Anglia Ruskin University

Recruiting and retaining healthcare professionals, particularly doctors, remains a critical challenge for the National Health Service (NHS), exacerbated by an ageing population, geographical disparities, and persistent workforce shortages. Traditional linear solutions fail to address the complexity of these interconnected issues, necessitating a multidimensional approach rooted in complexity science. This article frames the recruitment and retention of doctors as a wicked problem, characterized by interdependencies, dynamic interactions, and context-specific nuances. Using the Anglia Ruskin University School of Medicine in Essex as a case study, we explore a locally contextualized strategy within the national ‘train, retain, reform’ framework. Initiatives include the innovative Medical Degree Doctor Apprenticeship, targeted outreach programmes, and collaboration with NHS England to prioritize local foundation training posts for graduates. These strategies are designed to address workforce disparities in socioeconomically disadvantaged regions whilst fostering local retention. Our findings highlight the need for adaptive, non-linear solutions that integrate national policies with local innovations to address workforce inequalities effectively. We argue that sustainable improvements require distributed control, interdependent systemic interventions, and stakeholder collaboration. This approach not only addresses local recruitment challenges but also contributes to reducing health inequalities, emphasizing the importance of local agency within a national framework.

Purpose This study aims to explore the application of Artificial intelligence (AI) systems in radiology departments and the role they play in the shortage of radiologists. It examines the ethical and legal considerations for uptake of AI both in relation to patient safety and for the profession of radiology. Methods A systematised review was selected for this research study to collect maximum relevant evidence that provides a comprehensive overview of AI application in radiology specifically in terms of addressing radiologist shortages in hospitals. The search was complemented by grey literature to fill potential gaps. Results Findings suggest that AI can read and interpret images more effectively and faster than radiologists and that it could be more widely used to reduce the impact of the global radiologist shortage, leading to better patient outcomes and safety. However, there are potential challenges predominantly ethical and legal. Concerns over complete radiologist replacement by AI do not currently seem likely, but rather the use of AI to complement radiologists in their work. Conclusions AI cannot replace radiologists, instead radiology services will need the input of radiologists, AI systems and radiographers to provide a safe healthcare for all patients, therefore they are complementary. Radiologist jobs will most probably change to reduce repetitive tasks that can be conducted by AI. Radiologists and radiographers play a role in the provision of quality care in both normal day-to-day events and during times of disaster. Their role in diagnosing and prognosing diseases provides guidance during preparedness, response and recovery.

Background In 2009, the Minimum Information for Publication of Quantitative Real-Time PCR Experiments (MIQE) guidelines established standards for the design, execution, and reporting of quantitative PCR (qPCR) in research. The expansion of qPCR into numerous new domains has driven the development of new reagents, methods, consumables, and instruments, requiring revisions to best practices that are tailored to the evolving complexities of contemporary qPCR applications. Content Transparent, clear, and comprehensive description and reporting of all experimental details are necessary to ensure the repeatability and reproducibility of qPCR results. These revised MIQE guidelines reflect recent advances in qPCR technology, offering clear recommendations for sample handling, assay design, and validation, along with guidance on qPCR data analysis. Instrument manufacturers are encouraged to enable the export of raw data to facilitate thorough analyses and re-evaluation by manuscript reviewers and interested researchers. The guidelines emphasize that quantification cycle (Cq) values should be converted into efficiency-corrected target quantities and reported with prediction intervals, along with detection limits and dynamic ranges for each target, based on the chosen quantification method. Additionally, best practices for normalization and quality control are outlined and reporting requirements have been clarified and streamlined. The aim is to encourage researchers to provide all necessary information without undue burden, thereby promoting more rigorous and reproducible qPCR research. Summary Building on the collaborative efforts of an international team of researchers, we present updates, simplifications, and new recommendations to the original MIQE guidelines, designed to maintain their relevance and applicability in the context of emerging technologies and evolving qPCR applications.

