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The purpose of this paper is to report on the implementation of the World Health Organization (WHO) trauma care checklist (TCC) (WHO, 2016) in an emergency department in a tertiary hospital in Nepal. This research was undertaken as part of a Hybrid International Emergency Medicine Fellowship programme (Subedi et al., 2020) across UK and Nepal, incorporating a two-year rotation through the UK National Health Service, via the Medical Training Initiative (MTI) (AoMRC, 2017). The WHO TCC can improve outcomes for trauma patients (Lashoher et al., 2016); however, significant barriers affect its implementation worldwide (Nolan et al., 2014; Wild et al., 2020). This article reports on the implementation, barriers and recommendations of WHO TCC implementation in the context of Nepal and argues for Transformational Leadership (TL) to support its implementation.

Explanatory mixed methods research (Creswell, 2014), comprising quasi-experimental research and a qualitative online survey, were selected methods for this research. A training module was designed and implemented for 10 doctors and 15 nurses from a total of 76 (33%) of clinicians to aid in the introduction of the WHO TCC in an emergency department in a hospital in Nepal. The quasi-experimental research involved a pre- and post-training survey aimed to assess participant’s knowledge of the WHO TCC before and after training and before the implementation of the WHO TCC in the emergency department. Post-training, 219 patients were reviewed after four weeks to identify if process measures had improved the quality of care to trauma patients. Subsequently six months later, a qualitative online survey was sent to all clinical staff in the department to identify barriers to implementation, with a response rate of 26 (n = 26) (34%) (20 doctors and 6 nurses). Descriptive statistics were used to evaluate quantitative data and the qualitative data were analysed using the five stepped approach of thematic analysis (Braun and Clarke, 2006).

The evaluation of the implementation of the WHO TCC showed an improvement in care for trauma patients in an emergency setting in a tertiary hospital in Nepal. There were improvements in the documentation in trauma management, showing the training had a direct impact on the quality of care of trauma patients. Notably, there was an improvement in cervical spine examination from 56.1% before training to 78.1%; chest examination 125 (57.07%) before training and 170 (77.62%) post-training; abdominal examination 121 (55.25%) before training and 169 (77.16%) post-training; gross motor examination 13 (5.93%) before training and 131 (59.82%) post-training; sensory examination 4 (1.82%) before training and 115 (52.51%) post-training; distal pulse examination 6 (2.73%) before training and 122 (55.7%) post-training. However, while the quality of documentation for trauma patients improved from the baseline of 56%, it only reached 78% when the percentage improvement target agreed for this research project was 90%. The 10 (n = 10) doctors and 15 (n = 15) nurses in the Emergency Department (ED) all improved their baseline knowledge from 72.2% to 87% (p = 0.00006), by 14.8% and 67% to 85%) (p = 0.006), respectively. Nurses started with lower scores (mean 67) in the baseline when compared to doctors, but they made significant gains in their learning post-training. The qualitative data reported barriers, such as the busyness of the department, with residents and medical officers, suggesting a shortened version of the checklist to support greater protocol compliance. Embedding this research within TL provided a steer for successful innovation and change, identifying action for sustaining change over time.

The study is a single-centre study that involved trauma patients in an emergency department in one hospital in Nepal. There is a lack of internationally recognised trauma training in Nepal and very few specialist trauma centres; hence, it was challenging to teach trauma to clinicians in a single 1-h session. High levels of transformation of health services are required in Nepal, but the sample for this research was small to test out and pilot the protocol to gain wider stakeholder buy in. The rapid turnover of doctors and nurses in the emergency department, creates an additional challenge but encouraging a multi-disciplinary approach through TL creates a greater chance of sustainability of the WHO TCC.

International protocols are required in Nepal to support the transformation of health care. This explanatory mixed methods research, which is part of an International Fellowship programme, provides evidence of direct improvements in the quality of patient care and demonstrates how TL can drive improvement in a low- to medium-income country.

The Nepal/UK Hybrid International Emergency Medicine Fellowships have an opportunity to implement changes to the health system in Nepal through research, by bringing international level standards and protocols to the hospital to improve the quality of care provided to patients.

To the best of the authors’ knowledge, this research paper is one of the first studies of its kind to demonstrate direct patient level improvements as an outcome of the two-year MTI scheme.

Hazel Kyrk’s contribution is the most advanced formulation of the economics of consumption as a social phenomenon, an approach to the analysis of consumption that, originated from Veblen’s theory, was developed in the US in the early 20th century. This approach was part of a wider stream of empirical analyses of consumption expenditure that had begun more than a century earlier.

