopy solution an appealing alternative to the existing approaches.

Incoming governments sometimes abuse their power to manipulate the allocation of government contracts so as to buy loyalty from cronies. While scandals suggest such practices are relatively widespread, the extent of such partisan favoritism is difficult to measure and the conditions under which it flourishes under-theorized. Drawing on theory regarding the role of institutions as constraints on corruption, we identify three spheres of political influence over government contracting and show how elites can manipulate two of those spheres to increase their opportunities to influence the procurement process and minimize external accountability, facilitating the corrupt allocation of contracts to partisan allies. Using an innovative big data methodology, we then identify the effects of a change in government on procurement markets in two countries, Hungary and the United Kingdom, which differ in terms of political influence over these institutions. We find that politically-favored companies secure 50–60% of the central government contracting market in Hungary but only 10% in the UK.

In 2012, the WHO launched its Global Surveillance and Monitoring System (GSMS) for substandard and falsified medicines, with the aim of improving the quality of reporting and using the data to inform post-market surveillance and build regulatory capacity. However, from a regulatory governance perspective, its effectiveness depends on the willingness and ability of actors ‘on the ground’ to identify, report and investigate possible infringements and to enforce penalties. This paper presents findings from 27 interviews with representatives of agencies charged with regulating pharmaceutical markets and 4 interviews with pharmaceutical industry representatives in Tanzania. Their experiences provide important insights into how the theorised mechanism between reporting and a reduction in undesirable behaviours can play out in a low-income context, revealing hidden assumptions about regulator behaviour and motivations. A combination of chronic under-resourcing, information gaps and enforcement challenges conspires to limit the efforts of local regulators to achieve the GSMS goals, shedding new light on the relationship between apparent ‘misconduct’ and structural constraints.

The business model canvas is a popular tool used to develop value-driven business models. Specific emphasis is placed on understanding what customers value and providing users with steps on how to design and deliver value for their customers. In health care, creating and delivering value for patients is an often-discussed topic, with the provision of patient-centered care becoming a standard for many health care organizations. While patients play a key role in determining value, providers are the key to delivering value. Therefore, effective health care management relies on integrating multiple perspectives from key stakeholders. This process requires consideration of the key needs that must be addressed, the resources and capabilities necessary to meet these needs, and the interests and values specific to each set of stakeholders. The business model canvas lends itself well to health care service planning as it incorporates the factors described above into the business model’s conceptualization and subsequent realization. This article outlines how the business model canvas was applied to assess the needs of physician stakeholders to help guide the expansion of a pharmacogenomic-based precision medicine clinic that conducts genetic testing for patients at risk of experiencing adverse drug reactions. The article provides a detailed description of how the business model canvas was used and adapted to understand physician’s responsibilities and challenges related to drug prescription and dosing, and how the clinic could address physician needs and create value by mapping clinic services onto physician needs and wants. Interviews were conducted with physicians and the data were analyzed following the recommendations of the developers of the business model canvas. The article examines the strengths and limitations of the business model canvas and discusses its applicability to a health care setting.

A PhD is a globally recognised postgraduate degree and typically the highest degree programme awarded by a University, with students usually required to expand the boundaries of knowledge by undertaking original research. The purpose of PhD programmes of study is to nurture, support and facilitate doctoral students to undertake independent research to expected academic and research standards, culminating in a substantial thesis and examined by viva voce. In this paper—the first of two linked Research Made Simple articles—we explore what the foundations of a high-quality PhD are, and how a Doctoral candidate can develop a study which is successful, original and impactful. ### Supervision and support Central to the development and completion of a good PhD is the supervisory relationship between the student and supervisor. The supervisor guides the student by directing them to resources and training to ensure continuous learning, provides opportunity to engage with experts in the field, and facilitates the development of critical thinking through questioning and providing constructive criticism.1 The support needs of students will be different, so a flexible yet quality assured approach to PhD research training is required. A good supervisory team (usually …

