The problem of targeted network immunization can be defined as the one of finding a subset of nodes in a network to immunize or vaccinate in order to minimize a tradeoff between the cost of vaccination and the final (stationary) expected infection under a given epidemic model. Although computing the expected infection is a hard computational problem, simple and efficient mean-field approximations have been put forward in the literature in recent years. The optimization problem can be recast into a constrained one in which the constraints enforce local mean-field equations describing the average stationary state of the epidemic process. For a wide class of epidemic models, including the susceptible-infected-removed and the susceptible-infected-susceptible models, we define a message-passing approach to network immunization that allows us to study the statistical properties of epidemic outbreaks in the presence of immunized nodes as well as to find (nearly) optimal immunization sets for a given choice of parameters and costs. The algorithm scales linearly with the size of the graph, and it can be made efficient even on large networks. We compare its performance with topologically based heuristics, greedy methods, and simulated annealing on both random graphs and real-world networks.

BackgroundMultisource feedback (MSF) is currently being introduced in the UK as part of a cycle of performance review for doctors. However, although it is suggested that the provision of feedback can lead to a positive change in performance and learning for medical professionals, the evidence supporting these assumptions is unclear. The aim of this review, therefore, was to identify the key factors that influence the effectiveness of multisource feedback in improving the professional practice of medical doctors.MethodRelevant electronic bibliographic databases were searched for studies that aimed to assess the impact of MSF on professional practice. Two reviewers independently selected and quality assessed the studies and abstracted data regarding study design, setting, MSF instrument, behaviour changes identified and influencing factors using a standard data extraction form.ResultsA total of 16 studies met the inclusion criteria and quality assessment criteria. While seven studies reported only a general change in professional practice, a further seven studies identified specific changes in behaviour. The main professional behaviours that were found to be influenced by the feedback were communication, both with colleagues and patients and an improvement in clinical competence/skills. The main factors found to influence the acceptance and use of MSF were the format of the feedback, specifically in terms of whether it was facilitated, or if narrative comments were included in the review, and if the feedback was from sources that the physician believed to be knowledgeable and credible.ConclusionsWhile there is limited evidence suggesting that MSF can influence professional performance, the quality of this evidence is variable. Further research is necessary to establish how this type of feedback actually influences behaviours and what factors have greatest influence.

Introduction: Supporting doctors' wellbeing is crucial for medical education to help minimise negative long-term impacts on medical workforce retention and ultimately patient care. There is limited study of how doctors' transitions experiences impact wellbeing, particularly socially and culturally. Multiple Multidimensional Transitions (MMT) theory views transitions as dynamic, incorporating multiple contexts and multiple domains.Using MMT as our lens, we report a qualitative analysis of how transitions experienced by doctors during the pandemic impacted on social and cultural aspects of wellbeing. Methods: Longitudinal narrative inquiry was employed, using interviews and audio-diaries. Data were collected over 6 months in three phases: (i) interviews with doctors from across the career spectrum (n = 98); (ii) longitudinal audio-diaries for 2-4 months (n = 71); (iii) second interviews (n = 83). Data were analysed abductively, narrowing focus to factors important to social and cultural wellbeing. Results: Doctors described experiencing multiple interacting transitions triggered by the pandemic in multiple contexts (workplace, role, homelife and education). Patterns identifiable across the dataset allowed us to explore social and cultural wellbeing crosscutting beyond individual experience. Three critical factors contributed to social and cultural wellbeing both positively and negatively: being heard (e.g., by colleagues asking how they are); being valued (e.g., removal of rest spaces by organisations showing lack of value); and being supported (e.g., through regular briefing by education bodies). Conclusions: This study is the first to longitudinally explore the multiple-multidimensional transitions experienced by doctors during the COVID-19 pandemic. Our data analysis helped us move beyond existing perceptions around wellbeing and articulate multiple factors that contribute to social and cultural wellbeing. It is vital that medical educators consider the learning from these experiences to help pinpoint what aspects of support might be beneficial to trainee doctors and their trainers. This study forms the basis for developing evidenced-based interventions that ensure doctors are heard, valued and supported.

ObjectivesThe aim of this scoping review was to identify pre-existing interventions to support the well-being of healthcare workers during a pandemic or other crisis and to assess the quality of these interventions.DesignArksey and O’Malley’s five-stage scoping review framework was used to identify the types of evidence available in the field of well-being interventions for healthcare workers during a pandemic. PubMed, PsycINFO, Embase, Scopus, Web of Science, CINAHL and ERIC databases were searched to find interventions for the well-being of doctors during pandemics. Owing to a lack of results, this search was expanded to all healthcare workers and to include any crisis. Databases were searched in June 2020 and again in October 2020.Inclusion/exclusion criteriaArticles were included that studied healthcare workers, reported an intervention design and were specifically designed for use during a pandemic or other crisis. Well-being was defined broadly and could include psychological, physical, social or educational interventions.ResultsSearching produced 10 529 total academic references of which 2062 were duplicates. This left 8467 references. Of these, 16 met our inclusion criteria and were included in data extraction. During data extraction, three more papers were excluded. This left 13 papers to summarise and report. Of these 13 papers, 6 were prospective studies and 7 were purely descriptive. None of the interventions were theoretically informed in their development and the quality of the evidence was generally deemed poor.ConclusionsThere are no high-quality, theory-based interventions for the well-being of healthcare workers during a pandemic or other crisis. Given that previous pandemics have been shown to have a negative effect on healthcare workers well-being, it is imperative this shortcoming is addressed. This scoping review highlights the need for high-quality, theory-based and evidence-based interventions for the well-being of healthcare workers during a pandemic.

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