Seasonal variation of zooplankton nutritional quality at a reef! Manta Ray (Mobula alfredi) Feeding ground on Ningaloo Reef

Zooplankton provide a fundamental connection between primary producers and higher trophic level consumers, supporting some of the largest marine animals as well as microbial organisms. Therefore, the nutritional resource of zooplankton must be sufficient to support a wide array of marine species. The nutritional quality (lipids, protein and carbohydrates) varies seasonally with changes in species composition, as different organisms store varying amounts of biochemical components. These seasonal variations have direct effects on the marine food web, and those organisms that rely upon the nutritional resource. Zooplankton has a spatiotemporally patchy distribution, with variations in species composition. This is reflected by the variability of each biochemical component when comparing regions around the world. This study aimed to quantify the seasonal proportions of zooplankton nutritional components at Bateman Bay, Ningaloo Reef in Western Australia, in order to determine what planktivorous fish such as reef manta rays (Mobula'alfredi) are receiving year round. Feeding manta rays were used to locate patches of plankton, and samples were collected via towing a 300 μm mesh plankton net from the back of a boat. Samples were collected from four sites in autumn and three sites in winter. All samples were analysed for lipids, protein, carbohydrates, total organic carbon and nitrogen (C:N ratio) and biomass. All nutritional components varied significantly between seasons, and each site showed compositional variability, especially protein. Protein and lipids were significantly higher during autumn than winter, while carbohydrates were higher during winter. The C:N ratio was significantly higher during winter, when phytoplankton abundance was higher. Biomass was larger in winter when there was a greater abundance of portunid crab larvae, eggs and phytoplankton, however was not statistically significant. Environmental variables; temperature, turbidity and tide had no correlation to zooplankton biomass, nutritional value and reef manta ray feeding. However, greater nutritional quantities were found when manta rays were feeding, and the highest biomass was recorded when the largest feeding aggregation of reef manta rays was observed. This study has provided insight into the biochemical composition of mixed zooplankton populations around Bateman Bay, Ningaloo Reef in autumn and winter. It appears that manta rays match their distribution to the zooplankton, and nutritional quantities proved to be higher during warmer temperatures. However, additional year-round sampling is recommended for future studies, in order to better understand these preliminary findings. Knowledge of how manta rays rely on areas with high nutritional value will help to explain seasonal variations in reef manta ray visitation, and provide management implications for the conservation of this species

Overdetection in breast cancer screening: Development and preliminary evaluation of a decision aid

Objective: To develop, pilot and refine a decision aid (ahead of a randomised trial evaluation) for women around age 50 facing their initial decision about whether to undergo mammography screening. Design: Two-stage mixed-method pilot study including qualitative interviews (n=15) and a randomised comparison using a quantitative survey (n=34). Setting: New South Wales, Australia. Participants: Women aged 43–59 years with no personal history of breast cancer. Interventions: The decision aid provides evidence-based information about important outcomes of mammography screening over 20 years (breast cancer mortality reduction, overdetection and false positives) compared with no screening. The information is presented in a short booklet for women, combining text and visual formats. A control version produced for the purposes of comparison omits the overdetection-related content. Outcomes: Comprehension of key decision aid content and acceptability of the materials. Results: Most women considered the decision aid clear and helpful and would recommend it to others. Nonetheless, the piloting process raised important issues that we tried to address in iterative revisions. Some participants found it hard to understand overdetection and why it is of concern, while there was often confusion about the distinction between overdetection and false positives. In a screening context, encountering balanced information rather than persuasion appears to be contrary to people’s expectations, but women appreciated the opportunity to become better informed. Conclusions: The concept of overdetection is complex and new to the public. This study highlights some key challenges for communicating about this issue. It is important to clarify that overdetection differs from false positives in terms of its more serious consequences (overtreatment and associated harms). Screening decision aids also must clearly explain their purpose of facilitating informed choice. A staged approach to development and piloting of decision aids is recommended to further improve understanding of overdetection and support informed decision-making about screening.National Health and Medical Research Counci

Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study

Background In the UK, concerns about safety and fragmented community mental health care led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require service users to have a care coordinator, written care plan and regular reviews of their care. Processes are required to be collaborative, recovery-focused and personalised but have rarely been researched. We aimed to obtain the views and experiences of stakeholders involved in community mental health care and identify factors that facilitate or act as barriers to personalised, collaborative, recovery-focused care. Methods We conducted a cross-national comparative study employing a concurrent transformative mixed-methods approach with embedded case studies across six service provider sites in England and Wales. The study included a survey of views on recovery, empowerment and therapeutic relationships in service users (n = 448) and recovery in care coordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117) and a review of care plans (n = 33). Quantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and framework method. Results Significant differences were found across sites for scores on therapeutic relationships. Variation within sites and participant groups was reported in experiences of care planning and understandings of recovery and personalisation. Care plans were described as administratively burdensome and were rarely consulted. Carers reported varying levels of involvement. Risk assessments were central to clinical concerns but were rarely discussed with service users. Service users valued therapeutic relationships with care coordinators and others, and saw these as central to recovery. Conclusions Administrative elements of care coordination reduce opportunities for recovery-focused and personalised work. There were few common understandings of recovery which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work. Research to investigate innovative approaches to maximise staff contact time with service users and carers, shared decision-making in risk assessments, and training designed to enable personalised, recovery-focused care coordination is indicated

