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Aims This paper sets the discussion of emotions at work within the modern NHS and the current prioritisation of creating a safety culture within the service. Background The paper focuses on the work of students, frontline nurses and their managers drawing on recent studies of patient safety in the curriculum, and governance and incentives in the care of patients with complex long term conditions. Methods The primary research featured in the paper combined a case study design with focus groups, interviews and observation. Results In the patient safety research the importance of physical and emotional safety emerged as a key finding both for users and professionals. In the governance and incentives research, risk emerged as a key concern for managers, frontline workers and users. Conclusion The recognition of emotions and the importance of emotional labour at an individual and organizational level managed by emotionally intelligent leaders played an important role in promoting worker and patient safety and reducing workplace risk. Implications for nurse managers Nurse managers need to be aware of the emotional complexities of their organizations in order to set up systems to support the emotional wellbeing of professionals and users which in turn ensures safety and reduces risk. [ABSTRACT FROM AUTHOR]

Women who have had a caesarean birth face a decision about how to deliver their baby in a subsequent pregnancy. This paper describes a qualitative study exploring the decision making experience of such women. Eleven pregnant women who had had a caesarean section in their previous pregnancy took part in semi-structured interviews one to three days after they had made a choice about mode of delivery. A thematic analysis of the transcripts revealed that most women felt they had made a choice about delivery method, though the extent of involvement in the decision differed. Making choices about delivery after a previous caesarean birth was influenced by a number of people and other factors and it involved assessment of information from previous experiences and trusted others. Medical information about risk/benefit was considered alongside beliefs about birth and moral concerns about the `correct' choices to make. [ABSTRACT FROM AUTHOR]

Abstract Background Recent data show that only 15% of Australian adolescents participate in adequate amounts of physical activity (PA) and those students from Asian and Middle-Eastern backgrounds in Grades 6–12 are significantly less active than their English-speaking background peers. Schools have recently been recognised as the most widely used and cost-effective setting for promoting PA among youth and one domain within schools where PA can occur regularly for all youth, regardless of cultural background or socio-economic status, is during physical education (PE). Methods This study describes changes in physical activity (PA), lesson context and teacher interaction in physical education over the first two years in culturally and linguistically diverse secondary schools. Grade 7 PE classes in six schools were randomly observed using systematic direct observation (n = 81) and then followed up over the same period (n = 51) twelve months later. Results There was no significant decline in moderate-to-vigorous physical activity (MVPA) during PE (MD = −4.8%; p = .777), but a significant decline and medium negative effect in time spent in vigorous physical activity (VPA) (MD = −7.9%; p = .009) during PE was observed. Significant declines and large negative effects over time in percentage of PE time spent in management (MD = −8.8%; p < .001) and the number of observations where teachers promoted PA (MD = −20.7%; p Conclusions The decline of VPA and teacher promotion of PA in culturally and linguistically diverse schools is of concern. Given the declines in VPA and the increases in time spent in game play, further research is needed to ascertain whether PE instruction could be improved by focussing on skill instruction and fitness in a games-based PE instruction model. Further research for increasing teacher promotion of PA during PE is needed.

