Engaging with the Scottish Government's agenda on health and social care.

Outside of SF circles, SF remains relatively unknown. The Scottish Solution Focused Network (SSFN) is an organisation of SF practitioners established to support and promote SF practice in Scotland. In this paper, the authors discuss their recent thinking, derived from a series of conversations within the SSFN, on how their organisation can engage with one aspect of the Scottish Government's (formerly known as the Scottish Executive) strategy for health and wellbeing. They argue that SF practitioners in this field have a moral obligation to engage in political discourse, and that in Scotland, the Government are actively promoting SF methodologies in practice

Estimating ecological metrics for holistic conservation management in a biodiverse but information‐poor tropical region

Conservation ecologists face the dual challenge of working with difficult‐to‐study species and providing ecological metrics that support conservation management at global, regional, and local levels. We present metrics identifying distributions, site‐level and global abundance, site‐contextualized habitat requirements, and threats for seven dry forest endemic birds (two threatened, one Near Threatened) in the globally important Tumbes region of Peru. Extents of occurrence ranged from 36,000 to 152,000 km2, and while broad distributions were generally congruent, nearly half of species overlapped 150,000. Site‐level population estimates varied hugely, reflecting size of site and extreme variation in local abundances. Large tree girths and dense low cover generally promoted bird abundance, but stem density acted in opposite directions for different species, implying the need for site‐ and species‐specific habitat management. Habitat quality varied across sites, further complicating management options at the local level (e.g., reduced grazing). We highlight the suitability of our methods in providing useful conservation metrics for data‐poor regions, and demonstrate their application. Importantly, we propose key sites and priority actions for the region, including extensions of existing protected areas

Outreach Strategies to Recruit Low-Income African American Men to Participate in Health Promotion Programs and Research: Lessons From the Men of Color Health Awareness (MOCHA) Project

African American men continue to bear a disproportionate share of the burden of disease. Engaging these men in health research and health promotion programs—especially lower-income, African American men who are vulnerable to chronic disease conditions such as obesity and heart disease—has historically proven quite difficult for researchers and public health practitioners. The few effective outreach strategies identified in the literature to date are largely limited to recruiting through hospital clinics, churches, and barbershops. The Men of Color Health Awareness (MOCHA) project is a grassroots, community-driven initiative that has developed a number of innovative outreach strategies. After describing these strategies, we present data on the demographic and health characteristics of the population reached using these methods, which indicate that MOCHA has been highly effective in reaching this population of men

Nurse clinic versus home delivery of evidence-based community leg ulcer care: A randomized health services trial

BACKGROUND: International studies report that nurse clinics improve healing rates for the leg ulcer population. However, these studies did not necessarily deliver similar standards of care based on evidence in the treatment venues (home and clinic). A rigorous evaluation of home versus clinic care is required to determine healing rates with equivalent care and establish the acceptability of clinic-delivered care. METHODS: Health Services RCT was conducted where mobile individuals were allocated to either home or nurse clinic for leg ulcer management. In both arms, care was delivered by specially trained nurses, following an evidence protocol. Primary outcome: 3-month healing rates. Secondary outcomes: durability of healing (recurrence), time free of ulcers, HRQL, satisfaction, resource use. Data were collected at base-line, every 3 months until healing occurred, with 1 year follow-up. Analysis was by intention to treat. RESULTS: 126 participants, 65 randomized to receive care in their homes, 61 to nurse-run clinics. No differences found between groups at baseline on socio-demographic, HRQL or clinical characteristics. mean age 69 years, 68% females, 84% English-speaking, half with previous episode of ulceration, 60% ulcers at inclusion < 5 cm(2 )for < 6 months. No differences in 3-month healing rates: clinic 58.3% compared to home care at 56.7% (p = 0.5) or in secondary outcomes. CONCLUSION: Our findings indicate that organization of care not the setting where care is delivered influences healing rates. Key factors are a system that supports delivery of evidence-based recommendations with care being provided by a trained nursing team resulting in equivalent healing rates, HRQL whether care is delivered in the home or in a community nurse-led clinic. TRIAL REGISTRATION: ClinicalTrials.gov Protocol Registration System: NCT0065638

The medium-term sustainability of organisational innovations in the national health service

