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How LGBTQ + adults’ experiences of multiple disadvantage impact upon their health and social care service pathways in the UK & Ireland: a scoping review
Background
Despite increased awareness of the significant health and healthcare inequalities experienced by minoritised groups, limited research considers the interaction of multiple domains of social disadvantage. This review therefore sought to explore how LGBTQ + adults’ experiences of homelessness, substance use, and criminal justice involvement impact upon their access to and use of health and social care services in the UK and Ireland.
Methods
A qualitative scoping review was conducted in accordance with the PRISMA-ScR framework. Electronic database and web searches identified 26 eligible peer-reviewed and grey literature documents published between 2010–2024. The data were charted, coded, and knowledge gaps identified.
Results
Data were coded thematically, clustered around the concept of normativity. Descriptive qualitative techniques were applied to explore how this was enacted and experienced. Synthesis across the literature identified experiences of discrimination and anticipated stigma that acted as barriers to accessing and engaging with services.
Conclusions
Structural normativity and the privilege afforded to hegemonic population groups impacted upon this population’s access to and use of services. The review adds depth and context to questions around the lack of visibility or engagement in services by LGBTQ + people with experience of disadvantage, and contributes to the wider literature on improving service access for marginalised, underserved, or disadvantaged communities.
Journal Article
Endoscopic ultrasound-guided placement of lumen-apposing metal stent for transgastric drainage of loculated malignant ascites
Endoscopic ultrasound-guided drainage of loculated malignancy-related ascites has been reported in limited case series with success in achieving symptomatic relief. In this case report, we detail the successful drainage of a loculated paragastric ascites with insertion of a lumen-apposing metal stent (LAMS) in a patient diagnosed with metastatic ovarian cancer.
Plain language summary
Draining fluid buildup using a specialized stent: a case study in cancer treatment
This article discusses a specific procedure used to drain fluid buildup caused by cancer. The procedure involves using a special type of stent placed with the help of an ultrasound device. The case study shows how this method successfully relieved symptoms in a patient with advanced ovarian cancer.
Journal Article
Distinct form I, II, III, and IV Rubisco proteins from the three kingdoms of life provide clues about Rubisco evolution and structure/function relationships
There are four forms of ribulose 1,5-bisphosphate carboxylase/oxygenase (Rubisco) found in nature. Forms I, II, and III catalyse the carboxylation and oxygenation of ribulose 1,5-bisphosphate, while form IV, also called the Rubisco-like protein (RLP), does not catalyse either of these reactions. There appear to be six different clades of RLP. Although related to bona fide Rubisco proteins at the primary sequence and tertiary structure levels, RLP from two of these clades is known to perform other functions in the cell. Forms I, II, and III Rubisco, along with form IV (RLP), are thought to have evolved from a primordial archaeal Rubisco. Structure/function studies with both archaeal form III (methanogen) and form I (cyanobacterial) Rubisco have identified residues that appear to be specifically involved with interactions with molecular oxygen. A specific region of all form I, II, and III Rubisco was identified as being important for these interactions.
Journal Article
The Role of Power in Co‐Approaches to Health Research: Insights From Spain and the United Kingdom With a Rapid Review of Reviews
Introduction Co‐approaches to health research with socially excluded groups are becoming increasingly popular in the discourse of funding schemes in Spain and the United Kingdom. Such approaches aim to challenge the traditional research paradigm between researcher–participants by sharing power in knowledge production within the parameters of academic culture. This article collates the experience of six researchers working in ongoing funded health‐related research projects that use co‐approaches alongside racialized communities, people with learning disabilities, populations involved in the criminal justice system and people experiencing deep poverty. Methods Drawing from the authors' collective experiences and operational questions about power, a rapid review of reviews was implemented. This review included a search within five databases from April to May 2024. Findings were analysed from the Emancipatory Power Framework (Popay et al., Health Promotion International 36, no. 5 (2021): 1253–1263) to identify, evaluate and discover insight into power dynamics that should be understood to have meaningful impact in co‐approaches to health research, funding and evaluation of these initiatives. Results 38 articles were included in the review. A total of eight categories emerged in the analysis linked to ‘power within’, ‘power with’, ‘power to’ and ‘power over’. Conclusion These findings contribute to deepening the critical discussion of co‐approaches, peeling back the layers of power that define academic culture, and aligning current and future health equity research with valuation of care, Open Science and new dimensions of power such as digitalization. Patient or Public Contribution Statement This rapid review of reviews is informed by the authors' experience in co‐produced research. While patients and the public were not directly involved in conducting this review, the selection and synthesis of the literature were guided by insights from prior collaborative research with diverse communities.
