Unblocking the Circular Economy

There is a blockage in the Circular Economy. Discarded plastic products end up in the Indian Ocean where thousands of tonnes of waste plastic is washed up on the beaches of East Africa. This creates a detrimental impact on both the marine ecosystem and the economy where the locals rely on coastal fishing, trade and tourism for their livelihoods. Plastic comes ashore in many forms and is badly degraded by the elements such that when processed locally, the quality of the recycled material cannot meet the needs of the community. The researchers worked with shoreline communities to help develop a processing method capable of giving waste plastic a valuable second life. As a demonstration of the potential of this new recycled material they constructed a traditional dhow sailing boat entirely from plastic trash collected from Kenya’s beaches and towns. During its 500 kilometre maiden voyage from Lamu in Kenya to Zanzibar in Tanzania, the researchers stopped at communities along the way to change mindsets about plastic waste. This paper practically demonstrates how an environmentally and economically damaging waste problem can be re envisaged as a valuable resource that supports the local and regional economy and unblocks the circular economy in the shoreline communities of East Africa

A realist evaluation of a safe medication administration education programme

Background Continuing professional education (CPE) for nurses is deemed an essential component to develop, maintain and update professional skills. However, there is little empirical evidence of its effectiveness or factors which may influence its application into practice. Objective This paper explores a continuing professional education programme on the safe administration of medication and how new knowledge and skills are transferred into clinical practice. Design Realist evaluation provided the framework for this study. Realist evaluation stresses the need to evaluate programmes within “context,” and to ask what “mechanisms” are acting to produce which “outcomes.” This realist evaluation had four distinct stages. Firstly, theories were built as conjectured CMO configurations (Stage 1 and 2), then these cCMO were tested (Stage 3) and they were then refined (Stage 4). Methods Data was collected through document analysis and interviews (9) to build and refine CMOs. The conjectured CMOs were tested by clinical observation, interview (7), analysis of further documents and analysis of data from reported critical incidents and nursing care metric measurements. Results This study has shown the significant role of the ward manager in the application of new learning from the education programme to practice. Local leadership was found to enable a patient safety culture and the adoption of a quality improvement approach. The multi-disciplinary team at both organisation and local level was also found to be a significant context for the application of the education programme into practice. Reasoning skills and receptivity to change were identified to be key mechanisms which were enabled within the described contexts

Export of Ice Sheet Meltwater from Upernavik Fjord, West Greenland

Author Posting. © American Meteorological Society, 2022. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 52(3), (2022): 363–382, https://doi.org/10.1175/jpo-d-21-0084.1.Meltwater from Greenland is an important freshwater source for the North Atlantic Ocean, released into the ocean at the head of fjords in the form of runoff, submarine melt, and icebergs. The meltwater release gives rise to complex in-fjord transformations that result in its dilution through mixing with other water masses. The transformed waters, which contain the meltwater, are exported from the fjords as a new water mass Glacially Modified Water (GMW). Here we use summer hydrographic data collected from 2013 to 2019 in Upernavik, a major glacial fjord in northwest Greenland, to describe the water masses that flow into the fjord from the shelf and the exported GMWs. Using an optimum multi-parameter technique across multiple years we then show that GMW is composed of 57.8% ± 8.1% Atlantic Water (AW), 41.0% ± 8.3% Polar Water (PW), 1.0% ± 0.1% subglacial discharge, and 0.2% ± 0.2% submarine meltwater. We show that the GMW fractional composition cannot be described by buoyant plume theory alone since it includes lateral mixing within the upper layers of the fjord not accounted for by buoyant plume dynamics. Consistent with its composition, we find that changes in GMW properties reflect changes in the AW and PW source waters. Using the obtained dilution ratios, this study suggests that the exchange across the fjord mouth during summer is on the order of 50 mSv (1 Sv ≡ 106 m3 s−1) (compared to a freshwater input of 0.5 mSv). This study provides a first-order parameterization for the exchange at the mouth of glacial fjords for large-scale ocean models.This work was partially supported by the Centre for Climate Dynamics (SKD) at the Bjerknes Centre for Climate Research. The authors thank NASA and the OMG consortium for making observational data freely available, and acknowledge M. Morlighem for good support in the early stages of this project. MM and LHS and would also like to thank Ø. Paasche, the ACER project, and the U.S. Norway Fulbright Foundation for the Norwegian Arctic Chair Grant 2019–20 that made the visit to Scripps Institution of Oceanography possible. FS acknowledges support from the DOE Office of Science Grant DE-SC0020073, Heising-Simons Foundation and from NSF and OCE-1756272. DAS acknowledges support from U.K. NERC Grants NE/P011365/1, NE/T011920/1, and NERC Independent Research Fellowship NE/T011920/1. MW was supported by an appointment to the NASA Postdoctoral Program at the Jet Propulsion Laboratory, California Institute of Technology, administered by the Universities Space Research Association under contract with NASA. CSA would like to acknowledge Geocenter Denmark for support to the project “Upernavik Glacier.

