Tackling TB together : a community participatory study of the socio-cultural factors influencing an understanding of TB within the Somali community in Sheffield

This report presents the main findings from a study which sought to gain insight into the sociocultural influences on how TB is perceived within the Somali community and how these perspectives affect the prevention, diagnosis and treatment of the disease. The study also gained an understanding of healthcare practitioners’ perceptions of TB among the Somali community and their experiences of providing TB services to Somalis. A community participatory research approach was used which involved Somali community researchers and healthcare practitioners working in partnership with university researchers to design and conduct the research with the support of a community-based project advisory group. Data were collected by means of interviews and focus groups with Somali community leaders, patients suffering from TB, members of the wider Somali community, healthcare practitioners providing TB services and primary care practitioners. The findings identified a general awareness of TB among the Somali community in terms of the signs and symptoms of pulmonary TB, its treatment and prognosis. There was less understanding of nonpulmonary TB among Somali participants and some healthcare practitioners. Many Somalis lacked detailed understanding of how the disease was spread. Established community beliefs, for example that TB was a hereditary disease, or that it could be acquired by sharing eating utensils proved difficult for healthcare practitioners to challenge. Somali people spoke of how TB was perceived to be stigmatised within the Somali community. Whereas a person suffering from TB would generally share the diagnosis with their immediate family, concerns remained about the possibility of being ostracised by members of the wider community if knowledge of the disease became more widespread. This carried implications for contact tracing. However, attitudes towards TB were changing. Community leaders emphasised that as people became more knowledgeable about TB then the stigma would diminish but it was acknowledged that deeply held beliefs about the causes and consequences of TB would take some time to change. A number of barriers that hinder Somali people accessing TB services were identified. Some, like stigma, are embedded in cultural beliefs or are linked to socio-cultural activities such as chewing khat. A lack of trust and confidence in healthcare providers, especially some GPs arose from the protracted time it often took to diagnose TB. Healthcare practitioners lack of understanding of the Somali community and language barriers also hindered the uptake of primary care services. Several avenues through which culturally appropriate strategies targeted at minimising the spread of the disease, ensuring timely diagnosis and effective management of TB were identified. These are captured in the recommendations arising from the study which identify the need for a more proactive approach to raising awareness of TB within the Somali community and among primary care practitioners. Interpretations of TB are culturally bound and in order for TB services the better to meet the needs of the Somali community there is a need to develop greater awareness among healthcare practitioners of the needs of Somali patients and overcome linguistic barriers through improved access to interpreting services, especially in primary care

Observing the disintegration of the A68A iceberg from space

Icebergs impact the physical and biological properties of the ocean where they drift, depending on the degree of melting. We use satellite imagery and altimetry to quantify the area, thickness, and volume change of the massive A68A iceberg from its calving off the Larsen-C Ice Shelf in July 2017 until January 2021, when it disintegrated. A68A thinned from 235 ± 9 to 168 ± 10 m, on average, and lost 802 ± 34 Gt of ice in 3.5 years, 254 ± 17 Gt of which was through basal melting (a lower bound for the immediate fresh water input into the ocean). Basal melting peaked at 7.2 ± 2.3 m/month in the Northern Scotia Sea and an estimated 152 ± 61 Gt of freshwater was released off South Georgia, potentially altering the local ocean properties, plankton occurrence and conditions for predators

Luminescent Syllid (Odontosyllis sp.) Courtship Display Densities Vary Across Marine Habitats around South Water Caye, Belize

Bright—green luminescent clouds frequently occur at the surface of shallow waters of the Caribbean Sea. These clouds are produced by syllid polychaetes during courtship. Although temporal variation in the occurrence of these courtship displays has been documented throughout the diurnal and lunar cycle, other factors such as habitat type have not been well studied. In this study, we investigated how syllid courtship—display densities varied across 3 substrate types (grassbed, rubble and coral) over a 3 day period. In line with previous studies, we found that syllid courtship displays occurred over seagrass and rubble substrates; however, we also found that display densities were significantly higher over shallow coral substrates than over either seagrass or rubble habitats. These findings reflect published observations and newly collected observational data from other locations throughout the Caribbean. Future work across species, time and regions is required in order to better understand the factors underlying syllid display densities

An evaluation of the implementation of Advanced Nurse Practitioner (ANP) roles in an acute hospital setting.

Aim: To evaluate the impact of implementing Advanced Nurse Practitioner roles on patients, staff members and organizational outcomes in an acute hospital. Background: The worldwide development of advanced practice roles in nursing has been influenced by increasing demands and costs of health care. A key issue in the UK has been the reduction in hours junior doctors can work. While there is evidence these roles can have a positive impact in a variety of clinical specialties, little is known about the impact advanced nurses substituting for junior doctors can have on patients, staff members and organizational outcomes in general hospital care settings. Design: Collective case study. Methods: A collective case study in a district general hospital in England was undertaken in 2011–2012. Interviews with strategic stakeholders (n = 13) were followed by three individual case studies. Each case study represented the clinical area in which the roles had been introduced: medicine, surgery and orthopaedics and included interviews (n = 32) and non-participant observation of practice. Findings: The ANPs had a positive impact on patient experience, outcomes and safety. They improved staff knowledge, skills and competence and enhanced quality of working life, distribution of workload and team-working. ANPs contributed to the achievement of organizational priorities and targets and development of policy. Conclusion: ANPs undertaking duties traditionally performed by junior doctors in acute hospital settings can have a positive impact on a range of indicators relating to patients, staff members and organizational outcomes which are highly relevant to nursing

Nuclear Thermal Propulsion (NTP) and Power A New Capability for Outer Planet Science and Exploration

No abstract availabl

Health economic burden that wounds impose on the National Health Service in the UK

OBJECTIVE: To estimate the prevalence of wounds managed by the UK's National Health Service (NHS) in 2012/2013 and the annual levels of healthcare resource use attributable to their management and corresponding costs. METHODS: This was a retrospective cohort analysis of the records of patients in The Health Improvement Network (THIN) Database. Records of 1000 adult patients who had a wound in 2012/2013 (cases) were randomly selected and matched with 1000 patients with no history of a wound (controls). Patients' characteristics, wound-related health outcomes and all healthcare resource use were quantified and the total NHS cost of patient management was estimated at 2013/2014 prices. RESULTS: Patients' mean age was 69.0 years and 45% were male. 76% of patients presented with a new wound in the study year and 61% of wounds healed during the study year. Nutritional deficiency (OR 0.53; p<0.001) and diabetes (OR 0.65; p<0.001) were independent risk factors for non-healing. There were an estimated 2.2 million wounds managed by the NHS in 2012/2013. Annual levels of resource use attributable to managing these wounds and associated comorbidities included 18.6 million practice nurse visits, 10.9 million community nurse visits, 7.7 million GP visits and 3.4 million hospital outpatient visits. The annual NHS cost of managing these wounds and associated comorbidities was pound5.3 billion. This was reduced to between pound5.1 and pound4.5 billion after adjusting for comorbidities. CONCLUSIONS: Real world evidence highlights wound management is predominantly a nurse-led discipline. Approximately 30% of wounds lacked a differential diagnosis, indicative of practical difficulties experienced by non-specialist clinicians. Wounds impose a substantial health economic burden on the UK's NHS, comparable to that of managing obesity ( pound5.0 billion). Clinical and economic benefits could accrue from improved systems of care and an increased awareness of the impact that wounds impose on patients and the NHS.Ye

Visual pattern recognition as a means to optimising building performance?

Visual pattern recognition as a means to optimising building performance