A core mechanism for specifying root vascular patterning can replicate the anatomical variation seen in diverse plant species

Pattern formation is typically controlled through the interaction between molecular signals within a given tissue. During early embryonic development, roots of the model plant Arabidopsis thatiana have a radially symmetric pattern, but a heterogeneous input of the hormone auxin from the two cotyledons forces the vascular cylinder to develop a diarch pattern with two xylem poles. Molecular analyses and mathematical approaches have uncovered the regulatory circuit that propagates this initial auxin signal into a stable cellular pattern. The diarch pattern seen in Arabidopsis is relatively uncommon among flowering plants, with most species having between three and eight xylem poles. Here, we have used multiscale mathematical modelling to demonstrate that this regulatory module does not require a heterogeneous auxin input to specify the vascular pattern. Instead, the pattern can emerge dynamically, with its final form dependent upon spatial constraints and growth. The predictions of our simulations compare to experimental observations of xylem pole number across a range of species, as well as in transgenic systems in Arabidopsis in which we manipulate the size of the vascular cylinder. By considering the spatial constraints, our model is able to explain much of the diversity seen in different flowering plant species.Peer reviewe

Improving inpatient postnatal services: midwives views and perspectives of engagement in a quality improvement initiative

Background: despite major policy initiatives in the United Kingdom to enhance women's experiences of maternity care, improving in-patient postnatal care remains a low priority, although it is an aspect of care consistently rated as poor by women. As part of a systems and process approach to improving care at one maternity unit in the South of England, the views and perspectives of midwives responsible for implementing change were sought. Methods: a Continuous Quality Improvement (CQI) approach was adopted to support a systems and process change to in-patient care and care on transfer home in a large district general hospital with around 6000 births a year. The CQI approach included an initial assessment to identify where revisions to routine systems and processes were required, developing, implementing and evaluating revisions to the content and documentation of care in hospital and on transfer home, and training workshops for midwives and other maternity staff responsible for implementing changes. To assess midwifery views of the quality improvement process and their engagement with this, questionnaires were sent to those who had participated at the outset. Results: questionnaires were received from 68 (46%) of the estimated 149 midwives eligible to complete the questionnaire. All midwives were aware of the revisions introduced, and two-thirds felt these were more appropriate to meet the women's physical and emotional health, information and support needs. Some midwives considered that the introduction of new maternal postnatal records increased their workload, mainly as a consequence of colleagues not completing documentation as required. Conclusions: this was the first UK study to undertake a review of in-patient postnatal services. Involvement of midwives at the outset was essential to the success of the initiative. Midwives play a lead role in the planning and organisation of in-patient postnatal care and it was important to obtain their feedback on whether revisions were pragmatic and achieved anticipated improvements in care quality. Their initial involvement ensured priority areas for change were identified and implemented. Their subsequent feedback highlighted further important areas to address as part of CQI to ensure best quality care continues to be implemented. Our findings could support other maternity service organisations to optimise in-patient postnatal services

Can Low-Severity Fire Reverse Compositional Change in Montane Forests of the Sierra Nevada, California, USA?

Throughout the Sierra Nevada, nearly a century of fire suppression has altered the tree species composition, forest structure, and fire regimes that were previously characteristic of montane forests. Species composition is fundamentally important because species differ in their tolerances to fire and environmental stressors, and these differences dictate future forest structure and influence fire regime attributes. In some lower montane stands, shade-tolerant, fire-sensitive species have driven a threefold increase in tree density that may intensify the risk of high-severity fire. In upper montane forests, which were historically characterized by longer fire return intervals, the effects of fire exclusion are both less apparent and less studied. Although land managers have been reintroducing fire to lower and upper montane forests for \u3e4 decades, the potentially restorative effects of these actions on species composition remain largely unassessed. We used tree diameter and species data from 51 recently burned and 46 unburned plots located throughout lower and upper montane forests in Yosemite National Park and Sequoia & Kings Canyon National Parks to examine the effects of low-to moderate-severity (hereafter, lower-severity)fire on the demography of seven prevalent tree species. The density of Abies concolor concolor 30–45 cm dbh, A. magnifica Calocedrus decurrens concolor but not for C. decurrens, and (2) variability in tree density among plots that burned at lower severity exceeded the range of tree densities reported in historical data sets. High proportions of shade-tolerant species in some postfire stands may increase the prevalence of shade-tolerant species in the future, a potential concern for managers who seek to minimize ladder fuels and promote forest structure that is less prone to high-severity fire

