A qualitative study of the health experience of gypsy travellers in the UK with a focus on terminal illness

Aim To understand the experience of terminal care and health care access for Gypsy Travellers, to inform palliative and primary care service provision. Background Little contemporary research of UK English Romany Gypsy Travellers is available. This ethnic group is often overlooked in ethnic minority health research. Methods Access to Gypsy Traveller communities was through non-health care channels and required the development of trust through repeated contact over time. English Romany Gypsy Travellers at two Traveller sites participated in face-to-face contacts. Data collection was through field observation and seven semistructured interviews with Gypsy Traveller women who had experience of caring for relatives who were dying. In addition, data were collected over two years through discussion in a members-only Gypsy and Traveller interest e-mail forum. Findings The culture of Gypsy Travellers is distinct but diverse. Hygiene is important as is discretion and sensitivity to the information requirements of the patient and family. Gypsy Travellers are aware that their mobility (voluntary or enforced) can negatively impact on health care. Home care for the terminally ill is often preferred to hospital care often due to poor understanding of their cultural and personal needs by health care professionals and due to an aversion to ‘bricks and mortar’. Care may be provided by the extended family. Palliative care provision should consider the needs of Gypsy Travellers including respect for their culture and support for caring at home

Should we treat soft tissue injuries with Actovegin?

Actovegin is a biological drug produced from deproteinised hemodialysate of calf serum with over 50 years of history for its clinical use. There have been many in vitro studies to speculate its potential role and mechanism of action in cells; due to the nature of this drug and serum based culture techniques for most in vitro experiments, presumptuous conclusions and claims from these studies on performance enhancement should be cautiously interpreted. There have been well-designed human in vivo studies suggesting it does not enhance human performance, and has potentially good clinical applications to treat injuries, strokes and diabetes. Recently, evidence has emerged suggesting Actovegin has anti-inflammatory and anti-apoptotic effects on injured tissues; further clinical research is needed to define these effects. This article also provides a narrative review of Actovegin summarizing outcomes from recent publications

Actovegin equal to performance enhancing drug doping: fact or fiction?

Actovegin is a biological drug that has been used for the treatment of sports muscle injuries. Several in vitro studies have shed light on potential mechanisms of action and the drug has consistently demonstrated its potential to reduce return from injury time for muscle tears in elite athletes. Yet it was banned for a time under the International Olympic Committee (IOC) as a blood doping agent, this ban was based on presumptuous conclusions and subsequently lifted after no indisputable evidence could be provided. This editorial aims to provide readers with some of the key, objective facts relating to Actovegin and then based on this, will offer an informed opinion on its role in sports medicine. We also hope to highlight the importance of evidence-based medicine, particularly in the volatile field of Sports Medicine, and the need for facts, not fiction

Psychiatric nurses’ views on criteria for psychiatric intensive care: acute and intensive care staff compared

Aim: To explore and investigate differences between the views of qualified nurses working in psychiatric intensive care units (PICUs) and acute care wards on which patients are appropriate for PICU care. Background: Previous research on the area of psychiatric intensive care highlights the great differences that exist in all aspects of service provision, from unit size and staffing levels to treatment approaches and physical environment. One of the most common areas of controversy is the type of client behaviour that warrants admission to the PICU. Method: Structured interviews of 100 qualified nursing staff (in the London area, England) working on either acute or PICU wards were used to gather data on appropriate and inappropriate referral to PICUs. Comments made during the course of the interviews were also collected and subjected to content analysis. Findings: There was evidence to support the hypothesis that acute ward staff considered patients suitable for PICU care at a lower level of risk than PICU staff thought appropriate. In comparison to acute ward nurses, those working in PICUs attended to a broader range of factors when considering suitability for admission to PICU. Appropriate reasons for transfer fell into five groups: risk to others; risk of intentional harm to self; risk of unintentional harm to self; therapeutic benefit from the PICU environment; and legitimate acute ward care problem. Inappropriate reasons for transfer fell into four groups: low risk to others and/or self; illegitimate acute admission care problems; patient belongs elsewhere; policy issues. Conclusion: The study opens up a range of issues not previously studied in relation to the use of PICUs and the intricate relationship of this use with the available acute care wards and other services. These findings and their implications for the care of acute and disturbed psychiatric patients are discussed

Examining reliability of seasonal to decadal sea surface temperature forecasts: the role of ensemble dispersion

Useful probabilistic climate forecasts on decadal timescales should be reliable (i.e. forecast probabilities match the observed relative frequencies) but this is seldom examined. This paper assesses a necessary condition for reliability, that the ratio of ensemble spread to forecast error being close to one, for seasonal to decadal sea surface temperature retrospective forecasts from the Met Office Decadal Prediction System (DePreSys). Factors which may affect reliability are diagnosed by comparing this spread-error ratio for an initial condition ensemble and two perturbed physics ensembles for initialized and uninitialized predictions. At lead times less than 2 years, the initialized ensembles tend to be under-dispersed, and hence produce overconfident and hence unreliable forecasts. For longer lead times, all three ensembles are predominantly over-dispersed. Such over-dispersion is primarily related to excessive inter-annual variability in the climate model. These findings highlight the need to carefully evaluate simulated variability in seasonal and decadal prediction systems.Useful probabilistic climate forecasts on decadal timescales should be reliable (i.e. forecast probabilities match the observed relative frequencies) but this is seldom examined. This paper assesses a necessary condition for reliability, that the ratio of ensemble spread to forecast error being close to one, for seasonal to decadal sea surface temperature retrospective forecasts from the Met Office Decadal Prediction System (DePreSys). Factors which may affect reliability are diagnosed by comparing this spread-error ratio for an initial condition ensemble and two perturbed physics ensembles for initialized and uninitialized predictions. At lead times less than 2 years, the initialized ensembles tend to be under-dispersed, and hence produce overconfident and hence unreliable forecasts. For longer lead times, all three ensembles are predominantly over-dispersed. Such over-dispersion is primarily related to excessive inter-annual variability in the climate model. These findings highlight the need to carefully evaluate simulated variability in seasonal and decadal prediction systems