Development and Validation of a Measure of Birth-Related PTSD for Fathers and Birth Partners: The City Birth Trauma Scale (Partner Version)

Research suggests that some fathers and birth partners can experience post-traumatic stress disorder (PTSD) after witnessing a traumatic birth. Birth-related PTSD may impact on many aspects of fathers’ and birth partners’ life, including relationship breakdown, self-blame and reducing plans for future children. Despite the potential impact on birth partners’ lives there is currently no measure of birth-related PTSD validated for use with birth partners. The current study therefore adapted the City Birth Trauma Scale for use with birth partners. The City Birth Trauma Scale (Partner version) is a 29-item questionnaire developed to measure birth-related PTSD according to DSM-5 criteria: stressor criteria (A), symptoms of re-experiencing (B), avoidance (C), negative cognitions and mood (D), and hyperarousal (E), as well as duration of symptoms (F), significant distress or impairment (G), and exclusion criteria or other causes (H). A sample of 301 fathers/birth partners was recruited online and completed measures of birth-related PTSD, bonding, and demographic details. Results showed the City Birth Trauma Scale (Partner version) had good reliability (α = 0.94) and psychometric and construct validity. The fathers/birth partners version has the same two-factor structure as the original scale: (1) general symptoms and (2) birth-related symptoms, which accounted for 51% of the variance. PTSD symptoms were associated with preterm birth and maternal and infant complications. Overall, the City Birth Trauma Scale (Partner version) provides a promising measure of PTSD following childbirth that can be used in research and clinical practice

Walking the tightrope: communicating overdiagnosis in modern healthcare

Overdiagnosis and overtreatment have serious implications for individuals, healthcare systems, and society,1 2 and effective strategies are urgently needed to help the public, clinicians, and policy makers address this problem. Communication about overdiagnosis has been highlighted as essential for moving forward but presents several challenges, such as the potential to confuse the public, undermine trust, and adversely affect people who already have a diagnosis. Various communication based strategies offer real promise; we describe what is known and what we need to know to communicate effectively and safely about overdiagnosis and overtreatment. Key messages: Overdiagnosis provides no benefits to patients and is a challenge to the sustainability of modern healthcare systems Communication based strategies could help reduce overdiagnosis and its negative impact on individuals and health systems Mass media education, shared decision making, terminology changes for disease states, and deliberative methods (juries) all have potential as effective communication strategiesKJMcC is supported by a National Health and Medical Research Council (NHMRC) career development fellowship (1029241), JJ is supported by an NHMRC early career fellowship (1037028), and. JW is supported by a career development fellowship from Cancer Research UK (C7492/A17219)

Seeking help for perinatal psychological distress: a meta-synthesis of women's experiences

Background Women may not seek help for perinatal psychological distress, despite regular contact with primary care services. Barriers include ignorance of symptoms, inability to disclose distress, others’ attitudes, and cultural expectations. Much of the evidence has been obtained from North American populations and may not, therefore, extrapolate to the UK. Aim To understand the factors affecting women’s decision to seek help for perinatal distress. Design and setting Meta-synthesis of the available published qualitative evidence on UK women’s experiences of seeking help for perinatal distress. Method Systematic searches were conducted in accordance with PRISMA guidelines. Databases searched were PubMed, Scopus, PsycINFO, PsycARTICLES, CINAHL, and Academic Search Complete. Searches of grey literature and references were also conducted. Studies were eligible for inclusion if they reported qualitative data on UK women’s experiences of perinatal distress and contact with healthcare professionals. The synthesis was conducted using meta-ethnography. Results In all, 24 studies were eligible for inclusion. Metasynthesis identified three main themes: identifying a problem, the influence of healthcare professionals, and stigma. These themes build on current understanding of help seeking by identifying the need for women to be able to frame their experience, for healthcare professionals to educate women about their roles, the need for continuity of care, and the way that being seen as a ‘bad mother’ causes women to self-silence. Conclusion Perinatal care provision needs to allow for continuity of care and for staff training that facilitates awareness of factors that influence women’s help seeking. Further research is required, particularly in relation to effective means of identifying perinatal psychological distress