Background: There is a growing recognition of the importance of introducing new ways of working into the UK's National Health Service (NHS) and other health systems, in order to ensure that patient care is provided as effectively and efficiently as possible. Researchers have examined the challenges of introducing new ways of working-'organisational innovations'-into complex organisations such as the NHS, and this has given rise to a much better understanding of how this takes place-and why seemingly good ideas do not always result in changes in practice. However, there has been less research on the medium-and longer-term outcomes for organisational innovations and on the question of how new ways of working, introduced by frontline clinicians and managers, are sustained and become established in day-to-day practice. Clearly, this question of sustainability is crucial if the gains in patient care that derive from organisational innovations are to be maintained, rather than lost to what the NHS Institute has called the 'improvement-evaporation effect'. Methods: The study will involve research in four case-study sites around England, each of which was successful in sustaining its new model of service provision beyond an initial period of pilot funding for new genetics services provided by the Department of Health. Building on findings relating to the introduction and sustainability of these services already gained from an earlier study, the research will use qualitative methods-in-depth interviews, observation of key meetings, and analysis of relevant documents-to understand the longer-term challenges involved in each case and how these were surmounted. The research will provide lessons for those seeking to sustain their own organisational innovations in wide-ranging clinical areas and for those designing the systems and organisations that make up the NHS, to make them more receptive contexts for the sustainment of innovation. Discussion: Through comparison and contrast across four sites, each involving different organisational innovations, different forms of leadership, and different organisational contexts to contend with, the findings of the study will have wide relevance. The research will produce outputs that are useful for managers and clinicians responsible for organisational innovation, policy makers and senior managers, and academics

Calcification, Dissolution and Test Properties of Modern Planktonic Foraminifera From the Central Atlantic Ocean

The mass of well-preserved calcite in planktonic foraminifera shells provides an indication of the calcification potential of the surface ocean. Here we report the shell weight of 8 different abundant planktonic foraminifera species from a set of core-top sediments along the Mid-Atlantic Ridge. The analyses showed that near the equator, foraminifera shells of equivalent size weigh on average 1/3 less than those from the middle latitudes. The carbonate preservation state of the samples was assessed by high resolution X-ray microcomputed tomographic analyses of Globigerinoides ruber and Globorotalia truncatulinoides specimens. The specimen preservation was deemed good and does not overall explain the observed shell mass variations. However, G. ruber shell weights might be to some extent compromised by residual fine debris internal contamination. Deep dwelling species possess heavier tests than their surface-dwelling counterparts, suggesting that the weight of the foraminifera shells changes as a function of the depth habitat. Ambient seawater carbonate chemistry of declining carbonate ion concentration with depth cannot account for this interspecies difference. The results suggest a depth regulating function for plankton calcification, which is not dictated by water column acidity

Calcification, dissolution and test properties of modern planktonic foraminifera from the central Atlantic Ocean

This research was supported in part by a Royal Society Newton International postdoctoral Fellowship to SZ from the Royal Society of London. JWBR acknowledges funding from the European Research Council under the European Union’s Horizon 2020 research and innovation program (grant agreement 805246). We also acknowledge support from U.K. NERC Grant (PUCCA) NE/V011049/1.The mass of well-preserved calcite in planktonic foraminifera shells provides an indication of the calcification potential of the surface ocean. Here we report the shell weight of 8 different abundant planktonic foraminifera species from a set of core-to sediments along the Mid-Atlantic Ridge. The analyses showed that near the equator, foraminifera shells of equivalent size weigh on average 1/3 less than those from the middle latitudes. The carbonate preservation state of the samples was assessed by high resolution X-ray microcomputed tomographic analyses of Globigerinoides ruber and Globorotalia truncatulinoides specimens. The specimen preservation was deemed good and does not overall explain the observed shell mass variations. However, G. ruber shell weights might be to some extent compromised by residual fine debris internal contamination. Deep dwelling species possess heavier tests than their surface-dwelling counterparts, suggesting that the weight of the foraminifera shells changes as a function of the depth habitat. Ambient seawater carbonate chemistry of declining carbonate ion concentration with depth cannot account for this interspecies difference. The results suggest a depth regulating function for plankton calcification, which is not dictated by water column acidity.Publisher PDFPeer reviewe