OBJECTIVE The objective of this systematic review was to synthesize the best available evidence on the effect of various radiation protection strategies on radiation dose received by proceduralists performing cardiac catheterization procedures involving fluoroscopy. INTRODUCTION Cardiac catheterization procedures under fluoroscopy are the gold standard diagnostic and treatment method for patients with coronary artery disease. The growing demand of procedures means that proceduralists are being exposed to increasing amounts of radiation, resulting in an increased risk of deterministic and stochastic effects. Standard protective strategies and equipment such as lead garments reduce radiation exposure; however, the evidence surrounding additional equipment is contradictory. INCLUSION CRITERIA Randomized controlled trials that compared the use of an additional radiation protection strategy with conventional radiation protection methods were considered for inclusion. The primary outcome of interest was the radiation dose received by the proceduralist during cardiac catheterization procedures. METHODS A three-step search was conducted in MEDLINE, CINAHL, Embase, and the Cochrane Library (CENTRAL). Trials published in the English language with adult participants were included. Trials published from database inception until July 2019 were eligible for inclusion. The methodological quality of the included studies was assessed using the JBI critical appraisal checklist for randomized controlled trials. Quantitative data were extracted from the included papers using the JBI data extraction tool. Results that could not be pooled in meta-analysis were reported in a narrative form. RESULTS Fifteen randomized controlled trials were included in the review. Six radiation protection strategies were assessed: leaded and unleaded pelvic or arm drapes, transradial protection board, remotely controlled mechanical contrast injector, extension tubing for contrast injection, real-time radiation monitor, and a reduction in frame rate to 7.5 frames per second. Pooled data from two trials demonstrated a statistically significant decrease in the mean radiation dose (P

While core to our understanding of corruption in public office, conflicts of interest pose a complex regulatory challenge. Practically, the term relies on a conceptual distinction between public and private duties which – in a world of outsourcing, secondments and New Public Management – has become blurred. Most regulation trusts individuals to recognise their own conflicts and insulate decisions from personal and social obligations, yet we know that humans are prone to situational biases and struggle with ambiguity. Regulation should address the difficulties of avoiding bias, while training should allow individuals to explore risks in safe contexts. Professional groups may be important for creating peer support networks and helping to socialise members into norms of integrity. Such ‘soft’ regulation is not a substitute for rules and sanctions but might enhance the utility of traditional ‘hard’ approaches, by helping individuals become more self-aware and better able to make informed decisions about their conduct.

In the wake of the coronavirus (COVID-19) crisis, we caution against a return to old ways of working and, instead, urge healthcare leaders to consolidate and build on the recently achieved rapid gains in technology adoption. Primary care has been at the forefront, leading the dramatic surge in the use of telemedicine to deliver care through video consultations.1 2 This ability for telemedicine to deliver care at a distance, and with minimal contact, has been termed ‘ digital personal protective equipment (PPE) ’.3 These successful developments with life-changing consequences have whet the appetite with possibilities. As the context changes to the new ‘normal’, there is a growing determination to sustain and embed, rather than return to old ways of working. Although the shift to a care environment where virtual models of healthcare service delivery can be expected to increase, even predominate, the need to allow for human contact will remain an important, if not vital, consideration. We draw on our technology innovation research and wider scholarship in management to suggest two key strategies to sustain the momentum towards increasingly virtual models of care. First, the need to foster the joining up of care that has recently been catalysed through increased interoperability, data sharing and meaningful use. Second, together working that involves a shared leadership approach to service delivery. Such working towards a shared purpose has been fostered in the recent crisis where leaders sought to restore a sense of collective action, helping everyone realise we are in this together, working towards a common goal. The need for ‘joined-up thinking’ in healthcare is well established. Healthcare is delivered by a diverse set of stakeholders including primary, secondary and social care as well as those across local, regional and national levels. In addition, many chronic disease management pathways involve patients …

