Potential donor family behaviours, experiences and decisions following implementation of the Organ Donation (Deemed Consent) Act 2019 in England:A qualitative study

BACKGROUND: In May 2020, England implemented "deemed consent" legislation, to make it easier for individuals to donate their organs and convey their decision when alive. Families are supposed to support the decision but can still override it if they disagree. We aimed to learn more about this changed role when families were approached about organ donation.METHODS: A qualitative study using semi-structured interviews with families, feedback from nurses, comparisons with audit data, and public involvement. We used framework analysis with a health systems perspective and utilitarian theory to explore if the law worked.FINDINGS: 103 participants were interviewed representing 83 potential donation cases. In 31/83 (37%) cases donation was fully supported, in 41/83 (49%) cases families supported retrieval of some organs, tissues and procedures, and in 11/83 (13%) cases families declined completely. Themes explaining why the law was not (yet) working included: Understanding and agreeing the family's role, confusion about deemed consent, not supporting the deceased expressed decisions, organ donation as too much of a harm, the different experiences of donation pathways, transition from end-of-life to organ donation discussions, experiences of 'consent', paperwork and processes. Families frequently questioned if their relative wanted to have a surgery rather than supporting the person who died to save lives.CONCLUSION: Families use the unique experience of their relative dying in intensive care to create alternate narratives whereby the outcome satisfies their own utility and not necessarily those of the potential donor. New public ongoing media campaigns crafted to be more supportive of organ donation as a benefit to transplant recipients could help families overcome the many difficulties they encounter at the bedside.IMPLICATIONS FOR CLINICAL PRACTICE: The soft opt-out policy has not empowered nurses to help families at their most vulnerable to increase their support for and consent to deceased organ donation.</p

Investigating the relationship between language exposure and explicit and implicit language attitudes towards Welsh and English

Positive attitudes toward regional/minority languages are an essential precondition to language maintenance/revitalization. We investigate implicit and explicit attitudes toward Welsh and English and their relationship with childhood and adolescent age exposure among adult Welsh speakers from northwest Wales. Results indicate that implicit and explicit attitude constructs diverge and therefore bear differentially on language maintenance/revitalization.Specifically, comparing speaker data from the Language and Social Background Questionnaire with results from two independent studies, employing the Attitudes towards Languages (AToL) Scale and an Implicit Association Task respectively, we show that the implicit measure reveals a positive correlation between attitudes and exposure in primary school age. Conversely, the AToL returned no statistically significant factors, suggesting differential sensitivity of the explicit and implicit measures.We argue that an understanding of both types of attitude constructs, and attending to exposure levels especially as they relate to intergenerational transmission, is necessary to implement an effective language maintenance/revitalization strategy

Optimized Wide-Angle Metamaterial Edge Filters: Enhanced Performance with Multi-Layer Designs and Anti-Reflection Coatings

This study presents a systematic optimization of wide-angle metamaterial long-pass (LP) edge filters based on silicon nanospheres (SiNP). Multi-layered configurations incorporating SiNP-meta-films and anti-reflection coating (ARC) elements not previously considered in the literature are explored to enhance their filter performance in both stop and pass bands. This research has successfully developed an accurate model for the effective refractive index using Kramers–Kronig relations, enabling the use of classical thin-film design software for rapid device performance optimization, which is verified by full-wave numerical software. This systematic optimization has produced highly efficient, near-shift-free long-pass metamaterial filters, evidenced by their high optical density (OD = 2.55) and low spectral shift across a wide angular range (0°–60°). These advancements herald the development of high-efficiency metamaterial optical components suitable for a variety of applications that require a consistent performance across diverse angles of incidence

Evaluating the effects of the World Health Organization's online intervention ‘iSupport’ to reduce depression and distress in dementia carers: a multi-centre six-month randomised controlled trial in the UK

Background Sustaining the capabilities of dementia carers is a global priority. ‘iSupport’ is a self-guided onlineintervention designed by the World Health Organization (WHO) to reduce mental health problems in dementiacarers. iSupport is undergoing global implementation, however there is an absence of effectiveness evidence. Thisstudy tested the effectiveness of iSupport to reduce distress and depression in dementia carers.Methods A pragmatic randomised controlled trial was conducted in three centres. Adult carers (18+) living in thecommunity were recruited in England, Wales and Scotland and randomly assigned (1:1) through a web-basedsystem to iSupport or usual care. Outcome assessors were masked to allocation. The primary outcomesassessed the difference in distress and depression between baseline and six-months. The target sample sizewas 350 to enable 90% power, significance at 2.5% including 25% attrition (262 completers) on eitheroutcome. Analysis followed the intention-to-treat (ITT) principle. The trial was registered with ISRCTNregistry (17420703).Findings Between 12th November 2021 and 31st March 2023,177 carers (50.3%) were randomised to usual care and175 (49.7%) to iSupport. 263 (74.7%) completed the trial. All were included in the ITT analysis. Mean distress scoresat six-months were 20.0 (SD = 8.3) for usual care and 20.6 (SD = 8.6) for iSupport. The mean difference was 0.16 (95%CI −1.17 to 1.49, p = 0.29) after adjusting for covariates. Mean depression scores at six-months were 9.5 (SD = 7.0) forusual care and 9.8 (SD = 6.5) for iSupport. The mean difference at six-months was −0.54 (95% CI = −1.70 to 0.62,p = 0.44). No serious adverse events were linked to the trial.Interpretation To our knowledge this is the largest trial evaluating a self-guided online intervention in UK dementiacarers, and the first to successfully evaluate the effectiveness of iSupport. The null findings are significant given theongoing global implementation of iSupport by the WHO and the adoption of self-guided interventions intomainstream care delivery as part of digital health transformations.Funding NIHR