Late Quaternary Faulting History of the Carrizal and Related Faults, La Paz Region, Baja California Sur, Mexico

The southwest margin of the Gulf of California has an array of active normal faults despite this being an oblique-divergent plate boundary with spreading centers that localized deformation along the plate boundary 2–3 million years ago. The Carrizal and Centenario faults form the western border fault of the Gulf of California marginal fault system within and south of La Paz Bay, and ∼20–30 km west of the capital city of La Paz, Baja California Sur, Mexico. Geologic and geomorphic mapping, optically stimulated luminescence (OSL) geochronology, and paleoseismic investigations onshore, compressed high-intensity radar pulse (CHIRP) profiling offshore, and analysis of uplifted marine terraces in the footwall of the offshore Carrizal fault provide some of the first numerical and geometrical constraints on late Pleistocene–Holocene faulting along the Carrizal fault. The onshore Carrizal fault has ruptured with up to ∼1–2 m of vertical displacement per event, likely producing ∼M 6.3–6.9 earthquakes, and at least two to three surface rupturing earthquakes have occurred since 22 ka. Onshore paleoseismic excavations and uplifted marine terraces on the western side of La Paz Bay both suggest offset rates of 0.1–0.2 mm/yr, with a footwall uplift rate of 0.13 mm/yr since 128 ka, and an approximately constant rate since marine oxygen-isotope stage (MIS) 11 terraces (420 ka). A CHIRP survey identified underwater fault scarps with heights ranging from 21 to 86 m on the Carrizal fault in La Paz Bay and from 3 to 5 m along the Centenario fault. The offshore Carrizal fault lies 8–10 km east of the western edge of La Paz Bay, forming a right step from the onshore Carrizal fault. The offshore Carrizal fault is the oldest fault of the fault system, and the fault likely grew in the latest Miocene to Pliocene in a complex way to the south toward the onshore Centenario and Carrizal faults. When the Alarcon spreading center started its modern rates at 2.4 Ma, the Carrizal fault likely slowed to the 0.1–0.2 mm/yr rates of the late Quaternary determined in this study

SCoOP Acute Hospital Outcomes Report : An overview of outcomes of acute geriatric medicine services in Scotland

Hospital Reports 2017/18Publisher PD

Circulating 25-Hydroxyvitamin D Concentration and Risk of Breast, Prostate, and Colorectal Cancers: The Melbourne Collaborative Cohort Study.

BACKGROUND: The role of vitamin D in cancer risk remains controversial, and limited data exist on associations between vitamin D and subtypes of specific cancers. We investigated associations between circulating 25-hydroxyvitamin D (25(OH)D) and risk of colorectal, breast, and prostate cancers, including subtypes. METHODS: A case-cohort study within the Melbourne Collaborative Cohort Study included 547 colorectal, 634 breast, and 824 prostate cancers, and a sex-stratified random sample of participants (n = 2,996). Concentration of 25(OH)D in baseline-dried blood spots was measured using LC-MS/MS. Cox regression yielded adjusted HRs and 95% confidence intervals (CI) for each cancer in relation to plasma-equivalent 25(OH)D concentration. Associations by stage and BRAF/KRAS status for colorectal cancer, estrogen receptor status for breast cancer, and aggressiveness for prostate cancer were examined in competing risks models. RESULTS: 25(OH)D concentrations were inversely associated with risk of colorectal cancer [highest vs. lowest 25(OH)D quintile: HR, 0.71; 95% confidence interval (CI), 0.51-0.98], which was limited to women (HR, 0.52; 95% CI, 0.33-0.82). Circulating 25(OH)D was also inversely associated with BRAF V600E-positive colorectal cancer (per 25 nmol/L increment: HR, 0.71; 95% CI, 0.50-1.01). There were no inverse associations with breast cancer (HR, 0.98; 95% CI, 0.70-1.36) or prostate cancer (HR, 1.11; 95% CI, 0.82-1.48). CONCLUSIONS: Circulating 25(OH)D concentration was inversely associated with colorectal cancer risk for women, but not with risk of breast cancer or prostate cancer. IMPACT: Vitamin D might play a role in preventing colorectal cancer. Further studies are required to confirm whether vitamin D is associated with specific tumor subtypes