This article discusses the development of professional advocacy in the U.K. nursing and midwifery professions. Initially established in midwifery, the discourse of professional advocacy has gradually shifted from a patient focus to advocating for the professionals in their professional roles. This move is driven by the need to influence the health, well-being, and efficacy of the health professions, thereby positively impacting patient care. The concept of advocacy is thus expanding from advocacy focussing on patients/social groups, to incorporating advocating for health professionals by health professionals. However, it is unclear if literature and evidence is keeping pace with this potential conceptual shift taking place in the practice setting, and it is unclear if past patient-centered conceptualizations of advocacy are relevant to the context of professional-oriented advocacy. This article aims to initiate this discussion specific to the nursing profession.

Herpes zoster (HZ) in infancy is considered rare as both primary infection with varicella-zoster virus (VZV) and the reactivation of latent VZV would have to occur in the first year of life. We report a case of HZ, in an otherwise immunocompetent young infant, with a previous history of neonatal varicella. This case highlights the clinical presentation, management strategies and potential complications of infantile HZ, with a discussion of relevant literature. We advocate for a high index of clinical suspicion for infants who present with crusted lesions limited to one or two dermatomes to facilitate timely intervention, as well as long-term follow-up to improve clinical outcomes.

Recent advances in quantum communications have underscored the crucial role of optical coherence in developing quantum networks. This resource, which is fundamental to the phase-based architecture of the quantum internet¹, has enabled the only successful demonstrations of multi-node quantum networks2, 3–4 and substantially extended the range of quantum key distribution (QKD)⁵. However, the scalability of coherence-based quantum protocols remains uncertain owing to the specialized hardware required, such as ultra-stable optical cavities and cryogenic photon detectors. Here we implement the coherence-based twin-field QKD protocol over a 254-kilometre commercial telecom network spanning between Frankfurt and Kehl, Germany, achieving encryption key distribution at 110 bits per second. Our results are enabled by a scalable approach to optical coherence distribution, supported by a practical system architecture and non-cryogenic single-photon detection aided by off-band phase stabilization. Our results demonstrate repeater-like quantum communication in an operational network setting, doubling the distance for practical real-world QKD implementations without cryogenic cooling. In addition, to our knowledge, we realized one of the largest QKD networks featuring measurement-device-independent properties⁶. Our research aligns the requirements of coherence-based quantum communication with the capabilities of existing telecommunication infrastructure, which is likely to be useful to the future of high-performance quantum networks, including the implementation of advanced quantum communication protocols, quantum repeaters, quantum sensing networks and distributed quantum computing⁷.

The microscopic world of intracellular bacteria is rarely communicated to non‐scientists. By participating in the Sensory Science Exhibition, held at St Catharine's College, University of Cambridge as part of the Cambridge Festival, we sought to address this problem by creating a 3D mammalian cell with model bacteria, including Salmonella enterica , Chlamydia trachomatis and Orientia tsutsugamushi. By hijacking eukaryotic host cellular machinery and avoiding detection, these bacteria orchestrate their survival and replication within host cells. This tactile display aimed to guide participants through key aspects of intracellular bacterial life cycles such as host cell entry, Salmonella type three secretion system (T3SS) protein secretion, O. tsutsugamushi trafficking along microtubules, and C. trachomatis replication within an inclusion. We summarize our experiences in this report. We hope our multisensory conceptualization of intracellular bacteria provided inclusive and easy‐to‐understand communication of complex science concepts to the general public with modalities also accessible to the low‐vision and blind communities.

In shared tasks carried out with a partner, people often encode information related to their partner even when it’s irrelevant for themselves. This social encoding may be especially adaptive in fitness relevant situations, e.g. when survival is at stake. In two experiments we asked whether this joint encoding effect would be enhanced when the joint task was a survival related task. In experiment 1, using a survival processing paradigm combined with a joint encoding task, 47 university participants imagined themselves in either a survival or a moving scenario, alone or in dyads with a confederate. The participants and confederates rated the usefulness of words from different categories for their assigned scenario. A surprise recall test showed that participants in both groups recalled more items from their partner's category than items from the unassigned category. Crucially, this joint memory effect was larger in the survival group, suggesting that participants had superior encoding of the partner’s information in the survival scenario. In a second experiment, we replicated this finding with a different sample of 50 university students and a confederate. These findings point to a ‘social information hoarding’ strategy, where participants encoded as many items from their partner's category as those of their own when in a survival-related situation. The cognitive mechanisms underpinning such a social information hoarding strategy requires further investigation .