Journal Article
Motivation to access laparoscopic skills training: Results of a Canadian survey of obstetrics and gynecology residents
Competency based medical education (CBME) requires novel approaches to surgical education. Significant investment has been made in laparoscopic simulation, which has been shown to foster skill development prior to patient encounters. However, research suggests variable voluntary use of these resources by residents, and little is known about the motivational factors that influence their utilization. The purpose of this study was to characterize factors that motivate residents to seek laparoscopic simulation experience outside of the formal curriculum.
We developed a questionnaire grounded in Expectancy Value Theory, an established psychological theory of motivation, by adapting validated measures to fit the study context. We conducted a cross sectional survey of Canadian obstetrics and gynecology residents.
We invited residents enrolled in English-language obstetrics and gynecology training programs in Canada to participate.
All residents engaged in clinical duties during Winter 2018 were invited to complete the questionnaire. Forty-four Obstetrics and Gynecology (Ob/Gyn) residents participated in the study.
Residents reported limited use of simulation resources and identified multiple barriers including lack of time, access, and supervision. They expressed concern about development of bad habits during independent practice, and simulation use was positively correlated with perceived utility. Compared to junior residents, senior residents reported greater enjoyment of laparoscopic surgery, less emotional costs, and higher self-efficacy for learning laparoscopy.
Residents' perception of utility and barriers impede voluntary simulation use and overall use was limited. As programs undertake curricula redevelopment for CBME, mitigating barriers and improving perceived utility of laparoscopic simulation is vital to increase use and enhance skill development.
Journal Article
This needs to be a journey that we’re actually on together’—the introduction of integrated care systems for children and young people in England: a qualitative study of the views of local system stakeholders during winter 2021/22
Background
Integrated care has become a central feature of health system reform worldwide. In England, Integrated Care Systems (ICS) are intended to improve integration across public health, the National Health Service (NHS), education and social care. By April 2021, England had been divided into 42 geographical areas, each tasked with developing local ICS provision
.
However, it was not clear how ICSs would address the specific needs of children and young people (CYP). This study elicited the views of senior professional stakeholders in the first year of the ICS national roll out, to learn how integrated care for CYP was being implemented within the ICSs and future plans for service provision.
Methods
A qualitative analysis of in-depth interviews with stakeholders, including healthcare professionals, NHS managers and local authority leaders (
n
= 25) selected from a diverse sample of ICSs (
n
= 7) across England, conducted during winter 2021/22. Reflexive thematic analysis involving a collaborative coding approach was used to analyse interview transcripts.
Results
Four themes were identified, indicating challenges and opportunities for ICSs in relation to the health of CYP: 1) Best start in life (a more holistic approach to health afforded by integrated care); 2) Local and national contexts (tensions between local and national settings and priorities); 3) Funding and planning (instituting innovative, long-term plans using limited existing CYP funding streams); 4) Organisational complexities (integrating the work of diverse organisations).
Conclusions
The views of stakeholders, provided at the beginning of the journey towards developing local ICS CYP provision, revealed a common aspiration to change focus from provision of acute, largely adult-orientated services towards one with a broader, population health remit, including prevention and early intervention. This would be delivered by integration of a range of local services, including health, education, housing and social care, to set CYP on a life-long path towards improved health and wellbeing. Yet there was an awareness that change would take place over time within existing national policy and funding frameworks, and would require overcoming organisational barriers through further developing local collaborations and partnerships. As ICSs mature, the experiences of stakeholders should continue to be canvassed to identify practical lessons for successful CYP integrated care.
