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The active compounds found in many plants have been widely used in traditional medicine and ritual activities. However, archaeological evidence for the use of such plants, especially in the Palaeolithic period, is limited due to the poor preservation and fragility of seed, fruit, and other botanical macro-remains. In this study, we investigate the presence and possible uses of Ephedra during the Late Pleistocene based on the analysis of exceptionally preserved plant macrofossils recovered from c. 15 ka year-old archaeological deposits at Grotte des Pigeons in northeastern Morocco. This cave has yielded the earliest carbonized plant macrofossils of Ephedra , which were found concentrated in a human burial deposit along with other special finds. Ephedra is a plant known to produce high amounts of alkaloids, primarily ephedrine and pseudoephedrine, which have been utilized in traditional medicine. Direct radiocarbon dates on both Ephedra and the human remains indicate that they were contemporaneous. To understand the uses of Ephedra by people at the site, we discuss the different pathways through which plant remains could have arrived. We suggest that the charred cone bracts of Ephedra likely represent residues of the processing and consumption of the plant’s fleshy cones, which may have been valued for both their nutritional and therapeutic properties. Furthermore, we interpret the presence of Ephedra and its deposition in the burial area as evidence that this plant played a significant role during the funerary activities.

Background A highly skilled workforce is required to deliver high quality evidence-based care. Clinical academic career training programmes have been developed to build capacity and capabilities of nurses, midwives and allied health professionals (NMAHPs) but it remains unclear how these skills and roles are operationalised in the healthcare context. The aim of this study was to explore the experiences of early career clinical academic NMAHPs who have undertaken, or are undertaking, clinical academic master’s and doctoral studies in the United Kingdom. Methods We conducted 17 in-depth semi-structured interviews with early career clinical academics which included; nurses, midwives and allied health professionals. The data were analysed using thematic analysis. Results Two themes emerged from the data; identity transformation and operationalising transformation. Both these highlighted the challenges and opportunities that early clinical academic training provided to the individual and organisation in which they practiced. This required the reconceptualization of this training from the pure acquisition of skills to one of personal and professional transformation. The findings suggest that individuals, funders, and organisations may need to relinquish the notion that training is purely or largely a transactional exchange in order to establish collaborative initiatives. Conclusion Stakeholders need to recognise that a cultural shift about the purposes of research training from a transactional to transformative approaches is required to facilitate the development of NMAHPS clinical academics, to enable them to contribute to innovative health and patient care.

Background Supported wellbeing centres established during the COVID-19 pandemic provided high quality rest spaces and access to peer-to-peer psychological first aid for healthcare workers (HCWs). The centres were well accessed and valued by HCWs, but their relationship with wellbeing and job-related factors is not well established. The aim of this study was to explore the relationship between wellbeing centre use, HCWs wellbeing and job-related factors (job stressfulness, job satisfaction, presenteeism, turnover intentions). Methods Secondary analysis of data from 819 HCWs from an acute hospital trust who completed an online survey in April-July 2020, as part of the COVID-Well study. Measures included the Warwick Edinburgh Mental Wellbeing Scale, and four single-item global measures of job stressfulness, job satisfaction, presenteeism and turnover intentions. ANCOVA models and regression analyses were conducted on these data. Results HCWs who had not accessed the wellbeing centres had lower wellbeing (β = 0.12, p  < .001), higher job stressfulness (β = − 0.22, p  < .001), lower job satisfaction (β = 0.39, p  < .001), higher presenteeism (β = − 0.22, p  < .001) and were of younger age (β = 0.09, p  = .002). Centre use was associated with wellbeing irrespective of job stressfulness. Those reporting presenteeism and who accessed the centre (M = 3.30, SE = 0.04) had higher wellbeing than those who accessed the centre but did not report presenteeism (M = 3.06, SE = 0.04) (F(1, 791) = 18.65, p  < .001, η p 2  = 0.02). Centre use was not significantly associated with turnover intentions (B = − 0.30, p  = .13; Wald = 2.26; odds = 0.74), while job stress and job satisfaction showed significant effects. Conclusions Accessing wellbeing centres was associated with higher wellbeing of HCWs, particularly for those reporting presenteeism. Therefore, the centres may have provided greatest respite and restoration for those present at work but not in optimal health. Younger workers were disproportionately affected in terms of wellbeing, and targeted support for this population is needed. Strategies to decrease presenteeism and maximise job satisfaction are urgently required. Healthcare organisations should provide rest spaces and psychological support to HCWs for the long-term, as part of a systems-wide approach to improving workforce health and wellbeing.