Revision knee replacement (KR) is technically challenging, expensive, and outcomes can be poor. It is well established that increasing surgeon and unit volumes results in improved outcomes and cost-effectiveness for complex procedures. The aim of this study was to 1) describe the current provision of revision KR in England, Wales and Northern Ireland at the individual surgeon and unit level and 2) investigate the effect on workload of case distribution in a network model.Current practice was mapped using NJR summary statistics containing all revision KR procedures performed over a three-year period (2016-2018). Units were identified as revision centres based on threshold volumes. Units undertaking20 revisions per year were classified as Primary Arthroplasty Units (PAUs) in calculations on the effect of workload centralisation.Revision KR was performed by 1353 surgeons at 232 NHS sites. The majority of surgeons and units were low-volume;1000 surgeons performed7 and 125 sites performed20 procedures per year. Reallocation of work from these 125 PAUs (1235 cases, 21% of total workload) to a network model with even redistribution of cases between centres undertaking revision surgery would result in an additional average annual case increase of 11 per unit per year (range six to 14).Revision KR workload re-allocation would lift all revision centres above a 30 per year threshold and would appear to be a manageable increase in workload for specialist revision KR centres. Case complexity and local referral agreements will significantly affect the real increase in workload; these factors were not incorporated here.

Background Revision knee replacement (KR) is both challenging for the surgical team and expensive for the healthcare provider. Limited high quality evidence is available to guide decision-making. Aim To provide guidelines for surgeons and units delivering revision KR services. Methods A formal consensus process was followed by BASK’s Revision Knee Working Group, which included surgeons from England, Wales, Scotland and Northern Ireland. This was supported by analysis of National Joint Registry data. Results There are a large number of surgeons operating at NHS sites who undertake a small number of revision KR procedures. To optimise patient outcomes and deliver cost-effective care high-volume revision knee surgeons working at high volume centres should undertake revision KR. This document outlines practice guidelines for units providing a revision KR service and sets out: The current landscape of revision KR in England, Wales and Northern Ireland. Service organisation within a network model. The necessary infrastructure required to provide a sustainable revision service. Outcome metrics and auditable standards. Financial mechanisms to support this service model. Conclusions Revision KR patients being treated in the NHS should be provided with the best care available. This report sets out a framework to both guide and support revision KR surgeons and centres to achieve this aim.

Whenever developing training competencies, tools to support clinical practice or a response to a professional issue, seeking the opinion of experts is a common approach. By working to identify a consensus position, researchers can report findings on a specific question (or set of questions) that are based on the knowledge and experience of experts in their field. However, there are challenges to this approach. For example, what should be done when consensus cannot be reached? How can experts be engaged in a way that allows them to consider objectively the views of others and—where appropriate—change their own opinions in response? One approach that attempts to provide a clear method for gathering expert opinion is the Delphi technique . The Delphi technique was first developed in the 1950s by Norman Dalkey and Olaf Helmer in an attempt to gain reliable expert consensus. Specifically, they developed an approach—named after the Ancient Greek Oracle of Delphi , who could predict the future—which promoted anonymity and avoided direct confrontation between experts, so that the methods employed “…appear to be more conducive to independent thought on the part of the experts and to aid them in the gradual formation of a considered opinion ”.1 Though the original Delphi study was linked to the defence industry, the technique has spread to other research areas, including nursing.2 As with all research methods, the Delphi technique has evolved since it was first reported on in the 1960s. However, many of the fundamental characteristics of the approach still remain from Dalkey and Helmer’s original outline. First, the overarching approach is based on a …

Purpose Combined medial tibiofemoral and symptomatic patellofemoral osteoarthritis is not amenable to unicompartmental knee replacement (UKR). Total knee replacement (TKR) is an invasive option in younger adults with high functional demands. The aim of this study was to compare the clinical outcome of patients who have undergone UKR, bicompartmental knee replacement (BKR) and TKR up to 2 years post-operatively. Materials and methods This prospective study comprised 133 subjects including 30 patients in the medial UKR group, 53 patients in the BKR group (combined medial UKR with patellofemoral joint replacement) and 50 patients in the TKR group. All subjects were evaluated using the Oxford Knee Score (OKS) and the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Patients in each group were assessed using both scoring systems pre-operatively and 6 months, 1 year and 2 years post-operatively. Results Significant improvement of OKS was found at 6 months compared to baseline for UKR (22.7 to 38.1, p = 0.046), BKR (22.6 to 36.8, p p Conclusion The magnitude of clinical improvement following knee replacement is greatest at 6 months; thereafter, only modest improvements continue to occur. This study also found no significant differences of outcomes at 2 years after surgery among UKR, BKR and TKR. BKR is a good alternative option for combined symptomatic medial and patellofemoral arthritis of the knee.