Population policies and education: exploring the contradictions of neo-liberal globalisation

The world is increasingly characterised by profound income, health and social inequalities (Appadurai, 2000). In recent decades development initiatives aimed at reducing these inequalities have been situated in a context of increasing globalisation with a dominant neo-liberal economic orthodoxy. This paper argues that neo-liberal globalisation contains inherent contradictions regarding choice and uniformity. This is illustrated in this paper through an exploration of the impact of neo-liberal globalisation on population policies and programmes. The dominant neo-liberal economic ideology that has influenced development over the last few decades has often led to alternative global visions being overlooked. Many current population and development debates are characterised by polarised arguments with strongly opposing aims and views. This raises the challenge of finding alternatives situated in more middle ground that both identify and promote the socially positive elements of neo-liberalism and state intervention, but also to limit their worst excesses within the population field and more broadly. This paper concludes with a discussion outling the positive nature of middle ground and other possible alternatives

Dog‐assisted interventions and outcomes for older adults in residential long‐term care facilities: a systematic review and meta‐analysis

Objective To comprehensively review studies on dog‐assisted interventions (DAIs) among older people in residential long‐term care facilities (RLTCFs) and to provide an overview of their interventions, outcomes and methodological quality. Method We searched 18 electronic databases to identify English articles (published January 2000–December 2019) reporting on well‐defined DAIs targeting older adults (≥65 years) in RLTCF. Data were extracted by two independent reviewers. Descriptive statistics were produced for quantitative studies, with key themes identified among qualitative studies. Where possible, estimates were pooled from randomised controlled trials using random effects meta‐analyses. Results Forty‐three relevant studies (39 quantitative; 4 qualitative) were identified. The majority of quantitative studies were assessed as low‐quality according to the MMAT criteria (n = 26, 67%). Almost half of the quantitative studies (n = 18, 46%) found no significant changes over time or between groups across outcomes measured. The most salient intervention effects included improved social functioning (n = 10), reduced depressive symptoms (n = 6) and loneliness (n = 5). A random‐effects meta‐analysis revealed a medium effect in favour of DAT on reducing depressive or loneliness symptoms (pooled SMD: 0.66, 95%CI 0.21–1.11; I2 = 50.5; five trials), relative to treatment as usual. However, compared to treatment as usual, no overall effect of DAI on activities of daily living was detected (p = .737). Key themes from qualitative studies included (a) animals as effective transitional objects, (b) the therapeutic value of pets and (c) the significance of the care environment and stakeholders in facilitating DAI. Implications for practice The findings of this review indicate that while DAI has value for older people in RLTCF, challenges remain in accurately measuring its impact to provide a stronger evidence‐base. Standardisation of DAI service design, delivery and evaluation is required for future research and practice in providing holistic care for older adults

A systematic review of integrated working between care homes and health care services

© 2011 Davies et al; licensee BioMed Central LtdBackground In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. Methods A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. Results Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for integrated working were longer in duration. Conclusions Despite evidence about what inhibits and facilitates integrated working there was limited evidence about what the outcomes of different approaches to integrated care between health service and care homes might be. The majority of studies only achieved integrated working at the patient level of care and the focus on health service defined problems and outcome measures did not incorporate the priorities of residents or acknowledge the skills of care home staff. There is a need for more research to understand how integrated working is achieved and to test the effect of different approaches on cost, staff satisfaction and resident outcomes