Background In-Situ Simulation (ISS) enables teams to rehearse and review practice in the clinical environment to facilitate knowledge transition, reflection and safe learning. There is increasing use of ISS in healthcare organisations for which patient safety and quality improvement are key drivers. However, the effectiveness of ISS interventions has not yet been fully demonstrated and requires further study to maximise impact. Cohesive programmatic implementation is lacking and efforts to standardise ISS terms and concepts, strengthen the evidence base and develop an integrated model of learning is required. The aim of this study was to explore the current evidence, theories and concepts associated with ISS across all areas of healthcare and develop a conceptual model to inform future ISS research and best practice guidance. Methods A scoping review was undertaken with stakeholder feedback to develop a conceptual model for ISS. Medline, OpenGrey and Web of Science were searched in September 2018 and updated in December 2020. Data from the included scoping review studies were analysed descriptively and organised into categories based on the different motivations, concepts and theoretical approaches for ISS. Categories and concepts were further refined through accessing stakeholder feedback. Results Thirty-eight papers were included in the scoping review. Papers reported the development and evaluation of ISS interventions. Stakeholder groups highlighted situations where ISS could be suitable to improve care and outcomes and identified contextual and practical factors for implementation. A conceptual model of ISS was developed which was organised into four themes: 1. To understand and explore why systematic events occur in complex settings; 2.To design and test new clinical spaces, equipment, information technologies and procedures; 3. To practice and develop capability in individual and team performance; 4. To assess competency in complex clinical settings. Conclusions ISS presents a promising approach to improve individual and team capabilities and system performance and address the ‘practice-theory gap’. However, there are limitations associated with ISS such as the impact on the clinical setting and service provision, the reliance of having an open learning culture and availability of relevant expertise. ISS should be introduced with due consideration of the specific objectives and learning needs it is proposed to address. Effectiveness of ISS has not yet been established and further research is required to evaluate and disseminate the findings of ISS interventions.

Background Neonatal nurses are ideally placed in practice to undertake research enhancing the care of families. More information is required, however, around neonatal nursing led research to advance leadership in this area. The aim of this study was to determine neonatal nursing led research activity within the UK. Methods The study used a web-based survey design and neonatal nurses were eligible if they were working at or towards Masters or Doctoral level qualification in the UK. The survey was distributed to members of the Neonatal Nurses Association, UK Schools of Nursing and shared on social media pages of authors and professional organisations. Results were analysed using descriptive and frequency statistics and content analysis. Results Of the 56 respondents, 14% ( n  = 8) had a Doctoral level qualification and 43% ( n  = 24) of participants held a Masters qualification. Lack of time and funding knowledge was the largest barrier to research. Only 30% ( n  = 3) of participants had a research mentor and only 18% ( n  = 3) were from a neonatal nursing background. Conclusions There are limited numbers of neonatal nurses undertaking or leading nursing research in the UK. Further support is required to enhance clinical academic career trajectories to ensure research is a viable pathway for future generations of neonatal nurses.

Background In-situ simulation is increasingly employed in healthcare settings to support learning and improve patient, staff and organisational outcomes. It can help participants to problem solve within real, dynamic and familiar clinical settings, develop effective multidisciplinary team working and facilitates learning into practice. There is nevertheless a reported lack of a standardised and cohesive approach across healthcare organisations. The aim of this systematic mapping review was to explore and map the current evidence base for in-situ interventions, identify gaps in the literature and inform future research and evaluation questions. Methods A systematic mapping review of published in-situ simulation literature was conducted. Searches were conducted on MEDLINE, EMBASE, AMED, PsycINFO, CINAHL, MIDIRS and ProQuest databases to identify all relevant literature from inception to October 2020. Relevant papers were retrieved, reviewed and extracted data were organised into broad themes. Results Sixty-nine papers were included in the mapping review. In-situ simulation is used 1) as an assessment tool; 2) to assess and promote system readiness and safety cultures; 3) to improve clinical skills and patient outcomes; 4) to improve non-technical skills (NTS), knowledge and confidence. Most studies included were observational and assessed individual, team or departmental performance against clinical standards. There was considerable variation in assessment methods, length of study and the frequency of interventions. Conclusions This mapping highlights various in-situ simulation approaches designed to address a range of objectives in healthcare settings; most studies report in-situ simulation to be feasible and beneficial in addressing various learning and improvement objectives. There is a lack of consensus for implementing and evaluating in-situ simulation and further studies are required to identify potential benefits and impacts on patient outcomes. In-situ simulation studies need to include detailed demographic and contextual data to consider transferability across care settings and teams and to assess possible confounding factors. Valid and reliable data collection tools should be developed to capture the complexity of team and individual performance in real settings. Research should focus on identifying the optimal frequency and length of in-situ simulations to improve outcomes and maximize participant experience.