In common with many other countries, population ageing, advancements in medical technology, changing disease profiles, the influence of lifestyle choices on health and increased patient expectations are driving health and social care provision in the UK. As the number of people living with one or more long-term conditions rises, interventions to support their health and well-being become increasingly complex. Nurses will not only be expected to deliver complex interventions but are in an ideal position to contribute to priority setting and the development and evaluation of interventions that meet patient needs. It is essential that complex interventions are based on the best available evidence and evaluated if they are to improve health outcomes. In this article we will provide an overview of complex interventions, using dignity therapy as an example, and outline the principles of developing a complex intervention. The UK Medical Research Council (MRC) defines complex interventions as those with several interacting components.1 In addition, interventions can be thought of as complex if they are dependent on the behaviours of those delivering and receiving the intervention, there are a range of possible outcomes, or there is a need to tailor the intervention to different contexts and settings.1 In palliative and end of life care (EoLC) settings, helping people make sense …

There is increasing recognition that students in higher education are a population group at high risk of facing mental health challenges. Indeed, the Institute for Public Policy Research recently acknowledged that the level of mental illness and mental distress among UK university students is increasing, and is greater than other sections of the population.1 The prevalence of mental health issues among university students was highlighted by the results of a 2015 survey by the National Union of Students that found that in a sample of 1093 students

Introduction Heart failure is increasingly common, and characterised by frequent admissions to hospital. To try and reduce the risk of hospitalisation, techniques such as telemonitoring (TM) may have a role. We wanted to determine if TM in patients with newly diagnosed heart failure and ejection fraction Methods This is a retrospective study of 124 patients (78.2% male; 68.6 ± 12.6 years) who underwent TM and 345 patients (68.5% male; 70.2 ± 10.7 years) who underwent the usual care (UC). The TM group were assessed daily by body weight, blood pressure and heart rate using electronic devices with automatic transfer of data to an online database. Follow-up was 12 months. Results Death from any cause occurred in 8.1% of the TM group and 19% of the UC group ( p = 0.002). There was no difference between the two groups in all-cause hospitalisation, either in the number of subjects hospitalised ( p = 0.7) or in the number of admissions per patient ( p = 0.6). There was no difference in the number of heart-failure-related readmissions per person between the two groups ( p = 0.5), but the number of days in hospital per person was higher in the UC group ( p = 0.03). Also, there were a significantly greater number of days alive and out of hospital for the patients in the TM group compared with the UC group ( p = 0.0001). Discussion TM is associated with lower any-cause mortality and also has the potential to reduce the number of days lost to hospitalisation and death.

© 2017 Students who leave pre-registration nurse education having failed to complete remain a concern for higher education institutions. This study identifed factors influencing completion using a retrospective cohort analysis to map student characteristics at entry against Year 3 completion data. The study was set in a nursing faculty in a higher education institution in northern England. Data were collected between 2009 and 2014 with five cohorts of students participating (n = 807). Multinomial logistic regression was used to model the dependent variable Progression Outcome with categories of; completion and non-completion (academic and non-academic reasons). Predictors included cohort, programme, branch, gender, age on entry, ethnic group, disability status, domicile, change of home postcode, change of term-time postcode, entry qualifications, previous experience of caring, and dependents. Age on Entry and Domicile or alternatively Dependents and Domicile emerged as statistically significant (p < 0.05) in the multivariable analysis. Older students were less likely to be lost from the programme, as were students who lived locally at all times and those with dependents. There is currently little reliable, consistent information on nursing student attrition, progression and completion. This study contributes to the evidence base by identifying some of the factors that may contribute to successful programme completion.

