Stable isotope signals provide seasonal climatic markers for moss functional groups.

Living moss biomass and archival peat deposits represent key indicators of present and past climatic conditions, but prediction of future climatic impacts requires appropriate marker species to be characterized under a range of contemporary conditions. Stable isotope signals in high latitude moss deposits offer potential climatic proxies. Seasonal changes in δ13C and δ18O of organic material (cellulose) in representative functional groups, and associated photosynthetic activity (as chlorophyll fluorescence) have been compared across East Anglia, UK, as a function of tissue water content. Representative species from contrasting acid bog, heathland, and fen woodland habitats were selected for monthly sampling of recent growth tissues between spring 2017 and autumn 2018, with isotopic signals in purified cellulose compared with tissue water, precipitation, and nearby groundwater signals. Sphagnum and Polytrichum groups, which tend to dominate peat formation, provided contrasting and complementary indicators of seasonal variations in carbon assimilation. Cellulose δ18O signals from Sphagnum spp. demonstrate seasonal variations in source precipitation inputs; carbon isotope signals in Polytrichum spp. indicate evaporative demand and photosynthetic limitation

Qualitative critical incident study of patients’ experiences leading to emergency hospital admission with advanced respiratory illness

Objectives: The high volume of emergency admissions to hospital is a challenge for health systems internationally. Patients with lung cancer and chronic obstructive pulmonary disease (COPD) are frequently admitted to hospital as emergency cases. While the frequency of emergency admission has been investigated, few studies report patient experiences, particularly in relation to the decision-making process prior to emergency admission. We sought to explore patient and carer experiences and those of their healthcare professionals in the period leading up to emergency admission to hospital. Setting: 3 UK hospitals located in different urban and rural settings. Design: Qualitative critical incident study. Participants: 24 patients with advanced lung cancer and 15 with advanced COPD admitted to hospital as emergencies, 20 of their carers and 50 of the health professionals involved in the patients' care. Results: The analysis of patient, carer and professionals' interviews revealed a detailed picture of the complex processes involved leading to emergency admission to hospital. 3 phases were apparent in this period: self-management of deteriorating symptoms, negotiated decision-making and letting go. These were dynamic processes, characterised by an often rapidly changing clinical condition, uncertainty and anxiety. Patients considered their options drawing on experience, current and earlier advice. Patients tried to avoid admission, reluctantly accepting it, albeit often with a sense of relief, as anxiety increased with worsening symptoms. Conclusions: Patients with advanced respiratory illness, and their carers, try to avoid emergency admission, and use logical and complex decision-making before reluctantly accepting it. Clinicians and policy-makers need to understand this complex process when considering how to reduce emergency hospital admissions rather than focusing on identifying and labelling admissions as 'inappropriate'

Evaluation of a commercially available pedometer used to promote physical activity as part of a national programme

Objective: To assess the accuracy of a pedometer (manufactured by Silva) currently being used as part of a national programme to promote physical activity in the UK. Methods: Laboratory study: 68 participants (age 19.2±2.7 years, BMI 22.5±3.3 kg/m2) wore 2 Silva pedometers (over the right and left hips) whilst walking on a motorised treadmill at 2, 2.5, 3, 3.5 and 4mph. Pedometer step counts were compared with actual steps counted. Free-living study: 134 participants (age 36.4±18.1 years, BMI 26.3±5.1 kg/m2) wore one Silva pedometer, one New-Lifestyles NL-1000 pedometer and an ActiGraph GT1M accelerometer (the criterion) during waking hours for one day. Step counts registered by the Silva and NL- 1000 pedometers were compared to ActiGraph step counts. Percent error of the pedometers were compared across normal-weight (n=58), overweight (n=45) and obese (n=31) participants. Results: Laboratory study: Across the speeds tested percent error in steps ranged from 6.7 (4mph) – 46.9% (2mph). Free-living study: Overall percent errors of the Silva and NL-1000 pedometers relative to the criterion were 36.3% and 9% respectively. Significant differences in percent error of the Silva pedometer were observed across BMI groups (normal-weight 21%, overweight 40.2%, obese 59.2%, P<0.001). Conclusion: The findings suggest the Silva pedometer is unacceptably inaccurate for activity promotion purposes particularly in overweight and obese adults. Pedometers are an excellent tool for activity promotion however the use of inexpensive, untested pedometers is not recommended as they will lead to user frustration, low intervention compliance, and adverse reaction to the instrument, potentially impacting future public health campaigns

Social Business Education: An Interview With Nobel Laureate Muhammad Yunus

In this interview, Nobel Laureate Muhammad Yunus outlines the role of social business education and its potential in teaching the next generation of social innovation leaders. Our questions and his responses focus on Yunus's experience, drawing on lessons learned from the Grameen Bank and his most recent educational endeavors, including the Yunus Centre and the Grameen Creative Lab. The interview begins with a discussion of the development and evolution of social business and its distinction from social entrepreneurship. Then, we move on to the role of faculty and community engagement and student qualities that should be sought and cultivated in social business education. Next, Yunus formulates recommendations for what business schools and educators can do to prepare students to recognize and implement new social innovations for their communities. We conclude by highlighting some of the challenges involved in incorporating Yunus's social business model into the capitalist economic paradigm that dominates in western business schools and by reflecting on implications for educators as well as the programmatic challenges in integrating social business concepts and initiatives into curriculum and pedagogy

What are the optimum components in a care bundle aimed at reducing post-operative pulmonary complications in high-risk patients?