Facilitation skills: the catalyst for increased effectiveness in consultant practice and clinical systems leadership

Consultant practitioner is the pinnacle of the clinical career ladder for all health care disciplines in the United Kingdom. Consultant nurse, midwife and health visitor roles build on the clinical credibility and expertise characteristic of advanced level practice, but also possess expertise in: clinical systems leadership and the facilitation of culture change, learning and development; advanced consultancy approaches, and research and evaluation to prioritise person-centred, safe and effective care across patient pathways. This project aimed to help new and emerging consultants to become more effective in their role through a programme of support to develop their expertise. Emancipatory action research, supported by claims, concerns and issues tool, derived from Stakeholder Evaluation, and other methods (active learning, action learning, collaborative workshops and individual tools e.g. qualitative 360 degree feedback and reflective reviews) comprised the supportive intervention which enabled participants to research their own practice. The programme’s methodology and methods helped participants to: research their own practice; theorise from practice; grow the facilitation skills needed to develop and demonstrate their own effectiveness; foster the effectiveness of others and; transform practice culture. Greater effectiveness in their multiple roles was demonstrated, as was the impact of this on others, services and organisations. The study concludes that the support programme augmented by the methodology, facilitation skills and the 10 principles derived from a concept analysis of work-based learning is central to achieving improved effectiveness and transformation of others, services and organisations. Theoretical insights at collective/community levels also resulted. Key recommendations are identified for commissioners, higher education and research

Making space for co-produced research ‘impact’: learning from a participatory action research case study

There is growing emphasis in the UK on promoting research that creates a positive impact on society. Research Councils UK, the major national research funding agencies, have recently defined a framework for promoting and measuring this impact. This paper contributes to current debates about this developing agenda and, particularly, the problematic intersection of the impact agenda and co-production research approaches. I argue that processes of negotiating values, aims and power relations are essential to creating relevant, ethical impacts with research participants. In contrast to the emphasis placed on linear and top-down change by the impact agenda, my experience doing participatory action research with a UK community group shows that co-produced research produces different kinds of impacts: co-produced impacts are emergent and non-linear; responsive and relational; and empowering when rooted in reciprocal collaboration with research partners. This paper questions the implicit values the impact framework imposes on academic researchers and community partners, calling for continued critical engagement with the impact agenda to encourage the value-rational reflection, deliberation and collaboration needed for creating socially transformative research

Multiple sclerosis outpatient future groups: improving the quality of participant interaction and ideation tools within service improvement activities

BackgroundImproving the patient experience is a key focus within the National Health Service. This has led us to consider how health services are experienced, from both staff and patient perspectives. Novel service improvement activities bring staff and patients together to use design-led methods to improve how health services are delivered. The Multiple Sclerosis Outpatient Future Group study aimed to explore how analogies and props can be used to facilitate rich interactions between staff and patients within these activities. This paper will consider how these interactions supported participants to share experiences, generate ideas and suggest service improvements. MethodQualitative explorative study using ‘future groups,’ a reinterpretation of the recognised focus groups method directed towards exploring future alternatives through employing analogies and physical props to engage participants to speculate about future service interactions and health experiences. Participants were people with multiple sclerosis (PwMS) and outpatient staff: staff nurses, nursing assistants, junior sisters and reception staff. ResultsUse of future groups, analogies and physical props enabled PwMS and outpatient staff to invest their own ideas and feelings in the service improvement activity and envisage alternative health care scenarios. The combination of participants in the groups with their diverse perspectives and knowledge of the service led to a collaborative approach in which staff highlighted potential practical problems and patients ensured ideas were holistic. Service improvements were prototyped and tested in the outpatient clinic. ConclusionDesign-led methods such as future groups using analogies and physical props can be used to facilitate interactions between staff and patients in service improvement activities, leading to the generation of meaningful ideas. It is hoped that improving the quality of ideation tools within design-led methods can contribute to developing successful service interventions in service improvement activities. <br/