Aims and objectives The study aimed to develop a theory that offered an evidence-based insight into the use of teleconsultation by nurses. Background Teleconsultation is the use of video to facilitate real-time, remote interaction between healthcare practitioners and patients. Though its popularity is growing, there is little understanding of how teleconsultation impacts on the role of nurses. Method The study adopted a constructivist grounded theory method, supplemented by the use of Straussian analytical approaches. Using selective and theoretical approaches, Registered Nurses with experience of using video in healthcare were sampled. Data were collected using semi-structured interviews exploring experiences, knowledge and feelings surrounding teleconsultation. Interviews were recorded, transcribed and subjected to three-stage, non-linear manual analysis (open, axial and selective coding). Results Theoretical saturation occurred after 17 interviews. The core category identified from the data was ‘nursing presence’ Four subcategories of nursing presence were identified: Operational, clinical, technical and social. The degree to which presence could be achieved was dependent upon three influencing factors – enablers, constraints and compensation. Conclusion Nurses provide different types of presence during teleconsultation, with the degree of presence dependent on specific characteristics of video-mediated communication. Where the use of video constrains the delivery of presence, nurses utilise a range of compensatory mechanisms to enhance patient care. Relevance to clinical practice Teleconsultation provides an innovative approach to enhancing the delivery of healthcare. This study provides nurses with insight into the impact of teleconsultation on their professional role, and an understanding of how best to use video-mediated communication to support patient care. This article is protected by copyright. All rights reserved.

Background Academic supervision - the support available to students when writing assignments - is a fundamental element in the provision of support within nurse education. Not only can it underpin high levels of academic achievement, but it also has a role in enhancing the retention of students. Despite its importance, there is little investigation of undergraduate academic supervision within the nursing literature. Objectives To explore students' experiences and expectations of academic supervision as part of an undergraduate programme of nurse education. Design A qualitative approach to explore student perceptions. Setting The research was undertaken at a Higher Education Institution in the United Kingdom. The institution offers undergraduate nurse education programmes to approximately 800 students. Participants Eight pre-registration nursing students from a Bachelor of Science programme participated in a focus group interview. All were in the first semester of their final year. Methods Data were collected using focus group interviewing, based around a semistructured question framework. The focus groups explored students' expectations and previous experiences of academic supervision. The focus group was recorded, responses were transcribed and thematic analysis was undertaken to identify key findings. Results Three themes were identified from the data: relationship with supervisor, variation between supervisors, and the link between supervision and marking. Overall, students identified frustration with variability in the provision of academic supervision. Conclusions Effective academic supervision depends on a strong relationship between student and supervisor - something that can be difficult to achieve if supervision is only for a short period of time. Equally, students crave a consistent approach to supervision, in terms of both the amount and content of feedback. Students are able to identify and articulate a clear link between effective supervision and academic achievement.

All doctoral students strive for the day—after years of often all-consuming study—that their thesis is ready to submit. For both doctoral students and supervisors there is often trepidation about whether the thesis will meet the criteria to merit the award of a Doctor of Philosophy (PhD). As anxieties increase, doctoral students often ask what makes a good PhD, something we explored in a recent ‘Research Made Simple’ article,1 but perhaps the more important question is ‘what makes a PhD student successful?’ In this article we outline the core criteria on which PhD theses are judged and offer suggestions for achieving success. Traditionally, a PhD involves 3 to 4 years of full-time study (or a longer part-time programme), which is assessed by the student submitting the work they have undertaken as a thesis or—less commonly—a portfolio of published papers and an associated narrative (sometimes referred to as ‘PhD by publication’). In addition, the student must undertake an oral defence of their work through a discussion (the ‘viva’) with examiners, who are deemed to be experts in the field of study or with related methodological expertise.2 A thesis is a self-contained monograph written by the student which: 1. Sets out the problem and context of …

EBN Perspectives brings together key issues from the commentaries in one of our nursing topic themes.