A clinically integrated curriculum in Evidence-based Medicine for just-in-time learning through on-the-job training: The EU-EBM project

Background: Over the last years key stake holders in the healthcare sector have increasingly recognised evidence based medicine (EBM) as a means to improving the quality of healthcare. However, there is considerable uncertainty about the best way to disseminate basic knowledge of EBM. As a result, huge variation in EBM educational provision, setting, duration, intensity, content, and teaching methodology exists across Europe and worldwide. Most courses for health care professionals are delivered outside the work context ('stand alone') and lack adaptation to the specific needs for EBM at the learners' workplace. Courses with modern 'adaptive' EBM teaching that employ principles of effective continuing education might fill that gap. We aimed to develop a course for post-graduate education which is clinically integrated and allows maximum flexibility for teachers and learners. Methods: A group of experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions from eight European countries participated. We used an established methodology of curriculum development to design a clinically integrated EBM course with substantial components of e-learning. An independent European steering committee provided input into the process. Results: We defined explicit learning objectives about knowledge, skills, attitudes and behaviour for the five steps of EBM. A handbook guides facilitator and learner through five modules with clinical and e-learning components. Focussed activities and targeted assignments round off the learning process, after which each module is formally assessed. Conclusion: The course is learner-centred, problem-based, integrated with activities in the workplace and flexible. When successfully implemented, the course is designed to provide just-in-time learning through on-the-job-training, with the potential for teaching and learning to directly impact on practice. </p

Estimating heterotrophic respiration at large scales: challenges, approaches, and next steps

Heterotrophic respiration (HR), the aerobic and anaerobic processes mineralizing organic matter, is a key carbon flux but one impossible to measure at scales significantly larger than small experimental plots. This impedes our ability to understand carbon and nutrient cycles, benchmark models, or reliably upscale point measurements. Given that a new generation of highly mechanistic, genomic-specific global models is not imminent, we suggest that a useful step to improve this situation would be the development of “Decomposition Functional Types” (DFTs). Analogous to plant functional types (PFTs), DFTs would abstract and capture important differences in HR metabolism and flux dynamics, allowing modelers and experimentalists to efficiently group and vary these characteristics across space and time. We argue that DFTs should be initially informed by top-down expert opinion, but ultimately developed using bottom-up, data-driven analyses, and provide specific examples of potential dependent and independent variables that could be used. We present an example clustering analysis to show how annual HR can be broken into distinct groups associated with global variability in biotic and abiotic factors, and demonstrate that these groups are distinct from (but complementary to) already-existing PFTs. A similar analysis incorporating observational data could form the basis for future DFTs. Finally, we suggest next steps and critical priorities: collection and synthesis of existing data; more in-depth analyses combining open data with rigorous testing of analytical results; using point measurements and realistic forcing variables to constrain process-based models; and planning by the global modeling community for decoupling decomposition from fixed site data. These are all critical steps to build a foundation for DFTs in global models, thus providing the ecological and climate change communities with robust, scalable estimates of HR

A mixed‐method systematic review of the effectiveness and acceptability of preoperative psychological preparation programmes to reduce paediatric preoperative anxiety in elective surgery