BACKGROUND: Post-operative pulmonary complications (POPC) are common, predictable and associated with increased morbidity and mortality, independent of pre-operative risk. Interventions to reduce the incidence of POPC have been studied individually, but the use of a care bundle has not been widely investigated. The purpose of our work was to use Delphi consensus methodology and an independently chosen expert panel to formulate a care bundle for patients identified as being at high of POPC, as preparation towards an evaluation of its effectiveness at reducing POPC. METHODS: We performed a survey of members of the ESICM POIC section to inform a Delphi consensus and to share their opinions on a care bundle to reduce POPC, the POPC-CB. We formed a team of 36 experts to participate in and complete an email-based Delphi consensus over three rounds, leading to the formulation of the POPC-CB. RESULTS: The survey had 362 respondents and informed the design of the Delphi consensus. The Delphi consensus resulted in a proposed POPC-CB that incorporates components before surgery-supervised exercise programmes and inspiratory muscle training, during surgery, low tidal volume ventilation with individualised PEEP (positive end-expiratory pressure), use of routine monitoring to avoid hyperoxia and efforts made to limit neuromuscular blockade, and post-operatively, deep breathing exercises and elevation of the head of the bed. CONCLUSION: A care bundle has been suggested for evaluation in surgical patients at high risk of POPC. Evaluation of feasibility of both implementation and effectiveness is now indicated

Environmental DNA captures elasmobranch diversity in a temperate marine ecosystem

Abstract: Many sharks, skates, and rays (elasmobranchs) are highly threatened by the activities of commercial fisheries, and a clear understanding of their distributions, diversity, and abundance can guide protective measures. However, surveying and monitoring elasmobranch species can be highly invasive or resource‐intensive, and utilization of non‐invasive environmental DNA‐based methods may overcome these problems. Here, we studied spatial and seasonal variation in the elasmobranch community of the Western English Channel using environmental DNA (eDNA) collected from surface and bottom waters periodically over an annual cycle (2017–2018). In total we recovered 13 elasmobranch species within eDNA samples, and the number of transformed eDNA reads was positively associated with species (hourly) catch data resolved from 105‐year time series trawl data (1914–2018). These results demonstrate the ability of eDNA to detect and semi‐quantitatively reflect the prevalence of historically dominant and rare elasmobranch species in this region. Notably, eDNA recorded a greater number of species per sampling event than a conventional trawl survey in the same area over the same sampling years (2017–2018). Several threatened species were recovered within the eDNA, including undulate ray, porbeagle shark, and thresher shark. Using eDNA, we found differences in elasmobranch communities among sampling stations and between seasons, but not between sampling depths. Collectively, our results suggest that non‐invasive eDNA‐based methods can be used to study the spatial and seasonal changes in the diversity and abundance of whole elasmobranch communities within temperate shelf habitats. Given the threatened status of many elasmobranchs in human‐impacted marine environments, eDNA analysis is poised to provide key information on their diversity and distributions to inform conservation‐focused monitoring and management

Cost effectiveness of a community based prevention and treatment of acute malnutrition programme in Mumbai slums, India

Children in slums are at high risk of acute malnutrition and death. Cost-effectiveness of community-based management of severe acute malnutrition programmes has been demonstrated previously, but there is limited evidence in the context of urban slums where programme cost structure is likely to vary tremendously. This study assessed the cost-utility of adding a community based prevention and treatment for acute malnutrition intervention to Government of India Integrated Child Development Services (ICDS) standard care for children in Mumbai slums. The intervention is delivered by community health workers in collaboration with ICDS Anganwadi community health workers. The analysis used a decision tree model to compare the costs and effects of the two options: standard ICDS services with the intervention and prevention versus standard ICDS services alone. The model used outcome and cost data from the Society for Nutrition, Education & Health Action’s Child Health and Nutrition programme in Mumbai slums, which delivered services to 12,362 children over one year from 2013 to 2014. An activity-based cost model was used, with calculated costs based on programme financial records and key informant interviews. Cost data were coupled with programme effectiveness data to estimate disability adjusted life years (DALYs) averted. The community based prevention and treatment programme averted 15,016 DALYs (95% Uncertainty Interval [UI]: 12,246–17,843) at an estimated cost of $23 per DALY averted (95%UI:19–28) and was thus highly cost-effective. This study shows that ICDS Anganwadi community health workers can work efficiently with community health workers to increase the prevention and treatment coverage in slums in India and can lead to policy recommendations at the state, and potentially the national level, to promote such programmes in Indian slums as a cost-effective approach to tackling moderate and severe acute malnutrition

How does poverty affect children's nutritional status in Nairobi slums? A qualitative study of the root causes of undernutrition

Children in slums are at high risk of undernutrition, which has long-term negative consequences on their physical growth and cognitive development. Severe undernutrition can lead to the child's death. The present paper aimed to understand the causes of undernutrition in children as perceived by various groups of community members in Nairobi slums, Kenya. Analysis of ten focus group discussions and ten individual interviews with key informants. The main topic discussed was the root causes of child undernutrition in the slums. The focus group discussions and key informant interviews were recorded and transcribed verbatim. The transcripts were coded in NVivo by extracting concepts and using a constant comparison of data across the different categories of respondents to draw out themes to enable a thematic analysis. Two slum communities in Nairobi, Kenya. Women of childbearing age, community health workers, elders, leaders and other knowledgeable people in the two slum communities (n 90). Participants demonstrated an understanding of undernutrition in children. Findings inform target criteria at community and household level that can be used to identify children at risk of undernutrition. To tackle the immediate and underlying causes of undernutrition, interventions recommended should aim to: (i) improve maternal health and nutrition; (ii) promote optimal infant and young children feeding practices; (iii) support mothers in their working role; (iv) increase access to family planning; (v) improve water, sanitation and hygiene (WASH); (vi) address alcohol problems at all levels; and (vii) address street food issues with infant feeding counselling