Converging evidence that left extrastriate body area supports visual sensitivity to social interactions

Navigating our complex social world requires processing the interactions we observe. Recent psychophysical and neuroimaging studies provide parallel evidence that the human visual system may be attuned to efficiently perceive dyadic interactions. This work implies, but has not yet demonstrated, that activity in body-selective cortical regions causally supports efficient visual perception of interactions. We adopt a multi-method approach to close this important gap. First, using a large fMRI dataset (N=92), we found that the left-hemisphere Extrastriate Body Area (EBA) responds more to face-to-face than non-facing dyads. Second, we replicated a behavioural marker of visual sensitivity to interactions: categorisation of facing dyads is more impaired by inversion than non-facing dyads. Third, in a pre-registered experiment, we used fMRI-guided transcranial magnetic stimulation to show that online stimulation of the left EBA, but not a nearby control region, abolishes this selective inversion effect. Activity in left EBA, thus, causally supports the efficient perception of social interactions

Exploring spatial and temporal resilience in socio-ecological systems: evidence from sacred forests in Epirus, Greece.

Socio‐ecological resilience is the capacity of a system to adapt to changing ecological and social disturbances. Its assessment is extremely important to integrate long‐term management of ecological and social features of natural ecosystems. This is especially true for Sacred Natural Sites, such as sacred forests and groves, where it can reveal the influence of social processes in ecosystem recovery or degradation. Using tree ages determined through dendrochronology and tree population size‐class distributions collected in five sacred forests in Epirus (NW Greece), we explore spatial and temporal dynamics of resilience in a socio‐ecological system, identifying which cultural and social elements characterize resilience in space and time. Our main results show that over past centuries sacred forests in Epirus underwent periods of varying tree establishment rate, depending on the intensity of human activities and historical disturbance events. We also identified strong evidence of the role of the social component (i.e. the church and associated cultural praxis) in determining the spatial extent of the forests' current recovery phase, and thus the overall resilience of the system. Policy implications. Appreciation of the ways sacred forests' ecological resilience is linked to changing socio‐cultural praxis over both temporal and spatial scales is crucial for guiding conservation and restoration strategies. We argue that greater attention should be paid to the role of the social component of socio‐ecological systems and specifically for sacred natural sites that provide both a nucleus of established forest habitat and the conditions necessary for forest recovery and restoration. Read the free Plain Language Summary for this article on the Journal blog

The Diagnostic Pathway Experiences of People Living with Rare Dementia and Their Family Caregivers: A Cross-Sectional Mixed Methods Study Using Qualitative and Economic Analyses

The pathways for receiving a diagnosis of a rare type of dementia are poorly understood. Diagnostic challenges decrease access to relevant health promotion activities and post-diagnostic support. This study was focused on pathways experienced by people affected by rare dementia in Wales, United Kingdom (UK), considering the practical, emotional, and economic consequences. Semi-structured interviews were completed with 10 people affected by rare dementia across Wales, UK (nine family caregivers and one person living with rare dementia). The interview data were subject to a thematic analysis and a bottom-up costing approach was used to cost the pathway journeys. Five transitional points occurred across the diagnostic pathway (initial contact, initial referral, further referrals—provider, further referrals—private, and diagnosis) alongside two further themes (i.e., involved in the diagnostic process and disputes between stakeholders). The timeliness of the diagnosis was perceived to often be subject to ‘luck’, with access to private healthcare a personal finance option to expedite the process. Higher economic costs were observed when, in retrospect, inappropriate referrals were made, or multiple referrals were required. The confusion and disputes relating to individual diagnostic pathways led to further emotional burdens, suggesting that higher economic costs and emotional consequences are interlinked. Clearer diagnostic pathways for rare dementia may prevent unnecessary service contacts, waiting times, and associated distress. Prioritising appropriate and timely service contacts leads to diagnosis and support to families and enables people to increase control over their health. Appropriate diagnostic pathways may be less costly and reduce costs for families

The impact of mobile demersal fishing on blue carbon in seabed sediments:Fisheries Industry Science Partnerships scheme (FISP) report

Seabed sediments are one of the largest stores of organic carbon, and as such are an important stock of natural capital as this process aids in carbon sequestration. Recent scientific papers have raised concern over the potential impacts of mobile bottom gears on sediment carbon, suggesting that bottom trawling leads to a remineralisation of this organic carbon, and therefore reducing net uptake of CO2 from the atmosphere. Empirical data on the effect of bottom fishing on seabed organic carbon and its potential to be mineralised are mixed in outcome, and so more empirical data in needed from a range of fishing gears and habitat types to fully inform any potential management decision. In April 2023 experimental fishing was conducted by a beam trawler and scallop dredger off the southwestern coast of England to measure how, and if, organic carbon in the sediment is affected if resuspended and subsequently remineralized. We found no clear evidence of reduction in organic carbon due to trawling and dredging in the low carbon (mean 0.13 % Corg), coarse sediments (sandy gravels) of the study area. Potential signals of sediment resuspension were observed, but no consistent or significant signals of clear organic carbon resuspension and remineralisation from the carbon and nutrient analysis on water samples were found. We suggest that the underlying sedimentary environment results in low organic carbon content with naturally high remineralisation rates, which made the experimental fishing conducted limited in its potential direct effect on sedimentary carbon and remineralisation, and the ability of detecting any potential fishing effect difficult to detect