Summary Background Late-stage isolated medial knee osteoarthritis can be treated with total knee replacement (TKR) or partial knee replacement (PKR). There is high variation in treatment choice and little robust evidence to guide selection. The Total or Partial Knee Arthroplasty Trial (TOPKAT) therefore aims to assess the clinical effectiveness and cost-effectiveness of TKR versus PKR in patients with medial compartment osteoarthritis of the knee, and this represents an analysis of the main endpoints at 5 years. Methods Our multicentre, pragmatic randomised controlled trial was done at 27 UK sites. We used a combined expertise-based and equipoise-based approach, in which patients with isolated osteoarthritis of the medial compartment of the knee and who satisfied general requirements for a medial PKR were randomly assigned (1:1) to receive PKR or TKR by surgeons who were either expert in and willing to perform both surgeries or by a surgeon with particular expertise in the allocated procedure. The primary endpoint was the Oxford Knee Score (OKS) 5 years after randomisation in all patients assigned to groups. Health-care costs (in UK 2017 prices) and cost-effectiveness were also assessed. This trial is registered with ISRCTN (ISRCTN03013488) and ClinicalTrials.gov ( NCT01352247 ). Findings Between Jan 18, 2010, and Sept 30, 2013, we assessed 962 patients for their eligibility, of whom 431 (45%) patients were excluded (121 [13%] patients did not meet the inclusion criteria and 310 [32%] patients declined to participate) and 528 (55%) patients were randomly assigned to groups. 94% of participants responded to the follow-up survey 5 years after their operation. At the 5-year follow-up, we found no difference in OKS between groups (mean difference 1·04, 95% CI −0·42 to 2·50; p=0·159). In our within-trial cost-effectiveness analysis, we found that PKR was more effective (0·240 additional quality-adjusted life-years, 95% CI 0·046 to 0·434) and less expensive (−£910, 95% CI −1503 to −317) than TKR during the 5 years of follow-up. This finding was a result of slightly better outcomes, lower costs of surgery, and lower follow-up health-care costs with PKR than TKR. Interpretation Both TKR and PKR are effective, offer similar clinical outcomes, and result in a similar incidence of re-operations and complications. Based on our clinical findings, and results regarding the lower costs and better cost-effectiveness with PKR during the 5-year study period, we suggest that PKR should be considered the first choice for patients with late-stage isolated medial compartment osteoarthritis. Funding National Institute for Health Research Health Technology Assessment Programme.

REVIEW QUESTION What is the effectiveness of radiation protection strategies for reducing the radiation dose received by the proceduralist during cardiac catheterization procedures?

Collective action initiatives in which governments and companies make anti-corruption commitments have proliferated in recent years. This apparently prosocial behavior defies the logic of collective action and, given that bribery often goes undetected and unpunished, is not easily explained by principal-agent theory. Club theory suggests that the answer lies in the institutional design of anti-corruption clubs: collective action can work as long as membership has high entry costs, members receive selective benefits, and compliance is adequately policed. This article contributes to the debate by examining how these conditions manifest in the case of anti-corruption clubs in the realm of international business, with particular focus on the international dimension of many initiatives. This vertical aspect of institutional design creates a richer, more complex set of reputational and material benefits for members, as well as allowing for more credible and consistent monitoring and enforcement.

Dyadic social relations are known to exhibit homophily – attraction and bonding between similar individuals – and recent studies have detected homophily also on the social network level. Here, we investigate whether social media networks exhibit signs of homophily with regards to life stages. Using a large and global database (N = 111,863) of social media profile pictures, we investigate proportions of picture types in an individual’s social network. Typical stages of young adulthood include peer group formation, mate searching, union formation, and parenting. We studied to what extent different association categories with pictures of one or several individuals correlated with each other. Results showed that users with a profile picture of a single individual were more likely to have other profile pictures of single individuals of the opposite sex, but not of the same sex, in their social media network. Profile pictures of heterosexual couples were more likely to appear with other heterosexual couple pictures, and profiles with baby pictures were strongly associated with the frequency of other baby pictures within the same network; both of these types were negatively associated with the frequency of pictures of singles. Pictures of two females together were positively linked with the largest number of other association types. The results probably reflect both selection and contagion effects. We conclude that contemporary social media networks appear to exhibit homophily in displays related to mate searching, pair bonds, and the transition to parenthood.

Given a widespread sense among donors that mainstream anti-corruption reforms over the past 25 years have failed to yield results, there is a move towards more targeted interventions. Such interventions should, in principle, overcome implementation gaps and make it easier to evaluate impact, supporting learning. However, when interventions are narrowly targeted, there is a risk that corrupt actors simply adapt, shifting their focus to areas with weaker controls, so that overall corruption is not reduced but merely displaced. We analyse data points from World Bank-funded development aid tenders over 12 years in >100 developing countries, and observe the heterogeneous effects of a 2003 anti-corruption reform aimed at increasing oversight and opening up competition. Our tight matching estimations suggest that the reform is effective in the targeted area: it decreases corruption risks due to low competition (the share of single bidding falls from 22% to18%). But we also find that evasive tactics largely cancel out these positive direct effects: buyers switch to non-treated less competitive procedure types (whose share increases from 7% to 10%) and exploit them more intensively (single bidding goes from 61% to 81%). Our results demonstrate how data analytics can be used to observe public procurement at the system level to inform more adaptive and effective anti-corruption programming. More broadly, we underline that technical interventions might not represent the best way to tackle systemic corruption, instead strategies should target the root causes of corruption and contribute to building a culture of integrity.

