Maintaining standing stones benefits biodiversity in lowland heathland

The exploitation of natural resources by people generally has detrimental effects on nature but in some cases anthropogenic activities can result in changes to the natural environment that produce new habitats and increase biodiversity. Understanding and supporting such cultural aspects of land use is an important part of effective conservation strategies. The UK has a range of cultural landscapes that contribute to the landscape matrix and are often important for biodiversity. However, little research has been conducted on the relationship between various types of cultural landscapes or their effects on biodiversity. We examined the interaction between semi-natural sacred sites and lowland heathland in Cornwall, and the contribution these sites make to the overall biodiversity within the habitat. We found that semi-natural sacred sites had significantly higher levels of biodiversity compared to surrounding heathland; the existence and use of the sites created new and important habitats for rare and threatened heathland species; and the spiritual and cultural use of the sites aids the management of heathland. Promoting the use of semi-natural sacred sites could therefore contribute to biodiversity conservation. Furthermore, the cultural and spiritual importance of such sites potentially increases the availability of volunteer resources for their management. We highlight the importance of an integrated management approach for achieving effective biodiversity conservation in areas containing multiple types of cultural landscapes

Self, interpersonal and organisational acts of compassion amongst nurses during times of acute stress: A qualitative analysis

Background: There is a global shortage of nurses and new strategies are required to recruit, support and retain this staff group. Organisational culture can have a significant impact on staff wellbeing and commitment. Recent years have seen attempts to foster a compassionate culture across healthcare systems. However, little is known about how nurses initiate self-care and how they feel cared for by their organisation, particularly in times of acute stress and need. Aims: This paper aims to address the research question, ‘In what ways do nurses experience compassion (or not) during times of acute stress?’, identifying where and how compassionate acts were enacted by individuals, within teams or organisations. Methods: Semi-structured interviews were conducted with 50 UK National Health Service (NHS) nurses in a longitudinal qualitative study (between March 2020 and September 2022). Results: Three themes were derived from our narrative analysis including: (1) Learning and practising self-compassion; (2) The presence and absence of interpersonal compassion; and (3) Organisational (non) compassionate acts. Findings indicate that self-compassion requires permission and discipline, often being unfamiliar terrain for nurses. Interpersonal compassion can buoy nurses during challenging times but can often be absent across teams. Nurses’ experiences of organisational acts of compassion were limited, and they often felt de-valued, unsupported and replaceable. Conclusions: Compassionate acts are enacted across three levels (self, team and organisation). To retain staff, particularly in acutely stressful or challenging situations, organisations, and those responsible for nursing management and policy need to foster a systems-based approach to compassionate culture.<br/

Psychological impact of the Covid-19 pandemic on nurses and midwives

In response to findings of the Impact of Covid-19 on Nurses survey study, conducted in 2020, a subsequent study explored nurses’ qualitative experiences of the pandemic; this article discusses the results. Most participants struggled to transition to new working practices in altered care settings with more critically ill patients, and most experienced high levels of stress and psychological distress. Key themes included duty and fear, resilience and stigma, changing public responses, nurses’ voices, and leaving the profession. There is an urgent need to support and restore nurses’ psychological wellbeing, and to improve their working conditions to enhance retention rates

Paving the Way:Contributions of Big Data to Apicomplexan and Kinetoplastid Research

In the age of big data an important question is how to ensure we make the most out of the resources we generate. In this review, we discuss the major methods used in Apicomplexan and Kinetoplastid research to produce big datasets and advance our understanding of Plasmodium, Toxoplasma, Cryptosporidium, Trypanosoma and Leishmania biology. We debate the benefits and limitations of the current technologies, and propose future advancements that may be key to improving our use of these techniques. Finally, we consider the difficulties the field faces when trying to make the most of the abundance of data that has already been, and will continue to be, generated

‘There was a pivotal moment’. The dynamics, transitions, adaptations and trajectories of nursing at the front-line in the UK during the COVID-19 pandemic