Along with elements that can be traced back to the neoclassical tradition, in Keynes’ analysis of consumption, we find original elements. The dependence of consumption expenditure on the level of income, which is essential for asserting the principle of effective demand, can also be found in a long tradition of empirical studies. In qualifying this relationship, Keynes uses theoretical elements echoing key insights of the economics of consumption as a social phenomenon. There is no documentary evidence that Kyrk or the economics of the social relevance of consumption came to Keynes’ attention. It is possible, however, to develop reasonable speculative considerations to argue a link between Keynes’ elaboration and both the empirical literature on the determinants of consumption and the economics of consumption as a social phenomenon.

In the years following the publication of A Theory of Consumption (1923), Hazel Kyrk’s book became the flagship of the field that would later be known as the economics of consumption. It stimulated theoretical and empirical work on consumption. Some of the existing literature on Kyrk (e.g., Kiss & Beller, 2000; Le Tollec, 2020; Tadajewski, 2013) depicted her theory as the starting point of the economics of consumption. Nevertheless, how and why it emerged the way it did remain largely unexplored. This chapter examines Kyrk’s intellectual background, which, we argue, can be traced back to two main movements in the United States: the home economics and the institutionalist. Both movements conveyed specific endeavors as responses to the US material and social transformations that occurred at the turn of the 20th century, notably the perceived changing role of consumption and that of women in US society. On the one hand, Kyrk pursued first-generation home economists’ efforts to make sense of and put into action the shifting of women’s role from domestic producer to consumer. On the other hand, she reinterpreted Veblen’s (1899) account of consumption in order to reveal its operational value for a normative agenda focused on “wise” and “rational” consumption. This chapter studies how Kyrk carried on first-generation home economists’ progressive agenda and how she adapted Veblen’s fin-de-siècle critical account of consumption to the context of the household goods developed in 1900–1920. Our account of Kyrk’s intellectual roots offers a novel narrative to better understand the role of gender and epistemological questions in her theory.

Globally, hepatitis C treatment uptake is lower among people who are homeless or unstably housed compared to those who are housed. Understanding and addressing this is essential to ensure no one is left behind in hepatitis C elimination efforts. This study aims to explore peoples’ experiences of unstable housing and health care, and how these experiences influenced engagement in hepatitis C treatment.

Purposive sampling was used to recruit people with lived experience of injection drug use, hepatitis C and unstable housing in Melbourne, Australia. In-depth semistructured interviews were conducted and a case study approach with interpretative phenomenological analysis was used to identify personal experiential themes and group experiential themes.

Four people were interviewed. The precarious nature of housing for women who inject drugs was a group experiential theme, however, this did not appear to be a direct barrier to hepatitis C treatment. Rather, competing priorities, including caregiving, were personal experiential themes and these created barriers to treatment. Another group experiential theme was “right place, right time, right people” with these three elements required to facilitate hepatitis C treatment.

There is limited research providing in-depth insight into how personal experiences with unstable housing and health care shape engagement with hepatitis C treatment. The analyses indicate there is a need to move beyond a “one size fits-all” approach to hepatitis C care. Instead, care should be tailored to the needs of individuals and their personal circumstances and regularly facilitated. This includes giving greater attention to gender in intervention design and evaluation, and research more broadly.

Although situational crisis communication theory (SCCT) is centered on rationality and cognitive information processing, it ignores that people are also driven by irrationality and non-cognitive information processing. The purpose of this study aims to fill this gap by examining how gender stereotypes, based on perceived spokesperson sex influence the public’s perceptions of crisis response messages.

A 2 (industry type: automotive vs daycare industry) × 2 (spokesperson’s sex: male vs female) × 2 (crisis response appeal: rational vs emotional) between-subject online experiment was conducted to examine the effect of gender stereotype in crisis communication.

Results showed that either matching spokesperson sex with sex differed industry or matching sex differed industry with appropriate crisis response appeal can generate a more positive evaluation of the spokesperson and the organization. The results also revealed under which circumstances, the attractiveness of different sex of the spokesperson can either promote or mitigate people’s perceptions of the organization. Furthermore, when people are aware of a spokesperson’s sex, in a female-associated industry, a mismatching effect of a positive violation of a male-related stereotype overrides a matching effect of a female-related stereotype in crisis communication.

This study is among the first to identify how the gender of a spokesperson and industry type affect publics’ crisis response.