Patellofemoral surgery is in its developing phases and shows rapidly improving performance and reliability. This chapter details with the presentation, examination, and surgical techniques along with the complications that might be avoided in patellofemoral arthroplasty.

Identifying and safely navigating submerged obstacles in shallow waters is a difficult task as common navigation technologies based on acoustic sensing systems are not efficient in littoral zones [5]. Developing a vehicle-mounted active 3D reconstruction (structured light) imaging system that can be used for real-time obstacle detection and avoidance is now a viable approach to solving littoral navigation due to its affordability. Structured light has been researched and demonstrated as an object reconstruction technique, with particular focus on three-dimensional mapping and scanning [6]. Although it has been successfully applied to object reconstruction, utilizing the structured light data as an input to the on-board navigation stack has not yet been extensively tested. As a proven solution for highly accurate object reconstruction, the application of structured light to obstacle avoidance provides promise for improved vehicle navigation in littoral waters. The proposed sensing system is comprised of a single USB webcam and a blue-green line laser that can be easily integrated into existing computing hardware. By filtering the wavelengths of light viewable by the camera such that the only detected light is that produced by the laser, software on-board the vehicle can detect the laser line accurately under the majority of conditions. The object recognition and range estimation algorithms output estimates of an obstacles position based on the position of the laser line detected in the filtered camera frame. The obstacle avoidance algorithm calculates the best route based on the structured light input by iterating through an array of distance values and optimizing for the largest section of clear water. The on-board vehicle controller then dynamically sets motor values and directions to maneuver around obstacles.

Commentary on: Blakeman JR, Stapleton SJ. An integrative review of fatigue experienced by women before and during myocardial infarction. J Clin Nurs 2017; 27 : 906-916 Though mortality rates for coronary heart disease (CHD) have fallen over time due to improvements in prevention and management, the condition is still responsible for approximately one-third of adult deaths globally.1 As an acute manifestation of CHD, MI is a common cause of mortality and morbidity. Recognising the symptoms of MI is crucial, as early presentation, diagnosis and treatment improve patient outcomes. This review by Blakeman and Stapleton2 explored a symptom not always …

Traditional human societies use two of biology’s solutions to reduce free-riding: by collaborating with relatives, they rely on the mechanism of kin-selection, and by forming highly clustered social kin-networks, they can efficiently use reputation dynamics. Both of these solutions assume the presence of relatives. This paper shows how social networks change during demographic transition. With falling fertility, there are fewer children that could be relatives to one another. As the missing kin are replaced by non-kin friends, local clustering in the social network drops. This effect is compounded by increasing population size, characteristic of demographic transition. The paper also shows that the speed at which reputation spreads in the network slows down due to both falling fertility and increasing group size. Thus, demographic transition weakens both mechanisms for eliminating free-riders: there are fewer relatives around, and reputation spreads slower. This new link between falling fertility and the altered structure of the social network offers novel interpretations of the origins of legal institutions, the Small World phenomenon, the social impact of urbanisation, and the birds-of-a-feather friendship choice heuristic.

Following scandals about corruption in foreign aid, and in a political climate that increasingly questions the legitimacy of development assistance, donors are under pressure to control how their funds are spent. At the same time, they also face pressure to trust recipient governments to disburse project funds themselves, so as to build capacity in developing countries. This paper assesses under which conditions donor regulations are successful in controlling corruption in aid spent by national governments through procurement tenders. By mining procurement contracts funded by the World Bank in 100 countries over the period 1998-2008 for corruption “red flags”, we create a dataset that provides an unprecedentedly accurate picture of corruption risks in the spending of aid across the developing world. Through propensity score matching and regression analysis, we find that the 2003 World Bank regulatory reform aiming to control corruption was effective in reducing corruption risks: lowering single bidding on competitive markets by 3.8-4.3 percentage points. This effect is greater in countries with low state capacity.