Using qualitative interview data (n=142 interviews) generated with 50 nurses, over the course of the COVID-19 pandemic, this paper traces the trajectories of nurses in the UK and attempts to unpick the interplay between structure and agency in their narratives. Interviews were inductively analysed for themes and an additional narrative analysis was undertaken to preserve the form of each participant’s narrative. We argue that nurses’ pandemic trajectories occurred within the ‘psychological vulnerability-stigma nexus’ which operates within health and social care providers in the UK and whilst constraining nurses’ agency at times it could also provide an impetus to act agentically. We found that the nurses’ COVID-19 trajectories were characterised by: getting by, getting out (job-hopping) getting needs met and getting organised. We call for more considered systemic support to be generated and consistently provided to nurses to ensure retention of nurses and the security of society to avoid exacerbating existing workforce shortages

Detailed investigations into the Akabori–Momotani reaction for the synthesis of amphetamine type stimulants: Part 2

© 2018 Elsevier BV. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:http://creativecommons.org/licenses/by-nc-nd/4.0/The Akabori–Momotani reaction can be used to synthesise pseudoephedrine in 50% yield from N-methylalanine and benzaldehyde. This paper investigates electronic effects of substituted benzaldehydes on the reaction to synthesise amphetamine type stimulants and identifies several new Akabori–Momotani by-products, 1-[(4-methoxybenzyl)(methyl)amino]ethanol (11c), 2-(4-methoxyphenyl)-3,4-dimethyl-1,3-oxazolidine (12c), 1,2,3,4-tetramethyl-5,6-di-(4-methoxyphenyl)piperazine (13c) and 1,2,4,5-tetramethyl-3,6-di-(4-methoxyphenyl)piperazine (14c). This paper also investigates pseudoephedrine and methamphetamine isomeric distribution from the Akabori–Momotani reaction with the aid of molecular modelling to understand why more pseudoephedrine than ephedrine is produced

Response to Comment on "Ascent of Dinosaurs Linked to an Iridium Anomaly at the Triassic-Jurassic Boundary"

Our recent study on the nature of the ascent of the dinosaurs (1) argued three main points: (i) that a major terrestrial tetrapod mass extinction is concentrated at the palynologically identified Triassic-Jurassic boundary in eastern North America (based on footprints and bones); (ii) that truly large predatory dinosaurs appear immediately after the boundary (based on footprints); and (iii) that both the boundary and the mass extinction level are associated with a modest Ir anomaly and fern spike, plausibly of asteroid or comet impact origin. Although the comment of Thulborn (2) addresses a number of paleontological issues in (1), his only point salient to the conclusions of our paper is his extraordinary claim that very large theropod dinosaurs were already present in the Carnian, some 20 million years or so before the Triassic-Jurassic boundary [in contrast to our assertion in point (ii), above]

Computational Tracking of Shear-Mediated Platelet Interactions with von Willebrand Factor

The imaging of shear-mediated dynamic platelet behavior interacting with surface-immobilized von Willebrand factor (vWF) has tremendous potential in characterizing changes in platelet function for clinical diagnostics purposes. However, the imaging output, a series of images representing platelets adhering and rolling on the surface, poses unique, non-trivial challenges for software algorithms that reconstruct the positional trajectories of platelets. We report on an algorithm that tracks platelets using the output of such flow run experiments, taking into account common artifacts encountered by previously-published methods, and we derive seven key metrics of platelet dynamics that can be used to characterize platelet function. Extensive testing of our method using simulated platelet flow run data was carried out to validate our tracking method and derived metrics in capturing key platelet-vWF interaction-dynamics properties. Our results show that while the number of platelets present on the imaged area is the leading cause of errors, flow run data from two experiments using whole blood samples showed that our method and metrics can detect platelet property changes/differences that are concordant with the expected biological outcome, such as inhibiting key platelet receptors such as P2Y1, glycoprotein (GP)Ib and GPIIb/IIIa. These findings support the use of our methodologies to characterize platelet function among a wide range of healthy and disease cohorts

Implementing Outcomes-Based Managed Entry Agreements for Rare Disease Treatments:Nusinersen and Tisagenlecleucel