Aim To explore the effectiveness of preoperative psychological preparation programmes aimed to reduce paediatric preoperative anxiety and the potential factors that could have an impact on parent and children's acceptance of such interventions. Background Various preoperative psychological preparation programmes are available to address paediatric preoperative anxiety. No mixed‐method review has been conducted to explore the effectiveness and acceptability of these programmes. Design A mixed‐method systematic review. Data sources Seven bibliographic databases were searched from inception to September 2016, complemented by hand searching of key journals, the reference lists of relevant reviews, search for grey literature and the contacting of associated experts. Review methods The review process was conducted based on the framework developed by the Evidence for Policy and Practice Information and Co‐ordinating Centre. A narrative summary and a thematic synthesis were developed to synthesise the quantitative and qualitative data respectively, followed by a third synthesis to combine the previous syntheses. Results Nineteen controlled trials and eleven qualitative studies were included for data synthesis. The controlled trials reveal that educational multimedia applications and web‐based programmes may reduce paediatric preoperative anxiety, while the effectiveness of therapeutic play and books remains uncertain. Qualitative studies showed parent‐child dyads seek different levels of information. Conclusions Providing matched information provision to each parent and child, actively involving children and their parents and teaching them coping skills, may be the essential hallmarks of a successful preoperative psychological preparation. Further research is necessary to confirm the effectiveness of therapeutic play and books

The effectiveness of a clinically integrated e-learning course in evidence-based medicine: A cluster randomised controlled trial

BACKGROUND: To evaluate the educational effects of a clinically integrated e-learning course for teaching basic evidence-based medicine (EBM) among postgraduates compared to a traditional lecture-based course of equivalent content. METHODS: We conducted a cluster randomised controlled trial in the Netherlands and the UK involving postgraduate trainees in six obstetrics and gynaecology departments. Outcomes (knowledge gain and change in attitude towards EBM) were compared between the clinically integrated e-learning course (intervention) and the traditional lecture based course (control). We measured change from pre- to post-intervention scores using a validated questionnaire assessing knowledge (primary outcome) and attitudes (secondary outcome). RESULTS: There were six clusters involving teaching of 61 postgraduate trainees (28 in the intervention and 33 in the control group). The intervention group achieved slightly higher scores for knowledge gain compared to the control, but these results were not statistically significant (difference in knowledge gain: 3.5 points, 95% CI -2.7 to 9.8, p = 0.27). The attitudinal changes were similar for both groups. CONCLUSION: A clinically integrated e-learning course was at least as effective as a traditional lecture based course and was well accepted. Being less costly than traditional teaching and allowing for more independent learning through materials that can be easily updated, there is a place for incorporating e-learning into postgraduate EBM curricula that offer on-the-job training for just-in-time learning. TRIAL REGISTRATION: Trial registration number: ACTRN12609000022268

Teachers' ideas versus experts' descriptions of 'the good teacher' in postgraduate medical education: implications for implementation. A qualitative study

Contains fulltext : 96394.pdf (publisher's version ) (Open Access)BACKGROUND: When innovations are introduced in medical education, teachers often have to adapt to a new concept of what being a good teacher includes. These new concepts do not necessarily match medical teachers' own, often strong beliefs about what it means to be a good teacher.Recently, a new competency-based description of the good teacher was developed and introduced in all the Departments of Postgraduate Medical Education for Family Physicians in the Netherlands. We compared the views reflected in the new description with the views of teachers who were required to adopt the new framework. METHODS: Qualitative study. We interviewed teachers in two Departments of Postgraduate Medical Education for Family Physicians in the Netherlands. The transcripts of the interviews were analysed independently by two researchers, who coded and categorised relevant fragments until consensus was reached on six themes. We investigated to what extent these themes matched the new description. RESULTS: Comparing the teachers' views with the concepts described in the new competency-based framework is like looking into two mirrors that reflect clearly dissimilar images. At least two of the themes we found are important in relation to the implementation of new educational methods: the teachers' identification and organisational culture. The latter plays an important role in the development of teachers' ideas about good teaching. CONCLUSIONS: The main finding of this study is the key role played by the teachers' feelings regarding their professional identity and by the local teaching culture in shaping teachers' views and expectations regarding their work. This suggests that in implementing a new teaching framework and in faculty development programmes, careful attention should be paid to teachers' existing identification model and the culture that fostered it