Education is crucial to how nurses practice, talk and write about keeping patients safe. The aim of this multisite study was to explore the formal and informal ways the pre-registration medical, nursing, pharmacy and physiotherapy students learn about patient safety. This paper focuses on findings from nursing. A multi-method design underpinned by the concept of knowledge contexts and illuminative evaluation was employed. Scoping of nursing curricula from four UK university programmes was followed by in-depth case studies of two programmes. Scoping involved analysing curriculum documents and interviews with 8 programme leaders. Case-study data collection included focus groups (24 students, 12 qualified nurses, 6 service users); practice placement observation (4 episodes=19 hrs) and interviews (4 Health Service managers). Within academic contexts patient safety was not visible as a curricular theme: programme leaders struggled to define it and some felt labelling to be problematic. Litigation and the risk of losing authorisation to practise were drivers to update safety in the programmes. Students reported being taught idealised skills in university with an emphasis on 'what not to do'. In organisational contexts patient safety was conceptualised as a complicated problem, addressed via strategies, systems and procedures. A tension emerged between creating a 'no blame' culture and performance management. Few formal mechanisms appeared to exist for students to learn about organisational systems and procedures. In practice, students learnt by observing staff who acted as variable role models; challenging practice was problematic, since they needed to 'fit in' and mentors were viewed as deciding whether they passed or failed their placements. The study highlights tensions both between and across contexts, which link to formal and informal patient safety education and impact negatively on students' feelings of emotional safety in their learning., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Anorexia nervosa (AN) is a syndrome of unknown cause characterized by voluntary starvation. Cholecystokinin has been implicated as a neuroendocrine regulatory factor in control of satiety. Relatively little information is known about gastrointestinal hormone responses to feeding in subjects with anorexia nervosa. In the present studies, we examine fasting and postprandial levels of cholecystokinin (CCK), vasoactive intestinal peptide (VIP) and peptide histidine methionine (PHM) in anorexia nervosa subjects and in control individuals. Results of these studies indicate that plasma CCK response to a liquid meal (Ensure Plus) in untreated AN subjects was distinctly different from that observed in healthy controls, both in terms of temporal pattern of peptide released and the amount of CCK secreted into the circulation. Peak levels of CCK release occurred at 30 min following meal ingestion in AN patients and at 60 min in control subjects. Integrated CCK release in untreated AN patients was approximately twice that measured in control individuals. Renutrition therapy was associated with reversion of the pattern of CCK release to that observed in control subjects. Plasma VIP levels were unchanged following meal ingestion in both control and anorexic subjects. In contrast, PHM levels in AN subjects were significantly greater than that observed in control individuals. The pattern of PHM release following liquid meal ingestion was similar to that observed with plasma CCK; namely, peak release of peptide was observed at 30 min which was significantly greater than corresponding control values (P less than 0.05). In conclusion, these results demonstrate distinctive differences in plasma CCK and PHM levels in response to feeding in AN subjects when compared to control individuals. These findings suggest that the earlier and greater rise in plasma CCK levels in AN subjects following meal ingestion may contribute to the abnormal sensation of satiety in this condition.

Bone mineral measurements of the forearm and spine were made in 63 patients under treatment in the Eating Disorders Program of the University of Nebraska Medical Center, 26 with anorexia nervosa (AN), 11 with bulimia nervosa (BU) and 26 with features of both AN and BU (AN/BU). Comparison was made with a group of 211 normal women of similar age. Spinal bone mineral content (BMC) of L2-4 was 45.1 +/- 5.7 g in the normals, 38.0 +/- 7.5 in the AN's, 40.3 +/- 6.6 g in the AN/BU's and 44.4 +/- 6.9 g in the BU's. The AN and AN/BU averages were both significantly different from normal (p less than 0.0005), but the BU average was not. BMC was correlated with body weight in each group and weakly correlated with age in the patients under age 30 in the AN and AN/BU groups combined. Forearm bone mineral measurements in the AN's and AN/BU's were also significantly lower than normal, but the differences were not as great as for the spine. We conclude that bone mineral is reduced in these patients, severely in some of them, and that reduced body weight plays a role. Menstrual disturbances, inhibition of growth and development, and malnutrition remain open as causal factors. Potential for recovery from reduced bone mineral was not demonstrated in this study.

Pure preparations of the alpha and beta subunits of succinyl-CoA synthetase of Escherichia coli have been obtained by preparative gel electrophoresis in the presence of detergent or by gel filtration in acid urea solution. Substantial enzyme activity (50 to 60%) can be recovered following renaturation of an equimolar mixture of the two subunits prepared by gel filtration. The substrate ATP is required for reconstitution of activity, but the presence of our substrates does not appear to influence the renaturation process. Knowing that ATP phosphorylates the alpha subunit in the native enzyme, these data suggest that phosphorylation of this subunit is necessary for correct assembly. Comparison of the amino acid compositions of the stoichiometry of the subunit reassociation in the reconstitution process confirm the alpha2 beta2 structure for the native enzyme.

Transient salivary gland hypertrophy is a reported clinical finding in patients with bulimia. A retrospective chart review of 49 patients enrolled in the University of Nebraska Medical Center Eating Disorders Program with a diagnosis of bulimia showed 29% (14/49) had at some time either parotid and/or submandibular gland hypertrophy noted on physical exam. Resolution of the salivary gland enlargement occurred in all of our patients after treatment of their bulimia. Bulimia must, therefore, be considered in the differential diagnosis of salivary gland hypertrophy, and treatment should be directed at the underlying behavioral disorder.