Heart Rate and Energy Expenditure Concurrent Validity of Identical Garmin Wrist Watches During Moderately Heavy Resistance Training

Consistent with previous years, ACSM has found that wearable technology and resistance training (RT) are two of the top 5 fitness trends in 2023. Our lab recently found that wrist-worn devices, such as Garmin Instinct, are neither valid nor reliable at measuring average or maximal heart rate (HR) or estimating energy expenditure (EE) following light intensity circuit RT. We postulated that the errors may have been due to the device’s algorithms assuming higher intensity during RT. PURPOSE: The purpose of this study was to determine the concurrent validity of identical Garmin Instinct wrist-watches to record valid measures of average and maximal HR as well as estimated EE following moderately heavy RT. METHODS: Twenty-one adult participants completed this study (n=10 female, n=11 male). Two Garmin Instinct wrist-watches were evaluated, along with the Polar H10 chest strap and Cosmed K5 portable metabolic unit as the criterion devices for average/maximal HR and EE, respectively. Participants completed 8 supersets of the reverse lunge and shoulder press exercises using dumbbells at a light (4 sets) and moderately heavy (4 sets) intensity with 1 superset of 6 repetitions per exercise (12 repetitions per superset) and 1 min rest between supersets. Data were analyzed for validity (Mean Absolute Percent Error [MAPE] and Lin’s Concordance Coefficient [CCC]), with predetermined thresholds of MAPE\u3c10% and CCC\u3e0.70. A one-way repeated measures ANOVA with Sidak post-hoc test was used to determine differences (p\u3c0.05). RESULTS: The identical Garmin Instinct devices were not considered valid for average HR (MAPE range: 36.5-81.6%; CCC range: 0.07-0.18), maximal HR (MAPE range: 18.6-18.8%; CCC range: 0.15-0.31), or estimated EE (MAPE range: 14.0-16.4%; CCC range: 0.08-0.32) compared to the criterion references. The devices were significantly different than each other for average HR (p=0.005), maximal HR (p\u3c0.001), and estimated EE (p\u3c0.0001). CONCLUSION: The wearable wrist-worn devices tested herein should not be utilized for accurate measurements of HR or EE during RT, and there are even differences between identical devices. People who RT while using these devices should do so with caution if wishing to utilize them for physiological measures

Cross-national mixed methods comparative case study of recovery-focused mental health care planning and coordination in acute inpatient mental health settings (COCAPP-A)

Background Mental health service users in acute inpatient wards, whether informal or detained, should be involved in planning and reviewing their care. Care planning processes should be personalised and focused on recovery, with goals that are specific to the individual and designed to maximise their achievements and social integration. Objective(s) We aimed to ascertain the views and experiences of service users, carers and staff to enable us to identify factors that facilitated or acted as barriers to collaborative, recovery-focused care and to make suggestions for future research. Design A cross-national comparative mixed-methods study involving 19 mental health wards in six NHS sites in England and Wales included a metanarrative synthesis of policies and literature; a survey of service users (n = 301) and staff (n = 290); embedded case studies involving interviews with staff, service users and carers (n = 76); and a review of care plans (n = 51) and meetings (n = 12). Results No global differences were found across the sites in the scores of the four questionnaires completed by service users. For staff, there was significant difference between sites in mean scores on recovery-orientation and therapeutic relationships. For service users, when recovery-orientated focus was high, the quality of care was viewed highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Across all sites, staff’s scores were significantly higher than service users’ scores on the scale to assess therapeutic relationships. Staff across the sites spoke of the importance of collaborative care planning. However, the staff, service user and carer interviews revealed gaps between shared aspirations and realities. Staff accounts of routine collaboration contrasted with service user accounts and care plan reviews. Definitions and understandings of recovery varied, as did views of the role of hospital care in promoting recovery. ‘Personalisation’ was not a familiar term, although there was recognition that care was often provided in an individualised way. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent. Conclusions Our results suggest that there is positive practice taking place within acute inpatient wards, with evidence of widespread commitment to safe, respectful, compassionate care. Although ideas of recovery were evident, there was some uncertainty about and discrepancy in the relevance of recovery ideals to inpatient care and the ability of people in acute distress to engage in recovery-focused approaches. Despite the fact that staff spoke of efforts to involve them, the majority of service users and carers did not feel that they had been genuinely involved, although they were aware of efforts to keep them safe. Future work Future research should investigate approaches that increase contact time with service users and promote personalised, recovery-focused working; introduce shared decision-making in risk assessment and management; and improve service user experiences of care planning and review and the use of recovery-focused tools during inpatient care. Funding The National Institute for Health Research Health Services and Delivery Research programme