Critical review of leaflets about conservative management used in UK renal services

Background: Written information supplements nurse‐led education about treatment options. It is unclear if this information enhances patients’ reasoning about conservative management (CM) and renal replacement therapy decisions. Aim: This study describes a critical review of resources U.K. renal staff use when providing CM options to people with Established Kidney Disease (EKD) during usual pre‐dialysis education. Design: A survey using mixed methods identified and critically analysed leaflets about CM. Participants & measurements: All 72 renal units in the United Kingdom received an 11‐item questionnaire to elicit how CM education is delivered, satisfaction and/or needs with patient resources and staff training. Copies of leaflets were requested. A coding frame was utilised to produce a quality score for each leaflet. Results: Fifty‐four (75%) units participated. Patients discuss CM with a nephrologist (98%) or nurse (100%). Eighteen leaflets were reviewed, mean scores were 8.44 out of 12 (range 5–12, SD = 2.49) for information presentation; 3.50 out of 6 (range 0–6, SD = 1.58) for inclusion of information known to support shared decision‐making and 2.28 out of 6 (range 1–4, SD = 0.96) for presenting non‐biased information. Conclusions: Nurses preferred communicating via face‐to‐face contact with patients and/or families because of the emotional consequences and complexity of planning treatment for the next stage of a person's worsening kidney disease. Conversations were supplemented with written information; 66% of which were produced locally. Staff perceived a need for using leaflets, and spend time and resources developing them to support their services. However, no leaflets included the components needed to help people reason about conservative care and renal replacement therapy options during EKD education consultations

Dialysis vs conservative management decision aid: a study protocol

When patients' kidney function deteriorates to chronic kidney disease stage 5, services offer patients a choice for the next phase of their care. Renal replacement therapies may not have survival benefits, and conservative management may have less treatment burden for older patients with associated comorbidities or frailty. Anna E Winterbottom et al discuss the development of a patient decision aid

An enigmatic hypoplastic defect of the maxillary lateral incisor in recent and fossil orangutans from Sumatra (Pongo abelii) and Borneo (Pongo pygmaeus)

Developmental dental pathologies provide insight into health of primates during ontogeny, and are particularly useful for elucidating the environment in which extant and extinct primates matured. Our aim is to evaluate whether the prevalence of an unusual dental defect on the mesiolabial enamel of the upper lateral incisor, thought to reflect dental crowding during maturation, is lesser in female orangutans, with their smaller teeth, than in males; and in Sumatran orangutans, from more optimal developmental habitats, than in those from Borneo. Our sample includes 49 Pongo pygmaeus (87 teeth), 21 P. abelii (38 teeth), Late Pleistocene paleo-orangutans from Sumatra and Vietnam (67 teeth), Late Miocene catarrhines Lufengpithecus lufengensis (2 teeth), and Anapithecus hernyaki (7 teeth). Methods include micro-CT scans, radiography, and dental metrics of anterior teeth. We observed fenestration between incisor crypts and marked crowding of unerupted crowns, which could allow tooth-to-tooth contact. Tooth size does not differ significantly in animals with or without the defect, implicating undergrowth of the jaw as the proximate cause of dental crowding and defect presence. Male orangutans from both islands show more defects than do females. The defect is significantly more common in Bornean orangutans (71 %) compared to Sumatran (29 %). Prevalence among fossil forms falls between these extremes, except that all five individual Anapithecus show one or both incisors with the defect. We conclude that maxillary lateral incisor defect is a common developmental pathology of apes that is minimized in optimal habitats and that such evidence can be used to infer habitat quality in extant and fossil apes

Fostering appropriate behaviour in rehabilitant orangutans (Pongo pygmaeus)

Rehabilitation centres in Indonesia and Malaysia accommodate displaced orangutans (Pongo pygmaeus and P. abelii) and aim to facilitate their release into the wild by developing in them the skills that are necessary for survival. Regular forest excursions are provided but their efficacy in improving learning of appropriate behaviours is unknown. We observed forty rehabilitating orangutans from the Orangutan Care and Quarantine Centre during three forest excursions each to determine whether their behaviour fostered the development of survival skills. In total 38% of their time was spent in locomotion, particularly quadrupedal arboreal travel (13%), walking (8%), climbing (7%) and vine-swinging (4%). 26.5% of their time was spent 5 m or more from the ground, at heights up to 25 m. Arboreal activities were more 2 common early in the excursions and interaction with c are-givers more common later (hour 1: 0.3% of time; hour 5: 0.9% of time). Animals of lower body weight were significantly more likely to engage in arboreal movement, locomotion in general, eating of bark and leaves, and social play, and less likely to eat insects. Those that had been at the Centre the longest were less likely to perform arboreal activities and significantly more likely to be found standing and at ground level, than those that were there for a shorter time. During this study, many forest food items were consumed, particularly leaves and fruit, but also invertebrates and bark. Little time was spent in sexual behaviour, tool use, nest building or socially-mediated learning, but social play occupied almost 6% of their time. We conclude that regular excursions into the forest are likely to assist in the development of locomotion and feeding skills for survival in rehabilitating orangutans, but special attention is needed to encourage nest building, social activities and arboreal activity. Animals least likely to benefit are heavy animals and those that have been captive for a long time

