Occupational advice for Patients undergoing Arthroplasty of the Lower limb: An intervention development and feasibility study (The OPAL Study)

Background Hip and knee replacements are regularly performed for patients who work. There is little evidence about these patients’ needs and the factors influencing their return to work. There is a paucity of guidance to help patients return to work after surgery and a need for structured occupational advice to enable them to return to work safely and effectively. Objective(s) To develop an occupational advice intervention to support early recovery to usual activities including work which is tailored to the requirements of patients undergoing hip and knee replacements. To test the acceptability, practicality and feasibility of this intervention within current care frameworks Design An intervention mapping (IM) approach was used to develop the intervention. The research methods employed were: rapid evidence synthesis; qualitative interviews with patients and stakeholders; prospective cohort study; survey of clinical practice; modified Delphi consensus process. The developed intervention was implemented and assessed during the final feasibility stage of the IM process. Setting Orthopaedic departments within NHS secondary care. Participants Patients in work, and intending to return to work following primary elective hip and knee replacement surgery; healthcare professionals and employers. Interventions Occupational advice intervention. Main outcome measures Development of an occupational advice intervention. Fidelity of the developed intervention when delivered in a clinical setting. Patient and clinician perspectives of the intervention. Preliminary assessments of intervention effectiveness and cost. Results A cohort study (154 patients), 110 stakeholder interviews, survey of practice (152 respondents) and evidence synthesis provided the necessary information to develop the intervention. The intervention included information resources, personalized return to work plan and co-ordination from the healthcare team to support the delivery of 13 patient and 20 staff performance objectives (POs). To support delivery, a range of tools (e.g. occupational checklists, patient workbooks, employer information), roles (e.g. return-to-work coordinator) and training resources were created. Feasibility was assessed in 21 of the 26 patients recruited from 3 NHS trusts. Adherence with the defined performance objectives was 75% for patient POs and 74% for staff POs. The intervention was generally well received although the short timeframe available for implementation and concurrent research evaluation led to some confusion amongst patients and those delivering the intervention regarding its purpose and the roles and responsibilities of key staff. Limitations Implementation and uptake of the intervention was not standardized and was limited by the study timeframe. Evaluation of the intervention involved a small number of patients which limited the ability to assess it. Conclusions The developed occupational advice intervention supports best practice. Evaluation demonstrated good rates of adherence against defined performance objectives. However, a number of operational and implementation issues require further attention Future work The intervention warrants a randomised controlled trial to assess its clinical and cost effectiveness to improve rates and timing of sustained return to work after surgery. This research should include the development of a robust implementation strategy to ensure adoption is sustained. Funding This project was funded by the NIHR Health Technology Assessment programme (project number 15/28/02) Trial Registrations International Standard Randomised Controlled Trials Number Trial ID: ISRCTN27426982 International prospective register of systematic reviews (PROSPERO) Registration: CRD4201604523

In Honor of Dr. Larry R. Brown

Abstracts are not associated with Notes. -- the SFEWS Editor

Using Conceptual Models in Ecosystem Restoration Decision Making: An Example from the Sacramento-San Joaquin River Delta, California

The Sacramento–San Joaquin Delta (the Delta) is located on the western edge of California’s Central Valley and is of critical ecological and economic importance. However, ecosystem alterations for human uses changed many of the Delta’s natural processes, and it is now considered in need of restoration. An approach was developed to evaluate and rank restoration actions in the Delta under the Ecosystem Restoration Program’s Delta Regional Ecosystem Restoration Implementation Plan (DRERIP). The DRERIP approach provides an explicit framework for evaluating restoration actions, using linked conceptual models, an action evaluation procedure, and a decision-support tool. Conceptual models allow scientists and managers to synthesize scientific information and make qualitative predictions about ecosystem function and restoration outcomes to guide and focus restoration efforts. The action evaluation procedure is a structured assessment of restoration actions. The procedure clearly describes actions to be evaluated, assesses the magnitude (importance and scale) and certainty of anticipated ecological outcomes, estimates degrees of worth (achieving intended outcomes) and risk (causing adverse consequences), evaluates the reversibility of the action, and identifies opportunities for learning. The values for worthiness, risk, reversibility, and learning opportunity are used in the decision- support tool to determine the fate of a proposed action. The decision-support tool is a structured decision tree that determines the disposition of an action: whether a restoration project should be discarded, revised with a different approach and re-evaluated, or implemented; and, if implemented, at what scale (targeted research, pilot project, or full implementation). The DRERIP approach provides managers with a valuable tool for restoration planning, and a foundation for integration with quantitative methods for a comprehensive ecosystem restoration plan

Linking Hydrodynamic Complexity to Delta Smelt (<i>Hypomesus transpacificus</i>) Distribution in the San Francisco Estuary, USA