Introduction A quarter of women experience heavy periods in their lifetime, often significantly impairing their well-being, productivity and quality of life. Several treatment options are offered for heavy menstrual bleeding; however, there is limited evidence on the effectiveness, safety and cost of available treatments. We aim to conduct a comprehensive systematic review, network meta-analyses and health economic evaluation to compare all available treatment options while considering the views and treatment preferences of women with heavy menstrual bleeding. Methods and analysis We will systematically search electronic databases (MEDLINE, EMBASE, CENTRAL) as well as the grey literature, conference proceedings and trial registries to identify all relevant randomised trials that evaluated any medical or surgical treatment for women with heavy menstrual bleeding regardless of their cause compared with placebo or other active treatments. We will perform pairwise and network meta-analyses using standard methods. We will report primarily on changes in menstrual blood loss (using Pictorial blood loss assessment chart scores or the Alkaline-Haematin method), quality-of-life measures, safety in addition to other important clinical outcomes. We will develop a health economic model to evaluate the cost-effectiveness of available treatments within a healthcare perspective using data inputs from the planned meta-analyses. We will calculate the incremental cost per change in alternative outcomes and present the net monetary benefit for a range of cost-effectiveness thresholds for quality-adjusted life-year gained. We will conduct consultations and a discrete choice experiment involving patient representatives to capture the factors influencing women’s decision-making and treatment preferences in real life. Ethics and dissemination The project was approved by the UCL Institute for Women’s Health Low-Risk Research Ethics Committee (reference: 004_2023_24) and UCL Research Ethics Committee (ID 16351/003) for the planned patient involvement and qualitative research. We will produce an evidence-based decision aid toolkit and will publish the findings in peer-reviewed journals, as well as lay media outputs to inform health professionals, policymakers and the patient community. PROSPERO registration numbers https://doi.org/10.17605/OSF.IO/4MUSF , CRD42023468055, CRD42024519622, CRD42024520558 and CRD42024520634.

Education leadership for people who identify as lesbian, gay, bisexual, transgender, queer and other sexual and gender minorities (LGBTQ+) presents distinct challenges that heterosexual and cis-gendered leaders do not have to navigate. Despite this, there is currently no national leadership development programme specifically for LGBTQ+ aspirant leaders in UK Higher Education. This article researches the outcomes of the first LGBTQ+ specific leadership development programme at a university in England. The authors, one a participant and the other the founder and co-leader of the programme explore the outcomes for the mentees, the mentors and the host university through interviews, field notes and written feedback. The research underscores the distinct leadership development needs of the LGBTQ+ educators and the importance of having a dedicated LGBTQ+ leadership development programme. It also offers a framework to guide the development of future LGBTQ+ specific leadership development in Higher Education.