Using Simulation Models to Evaluate Ape Nest Survey Techniques

BACKGROUND: Conservationists frequently use nest count surveys to estimate great ape population densities, yet the accuracy and precision of the resulting estimates are difficult to assess. METHODOLOGY/PRINCIPAL FINDINGS: We used mathematical simulations to model nest building behavior in an orangutan population to compare the quality of the population size estimates produced by two of the commonly used nest count methods, the 'marked recount method' and the 'matrix method.' We found that when observers missed even small proportions of nests in the first survey, the marked recount method produced large overestimates of the population size. Regardless of observer reliability, the matrix method produced substantial overestimates of the population size when surveying effort was low. With high observer reliability, both methods required surveying approximately 0.26% of the study area (0.26 km(2) out of 100 km(2) in this simulation) to achieve an accurate estimate of population size; at or above this sampling effort both methods produced estimates within 33% of the true population size 50% of the time. Both methods showed diminishing returns at survey efforts above 0.26% of the study area. The use of published nest decay estimates derived from other sites resulted in widely varying population size estimates that spanned nearly an entire order of magnitude. The marked recount method proved much better at detecting population declines, detecting 5% declines nearly 80% of the time even in the first year of decline. CONCLUSIONS/SIGNIFICANCE: These results highlight the fact that neither nest surveying method produces highly reliable population size estimates with any reasonable surveying effort, though either method could be used to obtain a gross population size estimate in an area. Conservation managers should determine if the quality of these estimates are worth the money and effort required to produce them, and should generally limit surveying effort to 0.26% of the study area, unless specific management goals require more intensive sampling. Using site- and time- specific nest decay rates (or the marked recount method) are essential for accurate population size estimation. Marked recount survey methods with sufficient sampling effort hold promise for detecting population declines

Recent Surveys in the Forests of Ulu Segama Malua, Sabah, Malaysia, Show That Orang-utans (P. p. morio) Can Be Maintained in Slightly Logged Forests

BACKGROUND: Today the majority of wild great ape populations are found outside of the network of protected areas in both Africa and Asia, therefore determining if these populations are able to survive in forests that are exploited for timber or other extractive uses and how this is managed, is paramount for their conservation. METHODOLOGY/PRINCIPAL FINDINGS: In 2007, the "Kinabatangan Orang-utan Conservation Project" (KOCP) conducted aerial and ground surveys of orang-utan (Pongo pygmaeus morio) nests in the commercial forest reserves of Ulu Segama Malua (USM) in eastern Sabah, Malaysian Borneo. Compared with previous estimates obtained in 2002, our recent data clearly shows that orang-utan populations can be maintained in forests that have been lightly and sustainably logged. However, forests that are heavily logged or subjected to fast, successive coupes that follow conventional extraction methods, exhibit a decline in orang-utan numbers which will eventually result in localized extinction (the rapid extraction of more than 100 m(3) ha(-1) of timber led to the crash of one of the surveyed sub-populations). Nest distribution in the forests of USM indicates that orang-utans leave areas undergoing active disturbance and take momentarily refuge in surrounding forests that are free of human activity, even if these forests are located above 500 m asl. Displaced individuals will then recolonize the old-logged areas after a period of time, depending on availability of food sources in the regenerating areas. CONCLUSION/SIGNIFICANCE: These results indicate that diligent planning prior to timber extraction and the implementation of reduced-impact logging practices can potentially be compatible with great ape conservation

Outcomes of orangutan wild-to-wild translocations reveal conservation and welfare risks.

Wild orangutans (Pongo spp.) are captured and moved (wild-to-wild translocated) primarily to prevent crop foraging or out of concern for orangutans' survival in fragmented habitat. Little is known about wild-to-wild translocation frequency, circumstances, and possible species conservation and individual welfare outcomes. We investigated orangutan wild-to-wild translocations in Indonesia from 2005 to 2022 using primarily data from public sources and consultation with practitioners. At least 988 wild orangutans were captured for translocation during the study period, including many reproductively valuable resident females and adult males removed from unprotected fragmented forests and forest patches. Data on health condition (n = 808) indicated 81.7% were reported as healthy at time of capture. Information on post-capture disposition (n = 268) showed that only 23% were translocated immediately. Mean estimated killing combined with reported translocation removals was calculated to affect 3.3% of orangutans in Kalimantan, and 11.6% in Sumatra, both higher than the threshold of mortality from human actions expected to drive populations to extinction. Negative impacts are likely compounded where multiple individuals are translocated from the same area, and for the Tapanuli orangutan (P. tapanuliensis), which has the smallest population and range of all orangutan species. Data on reasons for capture (n = 743) indicated most translocations (69%) were conducted to address crop foraging and orangutan presence in or around croplands and plantations. Forest cover analysis around 104 orangutan capture sites with high resolution spatial information indicated that deforestation levels in the year preceding capture were not significantly associated with likelihood of captures for translocation. To improve conservation outcomes, wild-to-wild translocations should be used only in exceptional circumstances. Most orangutans should instead be monitored and protected in situ by addressing conflicts and maintaining the forests, including forest fragments, they are using. When translocation is necessary, post-release survival and potential conservation impacts must be monitored