Implementing the use of objective medication adherence data in routine clinical practice via the digital CFHealthHub platform: situation analysis and strategy development using the theoretical domains framework

Background Preventative inhaled treatments preserve lung function and reduce exacerbations in Cystic Fibrosis (CF). Self-reported adherence to these treatments is over-estimated. An online platform (CFHealthHub) has been developed with patients and clinicians to display real-time objective adherence data from dose-counting nebulisers, so that clinical teams can offer informed treatment support. Methods In this paper, we identify pre-implementation barriers to healthcare practitioners performing two key behaviours: accessing objective adherence data through the website CFHealthHub and discussing medication adherence with patients. We aimed to understand barriers during the pre-implementation phase, so that appropriate strategy could be developed for the scale up of implementing objective adherence data in 19 CF centres. Thirteen semi-structured interviews were conducted with healthcare practitioners working in three UK CF centres. Qualitative data were coded using the Theoretical Domains Framework (TDF), which describes 14 validated domains to implementation behaviour change. Results Analysis indicated that an implementation strategy should address all 14 domains of the TDF to successfully support implementation. Participants did not report routines or habits for using objective adherence data in clinical care. Examples of salient barriers included skills, beliefs in consequences, and social influence and professional roles. The results also affirmed a requirement to address organisational barriers. Relevant behaviour change techniques were selected to develop implementation strategy modules using the behaviour change wheel approach to intervention development. Conclusions This paper demonstrates the value of applying the TDF at pre-implementation, to understand context and to support the development of a situationally relevant implementation strategy. Contribution to the literature · Research indicates that the implementation of healthcare innovations may be more likely to succeed when context and theory are taken into consideration. · In this study, healthcare professionals identified barriers to two behaviours that were key to the implementation of a national Cystic Fibrosis (CF) healthcare innovation. By coding barriers to the Theoretical Domains Framework (TDF), a contextually relevant implementation strategy was developed, with a focus on clinician behaviour change. · The study highlights the challenges CF teams face when implementing new remote monitoring of medication adherence, and provides an important opportunity to apply the TDF in the pre-implementation phase of a healthcare innovation

Giant Panda (Ailuropoda melanoleuca) Buccal Mucosa Tissue as a Source of Multipotent Progenitor Cells

Since the first mammal was cloned, the idea of using this technique to help endangered species has aroused considerable interest. However, several issues limit this possibility, including the relatively low success rate at every stage of the cloning process, and the dearth of usable tissues from these rare animals. iPS cells have been produced from cells from a number of rare mammalian species and this is the method of choice for strategies to improve cloning efficiency and create new gametes by directed differentiation. Nevertheless information about other stem cell/progenitor capabilities of cells from endangered species could prove important for future conservation approaches and adds to the knowledge base about cellular material that can be extremely limited. Multipotent progenitor cells, termed skin-derived precursor (SKP) cells, can be isolated directly from mammalian skin dermis, and human cheek tissue has also been shown to be a good source of SKP-like cells. Recently we showed that structures identical to SKPs termed m-SKPs could be obtained from monolayer/ two dimensional (2D) skin fibroblast cultures. Here we aimed to isolate m-SKPs from cultured cells of three endangered species; giant panda (Ailuropoda melanoleuca); red panda (Ailurus fulgens); and Asiatic lion (Panthera leo persica). m-SKP-like spheres were formed from the giant panda buccal mucosa fibroblasts; whereas dermal fibroblast (DF) cells cultured from abdominal skin of the other two species were unable to generate spheres. Under specific differentiation culture conditions giant panda spheres expressed neural, Schwann, adipogenic and osteogenic cell markers. Furthermore, these buccal mucosa derived spheres were shown to maintain expression of SKP markers: nestin, versican, fibronectin, and P75 and switch on expression of the stem cell marker ABCG2. These results demonstrate that giant panda cheek skin can be a useful source of m-SKP multipotent progenitors. At present lack of sample numbers means that we can only postulate why we were unable to obtain m-SKPs from the lion and red panda cultures. However the giant panda observations point to the value of archiving cells from rare species, and the possibilities for later progenitor cell derivation

Mire ontogeny, environmental and climate change inferred from fossil beetle successions from Hatfield Moors, eastern England

Results of a fossil Coleoptera (beetle) fauna from a fen edge sequence from Hatfield Moors, Humber-head Levels, England, are presented. Mire ontogeny inferred from this location and others are discussed, particularly in the light of previous palynological and plant macrofossil investigations. Peat initiation across most of the site centres around 3000 cal. bc, characterized by a Calluna-Eriophorum heath with areas of PinusBetula woodland. The onset of peat accumulation on the southern margins of the site was delayed until 1520– 1390 cal. bc and appears to overlap closely with a recurrence surface at a pollen site (HAT 2) dated to 1610– 1440 cal. bc, suggesting that increased surface wetness may have caused mire expansion at this time. The faunas illustrate the transition from eutrophic and mesotrophic fen to ombrotrophic raised mire, although the significance of both Pinus- and Calluna-indicating species through the sequence suggests that heath habitats may have continued to be important. Elsewhere, this earlier phase of rich fen is lacking and mesotrophic mire developed immediately above nutrient-poor sands, with ombrotrophic conditions indicated soon after. Correspondence analysis of the faunas provides valuable insights into the importance of sandy heath habitats on Hatfield Moors. The continuing influence of the underlying coversands suggests these may have been instrumental in mire ontogeny. The research highlights the usefulness of using Coleoptera to assess mire ontogeny, fluctuations in site hydrology and vegetation cover, particularly when used in conjunction with other peatland proxies. The significance of a suite of extinct beetle species is discussed with reference to forest history and climatic change

Archaeological and environmental investigations of Late Glacial and Holocene river valley sequences on the River Soar, at Croft, Leicestershire

The sediments, stratigraphy and archaeology of several sections through Lateglacial and Holocene deposits associated with the past course of the Thurlston Brook at Croft, Leicestershire, UK are outlined. The results of pollen, plant macrofossil and insect analyses from these deposits are presented and this information is used to provide a detailed reconstruction of changing river conditions and human land use at this location during the Holocene. Despite the presence of hiatuses in the record seen at Croft, and other sites of this scale, with accurate work and clear dating controls it is possible to 'stitch' together continuous detailed sequences. The general pattern of Holocene landscape and fluvial change appears to echo that seen in the Trent valley region and nationally. It is suggested that small headwater catchments such as at Croft have the potential to provide detailed and sensitive records of Holocene events comparable with those from 'standard' sediment sequences