Enthusiasm for the use of outcomes-based managed entry agreements (OBMEAs) to manage uncertainties apparent at the time of appraisal/pricing and reimbursement of new medicines has waned over the past decade, as challenges in establishment, implementation and re-appraisal have been identified. With the recent advent of innovative treatments for rare diseases that have uncertainties in the clinical evidence base, but which could meet a high unmet need, there has been renewed interest in the potential of OBMEAs. The objective of this research was to review the implementation of OBMEAs for two case studies across countries in the European Union, Australia and Canada, to identify good practices that could inform development of tools to support implementation of OBMEAs. To investigate how OBMEAs are being implemented with rare disease treatments, we collected information from health technology assessment/payer experts in countries that had implemented OBMEAs for either nusinersen in spinal muscular atrophy or tisagenlecleucel in two cancer indications. Operational characteristics of the OBMEAs that were publicly available were documented. Then, the experts discussed issues in implementing these OBMEAs and specific approaches taken to overcome challenges. The OBMEAs identified were based on individual outcomes to ensure appropriate use, manage continuation of treatment and in two cases linked to payment schedules, or they were population based, coverage with evidence development. For nusinersen, population-based OBMEAs are documented in Belgium, England and the Netherlands and individual-based schemes in Bulgaria, Ireland, Italy and Lithuania. For tisagenlecleucel, there were population-based schemes in Australia, Belgium, England and France and individual-based schemes in Italy and Spain. Comparison of the OBMEA constructs showed some clear published frameworks and clarity of the uncertainties to be addressed that were similar across countries. Agreements were generally made between the marketing authorisation holder and the payer with involvement of expert physicians. Only England and the Netherlands involved patients. Italy used its long-established, national, web-based, treatment-specific data collection system linked to reimbursement and Spain has just developed such a national treatment registry system. Other countries relied on a variety of data collection systems (including clinical registries) and administrative data. Durations of agreements varied for these treatments as did processes for interim reporting. The processes to ensure data quality, completeness and sufficiency for re-analysis after coverage with evidence development were not always clear, neither were analysis plans. These case studies have shown that important information about the constructs of OBMEAs for rare disease treatments are publicly available, and for some jurisdictions, interim reports of progress. Outcomes-based managed entry agreements can play an important role not only in reimbursement, but also in treatment optimisation. However, they are complex to implement and should be the exception and not the rule. More recent OBMEAs have developed document covenants among stakeholders or electronic systems to provide assurances about data sufficiency. For coverage with evidence development, there is an opportunity for greater collaboration among jurisdictions to share processes, develop common data collection agreements, and share interim and final reports. The establishment of an international public portal to host such reports would be particularly valuable for rare disease treatments

Speaking up during the COVID‐19 pandemic : nurses' experiences of organizational disregard and silence

Aim To critically examine nurses' experiences of speaking up during COVID-19 and the consequences of doing so. Design Longitudinal qualitative study. Methods Participants were purposively sampled to represent differing geographical locations, specialities, settings and redeployment experiences. They were interviewed (remotely) between July 2020 and April 2022 using a semi-structured interview topic guide. Results Three key themes were identified inductively from our analysis including: (1) Under threat: The ability to speak up or not; (2) Risk tolerance and avoidance: Consequences of speaking up; and (3) Deafness and hostility: Responses to speaking up. Nurses reported that their attempts to speak up typically focused on PPE, patient safety and redeployment. Findings indicate that when NHS Trusts and community services initiated their pandemic response policies, nurses' opportunities to speak up were frequently thwarted. Conclusion Accounts presented in this article include nurses' feeling a sense of futility or of suffering in silence in relation to speaking up. Nurses also fear the consequences of speaking up. Those who did speak up encountered a ‘deaf’ or hostile response, leaving nurses feeling disregarded by their organization. This points to missed opportunities to learn from those on the front line. Impact Speaking up interventions need to focus on enhancing the skills to both speak up, and respond appropriately, particularly when power, hierarchy, fear and threat might be concerned. Patient or Public Contribution Nurses working clinically during COVID-19 were involved in the development of this study. Participants were also involved in the development of our interview topic guide and comments obtained from the initial survey helped to shape the study design