doi: http://dx.doi.org/10.15447/sfews.2016v14iss1art3Long-term fish sampling data from the San Francisco Estuary were combined with detailed three-dimensional hydrodynamic modeling to investigate the relationship between historical fish catch and hydrodynamic complexity. Delta Smelt catch data at 45 stations from the Fall Midwater Trawl (FMWT) survey in the vicinity of Suisun Bay were used to develop a quantitative catch-based station index. This index was used to rank stations based on historical Delta Smelt catch. The correlations between historical Delta Smelt catch and 35 quantitative metrics of environmental complexity were evaluated at each station. Eight metrics of environmental conditions were derived from FMWT data and 27 metrics were derived from model predictions at each FMWT station. To relate the station index to conceptual models of Delta Smelt habitat, the metrics were used to predict the station ranking based on the quantified environmental conditions. Salinity, current speed, and turbidity metrics were used to predict the relative ranking of each station for Delta Smelt catch. Including a measure of the current speed at each station improved predictions of the historical ranking for Delta Smelt catch relative to similar predictions made using only salinity and turbidity. Current speed was also found to be a better predictor of historical Delta Smelt catch than water depth. The quantitative approach developed using the FMWT data was validated using the Delta Smelt catch data from the San Francisco Bay Study. Complexity metrics in Suisun Bay were evaluated during 2010 and 2011. This analysis indicated that a key to historical Delta Smelt catch is the overlap of low salinity, low maximum velocity, and low Secchi depth regions. This overlap occurred in Suisun Bay during 2011, and may have contributed to higher Delta Smelt abundance in 2011 than in 2010 when the favorable ranges of the metrics did not overlap in Suisun Bay.</p

Linking Hydrodynamic Complexity to Delta Smelt (Hypomesus transpacificus) Distribution in the San Francisco Estuary, USA

Long-term fish sampling data from the San Francisco Estuary were combined with detailed three-dimensional hydrodynamic modeling to investigate the relationship between historical fish catch and hydrodynamic complexity. Delta Smelt catch data at 45 stations from the Fall Midwater Trawl (FMWT) survey in the vicinity of Suisun Bay were used to develop a quantitative catch-based station index. This index was used to rank stations based on historical Delta Smelt catch. The correlations between historical Delta Smelt catch and 35 quantitative metrics of environmental complexity were evaluated at each station. Eight metrics of environmental conditions were derived from FMWT data and 27 metrics were derived from model predictions at each FMWT station. To relate the station index to conceptual models of Delta Smelt habitat, the metrics were used to predict the station ranking based on the quantified environmental conditions. Salinity, current speed, and turbidity metrics were used to predict the relative ranking of each station for Delta Smelt catch. Including a measure of the current speed at each station improved predictions of the historical ranking for Delta Smelt catch relative to similar predictions made using only salinity and turbidity. Current speed was also found to be a better predictor of historical Delta Smelt catch than water depth. The quantitative approach developed using the FMWT data was validated using the Delta Smelt catch data from the San Francisco Bay Study. Complexity metrics in Suisun Bay were evaluated during 2010 and 2011. This analysis indicated that a key to historical Delta Smelt catch is the overlap of low salinity, low maximum velocity, and low Secchi depth regions. This overlap occurred in Suisun Bay during 2011, and may have contributed to higher Delta Smelt abundance in 2011 than in 2010 when the favorable ranges of the metrics did not overlap in Suisun Bay

Linking Hydrodynamic Complexity to Delta Smelt (Hypomesus transpacificus) Distribution in the San Francisco Estuary, USA

Long-term fish sampling data from the San Francisco Estuary were combined with detailed three-dimensional hydrodynamic modeling to investigate the relationship between historical fish catch and hydrodynamic complexity. Delta Smelt catch data at 45 stations from the Fall Midwater Trawl (FMWT) survey in the vicinity of Suisun Bay were used to develop a quantitative catch-based station index. This index was used to rank stations based on historical Delta Smelt catch. The correlations between historical Delta Smelt catch and 35 quantitative metrics of environmental complexity were evaluated at each station. Eight metrics of environmental conditions were derived from FMWT data and 27 metrics were derived from model predictions at each FMWT station. To relate the station index to conceptual models of Delta Smelt habitat, the metrics were used to predict the station ranking based on the quantified environmental conditions. Salinity, current speed, and turbidity metrics were used to predict the relative ranking of each station for Delta Smelt catch. Including a measure of the current speed at each station improved predictions of the historical ranking for Delta Smelt catch relative to similar predictions made using only salinity and turbidity. Current speed was also found to be a better predictor of historical Delta Smelt catch than water depth. The quantitative approach developed using the FMWT data was validated using the Delta Smelt catch data from the San Francisco Bay Study. Complexity metrics in Suisun Bay were evaluated during 2010 and 2011. This analysis indicated that a key to historical Delta Smelt catch is the overlap of low salinity, low maximum velocity, and low Secchi depth regions. This overlap occurred in Suisun Bay during 2011, and may have contributed to higher Delta Smelt abundance in 2011 than in 2010 when the favorable ranges of the metrics did not overlap in Suisun Bay

Climate Change Impacts on San Francisco Estuary Aquatic Ecosystems: A Review

Climate change is intensifying the effects of multiple interacting stressors on aquatic ecosystems worldwide. In the San Francisco Estuary, signals of climate change are apparent in the long-term monitoring record. Here we synthesize current and potential future climate change effects on three main ecosystems (floodplain, tidal marsh, and open water) in the upper estuary and two representative native fishes that commonly occur in these ecosystems: anadromous Chinook Salmon (Oncorhynchus tshawytscha) and estuarine resident Sacramento Splittail, (Pogonichthys macrolepidotus). Based on our review, we found that the estuary is experiencing shifting baseline environmental conditions, amplification of extremes, and restructuring of physical habitats and biological communities. We present priority topics for research and monitoring, and a conceptual model of how the estuary currently functions in relation to climate variables. In addition, we discuss four tools for management of climate change effects: regulatory, water infrastructure, habitat development, and biological measures. We conclude that adapting to climate change requires fundamental changes in management