Background and Aims Literature suggests that outdoor air pollutant exposure is associated with hearing problems, but examination of this link has not extended to any potential association between hearing ability and the use of unclean cooking fuels. The current paper investigates whether such a link exists, utilizing a large sample of older adults from low‐ and middle‐income countries (LMICs) where such fuels are commonly used. Methods Data from the Study on global AGEing and adult health (SAGE) were analyzed. This is a nationally representative and cross‐sectional data set collected for the World Health Organization for residents of South Africa, China, Ghana, India, Mexico, and Russia. A range of “unclean” cooking fuels were assessed, namely agriculture or crop, animal dung, coal or charcoal, Kerosene or paraffin, shrubs or grass, and wood. Hearing problems referred to the interviewer‐rated presence of this condition. Statistical analysis was done using multivariable logistic regression. Results The present work analyzed data from 14,585 individuals aged ≥ 65 years [mean (SD) age 72.6 (11.5) years; 55.0% females]. In the overall sample and in the final adjusted model, unclean cooking fuel use was associated with a significantly increased risk of hearing problems (OR = 1.68 (95% CI = 1.22–2.30). This association was significant for females (OR = 2.36; 95% CI = 1.53–3.63) but not for males (OR = 1.20; 95% CI = 0.79–1.81). Conclusion Unclean cooking fuel use is associated with an increased risk of hearing problems among adult residents of LMICs over 65 years of age, particularly among females. Findings from this study support the development of Sustainable Development Goal 7 (United Nations), which advocates for fairer and more sustainable access to modern energy, as well as a means to prevent avoidable hearing problems.

Background and Aims A low intake of fruit and vegetable consumption has been found to be associated with a plethora of negative health outcomes in adolescents. However, there is a scarcity of literature on long‐term trends in fruit and vegetable intake in the adolescent population. Therefore, we examined this trend in a nationally representative sample of adolescents (12–15 years) attending school in 31 countries, including Africa, Asia, and the Americas, where investigation of such trends has been scarce. Methods The present study analyzed data from the Global School‐based Student Health Survey 2003–2017. The prevalence (95% CI) of inadequate fruit and vegetable intake (i.e., consumption < 5 times/day) was calculated for each survey, and crude linear trends were examined by linear regression models for each country. Results We analyzed data from students (n = 193,388) aged 12–15 years [mean (SD) age 13.7 (1.0) years; 49.0% boys]. A high overall prevalence of inadequate fruit and vegetable consumption was found (75%). We observed increasing, decreasing, and stable trends in 6, 3, and 22 countries, respectively. In countries where decreasing trends were found, this decrease was minimal. Moreover, the majority of countries with stable trends exhibited a high prevalence of inadequate fruit and vegetable intake across multiple years. Conclusion Our data show that inadequate fruit and vegetable consumption among adolescents is a major global problem with almost no improvements being observed in recent years. Intensification of global efforts to combat inadequate fruit and vegetable consumption is necessary.

Objectives The 12-item Self-Compassion Scale–Short Form (SCS–SF) is a widely used instrument for the assessment of self-compassion. To date, there have been few examinations of this instrument’s psychometric properties, particularly across nations and languages. Therefore, we used data from the Body Image in Nature Survey (BINS) to assess measurement invariance of the SCS–SF across nations, languages, gender identities, and age groups. Methods Participants (N = 56,968) from 65 nations completed the SCS–SF in 40 languages. Using these data, we tested various hypothesised models of the SCS–SF in the total sample and, using multi-group confirmatory factor analysis, tested for invariance of the optimal model across national groups, languages, gender identities, and age groups. Results In the total dataset, we found that an 11-item, 2-factor model (i.e., SCS-11) provided best fit to the data, with the two factors tapping distinct constructs of compassionate and uncompassionate self-responding. The SCS-11 was found to be partially scalar invariant across national groups and languages, and fully scalar invariant across gender identities and age groups. There was wide variation in latent means for the two factors, particularly across national groups and languages. Further analyses showed negligible associations between the two factors and sociodemographic variables, including marital status, financial security, and urbanicity. Conclusions Our results suggest that it may be possible to derive a stable 2-factor model of the SCS–SF for use in cross-cultural research, but also highlight the likelihood of cross-national and cross-linguistic variations in the way that self-compassion is understood.