Journal Article
‘I Enjoy Having Someone to Rant to, I Feel Like Someone is Listening to Me’: Exploring Emotion in the Use of Qualitative, Longitudinal Diary-Based Methods
Emotions and the emotional labour of researchers have been increasingly recognised in social science disciplines, with many researchers providing personal and reflexive accounts. Such debates are less well recognised in health-related disciplines, particularly public health, who remain at earlier stages of valuing and understanding qualitative research. Drawing on personal experiences and methodological reflections gathered from a qualitative study, undertaken with young people over the course of 16 months during the COVID-19 pandemic in England, UK, the aim of this article is to offer further insight into the impact of researcher emotion, by specifically focussing on longitudinal, diary-based methods. My reflections are framed as three overlapping and intersecting themes. First, that qualitative longitudinal methods (and diary studies in particular) have enormous potential to curate rich emotional narratives. Second, that despite these positives, there are tensions or conflicting dynamics in using a method which helps to explore young people’s emotions but also involves emotional labour for the researcher. Third, that greater attention should be paid to ensuring ethical care for researchers, particularly those engaging with qualitative longitudinal and/or creative methods. Such strategies should not solely rely on self-care and must be considered at institutional or funding body level. To this end, my personal experiences and reflections, as well as those from previous offerings, are used here to underpin a framework for researchers or research teams embarking upon novel qualitative longitudinal methods: 1. Do not underestimate emotional burden. 2. Ensure meaningful debriefing is available. 3. Establish boundaries. 4. Make space for emotion throughout fieldwork as well as during analysis and writing (‘entering and exiting the field’).
Journal Article
Genomic characterization of explant tumorgraft models derived from fresh patient tumor tissue
Background
There is resurgence within drug and biomarker development communities for the use of primary tumorgraft models as improved predictors of patient tumor response to novel therapeutic strategies. Despite perceived advantages over cell line derived xenograft models, there is limited data comparing the genotype and phenotype of tumorgrafts to the donor patient tumor, limiting the determination of molecular relevance of the tumorgraft model. This report directly compares the genomic characteristics of patient tumors and the derived tumorgraft models, including gene expression, and oncogenic mutation status.
Methods
Fresh tumor tissues from 182 cancer patients were implanted subcutaneously into immune-compromised mice for the development of primary patient tumorgraft models. Histological assessment was performed on both patient tumors and the resulting tumorgraft models. Somatic mutations in key oncogenes and gene expression levels of resulting tumorgrafts were compared to the matched patient tumors using the OncoCarta (Sequenom, San Diego, CA) and human gene microarray (Affymetrix, Santa Clara, CA) platforms respectively. The genomic stability of the established tumorgrafts was assessed across serial
in vivo
generations in a representative subset of models. The genomes of patient tumors that formed tumorgrafts were compared to those that did not to identify the possible molecular basis to successful engraftment or rejection.
Results
Fresh tumor tissues from 182 cancer patients were implanted into immune-compromised mice with forty-nine tumorgraft models that have been successfully established, exhibiting strong histological and genomic fidelity to the originating patient tumors. Comparison of the transcriptomes and oncogenic mutations between the tumorgrafts and the matched patient tumors were found to be stable across four tumorgraft generations. Not only did the various tumors retain the differentiation pattern, but supporting stromal elements were preserved. Those genes down-regulated specifically in tumorgrafts were enriched in biological pathways involved in host immune response, consistent with the immune deficiency status of the host. Patient tumors that successfully formed tumorgrafts were enriched for cell signaling, cell cycle, and cytoskeleton pathways and exhibited evidence of reduced immunogenicity.
Conclusions
The preservation of the patient’s tumor genomic profile and tumor microenvironment supports the view that primary patient tumorgrafts provide a relevant model to support the translation of new therapeutic strategies and personalized medicine approaches in oncology.
Journal Article
Regulation of lung progenitor plasticity and repair by fatty acid oxidation
Idiopathic pulmonary fibrosis (IPF) is an age-related interstitial lung disease, characterized by inadequate alveolar regeneration and ectopic bronchiolization. While some molecular pathways regulating lung progenitor cells have been described, the role of metabolic pathways in alveolar regeneration is poorly understood. We report that expression of fatty acid oxidation (FAO) genes is significantly diminished in alveolar epithelial cells of IPF lungs by single-cell RNA sequencing and tissue staining. Genetic and pharmacological inhibition in AT2 cells of carnitine palmitoyltransferase 1a (CPT1a), the rate-limiting enzyme of FAO, promoted mitochondrial dysfunction and acquisition of aberrant intermediate states expressing basaloid, and airway secretory cell markers SCGB1A1 and SCGB3A2. Furthermore, mice with deficiency of CPT1a in AT2 cells show enhanced susceptibility to developing lung fibrosis with an accumulation of epithelial cells expressing markers of intermediate cells, airway secretory cells, and senescence. We found that deficiency of CPT1a causes a decrease in SMAD7 protein levels and TGF-β signaling pathway activation. These findings suggest that the mitochondrial FAO metabolic pathway contributes to the regulation of lung progenitor cell repair responses and deficiency of FAO contributes to aberrant lung repair and the development of lung fibrosis.
Journal Article