In this conceptual article, we explore the idea of refining the role of the researcher. Using emotional intelligence as a framework, we synthesize methodological writing about the role of the researcher and ways to enhance the connection between humans in qualitative research. Emotional intelligence can strengthen the ability to connect with participants, skillfully listen during the interview process, and more clearly understand the lifeworlds participants articulate.

ObjectivesOesophago-gastric cancer is one of the most common causes of cancer death worldwide. Care pathways are highly variable and complex to organise;however,there is limited evidence from a service user perspective to inform service design for best experience of care. This study explored the experiences of people living with incurable oesophago-gastric cancer to determine how services can be delivered to best support their needs.DesignBased on interpretivism, this qualitative study used single, face-to-facesemistructured interviews. Interviews were audiorecorded and transcribed verbatim by a professional transcription serviceandinterrogated throughframework analysis.Setting and participantsThe study was based in a large UKNational Health ServiceTrust and designated regional specialist cancer centre. A total of27 patientsliving with incurable oesophago-gastric cancer took part in the study.ResultsThe analysis revealed a central theme of‘integrated relationship-centred care’and three subthemes: compassionate care interactions, integrated processes and systems and compassionate care environments. Positive experiences were marked by high-quality relationships with healthcare professionals, further strengthened by care process and environments that responded to their individual symptoms and healthcare needs, effectively spanning multiple agencies and professions.ConclusionsHigh quality services require enhanced clinical awareness and integrated service design to address a range of physical and psychosocial challenges which are often overlooked in thispatientpopulation. These essential components of positive care experiences must be driven at policy level to ensure a pathway approach to quality relationship-centred care, which crucially is not interrupted aspatientsmove across organisations and systems.

Phosphatidylserine (PS) exposure is normally associated with apoptosis and the removal of dying cells. We observed that PS is exposed constitutively at high levels on T lymphocytes that express low levels of the transmembrane tyrosine phosphatase CD45RB. CD45 was shown to be a negative regulator of PS translocation in response to various signals, including activation of the ATP receptor P2X 7 . Changes in PS distribution were shown to modulate several membrane activities: Ca 2+ and Na + uptake through the P2X 7 cation channel itself; P2X 7 -stimulated shedding of the homing receptor CD62L; and reversal of activity of the multidrug transporter P-glycoprotein. The data identify a role for PS distribution changes in signal transduction, rapidly modulating the activities of several membrane proteins. This seems to be an all-or-none effect, coordinating the activity of most or all the molecules of a target protein in each cell. The data also suggest a new approach to circumventing multidrug resistance.

ObjectivesScreening in selected high risk populations for Barrett’s oesophagus (BO) and oesophageal varices (OVs) has been proposed, but there are obstacles with conventional oesophagogastroduodenoscopy (C-OGD), including patient acceptability. Portable and disposable office-based transnasal endoscopy (TNE) is a feasible and accurate alternative to C-OGD that may have use in primary and secondary care. This article outlines a qualitative analysis of patient experiences of TNE and C-OGD in order to gain an insight into an acceptable delivery of an endoscopic screening service.DesignPurposeful sampling identified 23 participants who then underwent semi-structured interviews to determine their experiences of both procedures. Thematic analysis was conducted to derive meaning from their lived experiences.SettingA secondary care endoscopy unit, clinic room and interview room.ParticipantsPatients referred for BO or OV surveillance and for endoscopy to investigate dyspepsia underwent unsedated TNE using the EG Scan II device followed by C-OGD with or without sedation (patient choice), as part of a clinical trial.ResultsThe themes that arose from our analysis were: inclusivity in one’s own healthcare, comfort level and convenience, validity of the procedure and application to a screening population and a sense of altruism and reciprocity. Positive aspects of TNE included participant empowerment, reduced discomfort and avoidance of conscious sedation. Participants felt that if TNE screening was of proven efficacy it would be welcomed, though views on use in a community setting were mixed.ConclusionsMost patients preferred TNE to unsedated C-OGD and the reasons they gave featured strongly in the emerging themes. Preferences between TNE and sedated C-OGD were more subtle, with equivalent comfort scores but merits and drawbacks of both being discussed. This information identifies opportunities and challenges in establishing an endoscopic screening service. Trial registration number ISRCTNregistry identifier: 70595405; Pre-results.