In 1951, Richard Doll and Austin Bradford-Hill commenced a ground-breaking research project by writing to all registered doctors in the UK to ask about their smoking habits. The British Doctors Study recruited and followed-up over 40 000 participants, monitoring mortality rates and causes of death over the subsequent years and decades. Even by the time of the first set of preliminary results in 1954, there was evidence to link smoking with lung cancer and increased mortality.1 Over the following decades, the study provided further definitive evidence of the health risks from smoking, and was extended to explore other causes of death (eg, heart disease) and other behavioural variables (eg, alcohol intake). The Doctors Health Survey is one of the largest, most ambitious and best-known cohort studies and demonstrates the value of this approach in supporting our understanding of disease risk. However, as a method, cohort studies can have much wider applications. This article provides an overview of cohort studies, identifying the opportunities and challenges they present to researchers, and the role they play in developing the evidence base for nursing and healthcare more broadly. Cohort studies are a type of longitudinal study —an approach that follows research participants over a period of time (often many years). Specifically, cohort studies recruit and follow participants who share a common characteristic, such as a particular occupation or demographic similarity. During the period of follow-up, some of the cohort will be exposed to a specific risk factor or characteristic; by measuring outcomes over a period of time, it is then possible …

Transparency in the extractives sector is widely seen as a key tool for improving accountability and deterring corruption. Yet for those very reasons, it is a puzzle that so many governments in corruption-prone countries have voluntarily signed up to greater scrutiny in this area, by joining the Extractive Industries Transparency Initiative (EITI). We argue that EITI serves as a reputational intermediary, whereby reformers can signal good intentions and international actors can reward achievement. International and domestic actors thus utilize EITI to diffuse the norm of resource transparency and to advance reformist aims in a highly problematic policy area.

We investigate why top-down directives aimed at eradicating corruption are ineffective at altering on-the-ground practices for organizations that have adopted industry-wide “gold standards” to prevent bribery and corruption. Using interview and focus group data collected from leading multinational pharmaceutical firms, we unearth antecedents contributing to organizations’ systemic failure to embed their anticorruption policies in business practice. We identify two tensions that contribute to this disconnect: a culture clash between global and local norms, especially in emerging markets and a similar disconnect between the compliance and commercial functions. To overcome these tensions, we suggest that organizations are likely to find it easier to implement a no gifts policy if they cease to rely on local agents embedded in local norms and that there needs to be strong evidence of board-level commitment to antibribery programs, innovative ways of incentivizing compliant behavior, and a fundamental rethinking of organizations’ business model and remuneration practices.

On-demand economics and mHealth technologies hold tremendous opportunity for health care to digitalize and incorporate itself into individuals’ everyday routines through media, such as mobile applications or online programs. These concepts could potentially change a culture of reactionary and passive consumer use of health systems to one that is preventative, proactive, and empowers the patient, while at the same time returning value to the greater health system. This chapter aims to introduce the concept of the on-demand economy and illustrate how this new model has affected the health-care sector to date, particularly through mHealth innovation. The chapter then introduces a potential future state for health care, highlighting how concepts from the on-demand economy could shape health care to promote shared value across the system.

The grade yields of Hem-Fir (N) (Tsuga heterophylla and Abies amabilis) laminas were compared for visual and machine grades based on the Japanese Agricultural Standard (JAS) for glued laminated timber. The main objective of this study was to assess technical and material benefits when a glued laminated timber is manufactured using machine-graded laminas rather than visually graded. Total 1000 pieces of Hem-Fir (N) lamina were tested for modulus of elasticity (E) and tensile strength. Also, the E’s measured by two different test equipment (vibration and continuous bending) were compared. The test data showed that if the laminas were machine graded, 54 % of the lamina would achieve a modulus of elasticity of 12.5 GPa or higher, which are above the average 11 GPa assigned to JAS visual Grade 1 of the wood species group D. It was concluded that the machine grading method was able to derive higher mechanical properties leading to a yield benefit for the lamina production.