Corneal diseases are a leading cause of visual impairment, and their treatment remains challenging. Corneal epithelial stem cells exist in the limbus, the peripheral region of the cornea, and play an important role in corneal regeneration. Here, we evaluated the effects of extracellular vesicles from human adipose-derived mesenchymal stem cells (AdMSC-EVs) on limbal epithelial cells (LECs). Colony formation assays showed that the colony-forming efficiency of LECs significantly increased in the presence of AdMSC-EVs. We next demonstrated that AdMSC-EVs accelerated the migration of LECs in a scratch assay, whereas the proliferation of LECs was decreased by AdMSC-EVs in the cell proliferation assay. RNA sequencing analysis of LECs indicated that AdMSC-EVs maintained their stem cell properties and improved epithelial-mesenchymal transition (EMT). Furthermore, after identifying the six most abundant microRNAs (miRNAs) in AdMSC-EVs, LEC transfection with miRNA mimics indicated that miR-25, miR-191, and miR-335 were the most probable miRNA factors within AdMSC-EVs at improving colony formation ability and EMT. Taken together, our findings indicated that AdMSC-EVs enhanced the colony formation ability and EMT of LECs, and the effects of AdMSC-EVs were in-part mediated by the miRNAs within the AdMSC-EVs.

The global construction industry faces serious safety challenges, characterised by high rates of accidents and fatalities. A systematic review that analysed 95 academic articles from the Scopus and Web of Science databases investigated the current use of digital technologies (DTs) in construction safety management across developed and developing countries. The research discovered that digital technology applications in construction safety primarily focus on developing models and simulations. These technologies are making significant contributions by enhancing worker training, improving risk prediction capabilities, enabling real-time monitoring, facilitating better communication, and supporting more proactive safety interventions. The most frequently utilised digital technologies in this domain include virtual reality (VR), building information modelling (BIM), machine learning, and artificial intelligence (AI). Despite the promising potential of these technologies, their actual implementation remains somewhat limited, especially in developing countries. This study identified critical knowledge gaps, specifically the limited understanding of digital technology trends in construction safety management across different economic contexts, the insufficient research on strategies to increase digital technology adoption in the construction sector, and the need for more comprehensive investigations into how the technology adoption divide can be bridged. This research aimed to facilitate future empirical studies that can advance the understanding of digital technologies and the development of strategies to integrate them more comprehensively into construction safety practices. By providing a detailed overview of current digital technology applications, highlighting research limitations, and suggesting future research directions, this review seeks to contribute to both academic understanding and practical improvements in global construction industry safety.

Vaccine-induced immunosuppression can reactivate the varicella-zoster virus, potentially leading to the development of herpes zoster. However, the literature on this topic is inconsistent, resulting in limited clarity. Therefore, we aimed to enhance our understanding of vaccine-associated herpes zoster and establish guidelines for future research, utilizing a global database to improve global public health. We investigated vaccine-associated adverse events in herpes zoster using reports (~ 13 million reports) from the WHO international pharmacovigilance database. Data were analyzed for the global number of reports, reported odds ratios (ROR), and information components (IC) to determine the potential association between 18 vaccines and vaccine-associated herpes zoster reports in nearly 170 countries and territories from 1969 to 2023. Of 7,805,380 vaccine-associated adverse events, there were 51,985 herpes zoster reports. Vaccine-associated herpes zoster showed the highest strength of association with COVID-19 mRNA vaccines (ROR, 11.85 [95% CI, 11.70-12.01]; IC, 2.74 [IC0.25, 2.72]), followed by encephalitis (ROR, 4.07 [95% CI, 3.37–4.92]; IC, 2.00 [IC0.25, 1.68]), influenza (ROR, 3.44 [95% CI, 3.28–3.62]; IC, 1.77 [IC0.25, 1.69]), and ad5-vectored COVID-19 vaccines (ROR, 3.05 [95% CI, 2.97–3.14]; IC, 1.54 [IC0.25, 1.50]). The ROR and IC of vaccine-associated herpes zoster in males (ROR, 7.94 [95% CI, 7.80–8.08]; IC, 2.47 [IC0.25, 2.45]) and females (ROR, 6.71 [95% CI, 6.62–6.80]; IC, 2.30 [IC0.25, 2.28]). The ROR and IC increased with advancing age. Our findings emphasize the need to consider the immune status of vaccine recipients and to implement appropriate compensation and management manuals for vaccine-associated herpes zoster.