Estimated effects of climate change on flood vulnerability of U.S. bridges

We assessed the potential impacts of increased river flooding from climate change on bridges in the continental United States. Daily precipitation statistics from four climate models and three greenhouse gas (GHG) emissions scenarios (A2, A1B, and B1) were used to capture a range of potential changes in climate. Using changes in maximum daily precipitation, we estimated changes to the peak flow rates for the 100-year return period for 2,097 watersheds. These estimates were then combined with information from the National Bridge Inventory database to estimate changes to bridge scour vulnerability. The results indicate that there may be significant potential risks to bridges in the United States from increased precipitation intensities. Approximately 129,000 bridges were found to be currently deficient. Tens of thousands to more than 100,000 bridges could be vulnerable to increased river flows. Results by region vary considerably. In general, more bridges in eastern areas are vulnerable than those in western areas. The highest GHG emissions scenarios result in the largest number of bridges being at risk. The costs of adapting vulnerable bridges to avoid increased damage associated with climate change vary from approximately $140 to$250 billion through the 21st century. If these costs were spread out evenly over the century, the annual costs would be several billion dollars. The costs of protecting the bridges against climate change risks could be reduced by approximately 30% if existing deficient bridges are improved with riprap.United States. Environmental Protection Agency. Office of Atmospheric Programs (Contract #EP-W-07-072

High site-fidelity in common bottlenose dolphins despite low salinity exposure and associated indicators of compromised health

Funding for this work was provided by the National Fish and Wildlife Foundation Gulf Environmental Benefit Fund (https://www.nfwf.org/gulf-environmental-benefit-fund; contract number 57223) to CS under subcontracts to Abt Associates Inc.More than 2,000 common bottlenose dolphins (Tursiops truncatus) inhabit the Barataria Bay Estuarine System in Louisiana, USA, a highly productive estuary with variable salinity driven by natural and man-made processes. It was unclear whether dolphins that are long-term residents to specific areas within the basin move in response to fluctuations in salinity, which at times can decline to 0 parts per thousand in portions of the basin. In June 2017, we conducted health assessments and deployed satellite telemetry tags on dolphins in the northern portions of the Barataria Bay Estuarine System Stock area (9 females; 4 males). We analyzed their fine-scale movements relative to modeled salinity trends compared to dolphins tagged near the barrier islands (higher salinity environments) from 2011 to 2017 (37 females; 21 males). Even though we observed different movement patterns among individual dolphins, we found no evidence that tagged dolphins moved coincident with changes in salinity. One tagged dolphin spent at least 35 consecutive days, and 75 days in total, in salinity under 5 parts per thousand. Health assessments took place early in a seasonal period of decreased salinity. Nonetheless, we found an increased prevalence of skin lesions, as well as abnormalities in serum biochemical markers and urine:serum osmolality ratios for dolphins sampled in lower salinity areas. This study provides essential information on the likely behavioral responses of dolphins to changes in salinity (e.g., severe storms or from the proposed Mid-Barataria Sediment Diversion project) and on physiological markers to inform the timing and severity of impacts from low salinity exposure.Publisher PDFPeer reviewe

Estimating age and investigating epigenetic changes related to health across multiple bottlenose dolphin populations

Funding: This study was partially funded by SERDP grants RC20-C2-1097, RC20-7188 and RC21-3091 awarded to Peter Tyack, Prescott Award NA20NMF4390132 awarded to Ashley Barratclough, and the NOAA Office of Response and Restoration, Assessment and Restoration Division. This work was also supported by the Office of Naval Research Marine Mammal Biology Program (grant N00014-22-1-2706), and the Oiled Wildlife Care Network Grant A23-1689-S002.Epigenetic age estimation has the potential to influence conservation approaches for wildlife. DNA extracted from a small skin sample can be analyzed for methylation changes, which can be related to chronological age through an epigenetic clock to obtain a DNA-based age estimate (DNAm age). For a wide range of cetacean species, skin samples can be obtained remotely using dart biopsy. We tested multiple modeling approaches (elastic net regression, random forest regression, and a hybrid of elastic net and random forest classification) using DNA methylation data from 426 skin samples from observed-age wild bottlenose dolphins (Tursiops spp.), and 50 managed care dolphins, to develop an epigenetic clock. The hybrid model gave highly accurate age predictions for calf (25 yrs., n = 65), age predictions were less accurate, with MAE of 5.90 yrs. The overall MAE across all ages (n = 476) was 1.91 yrs. DNAm age has been linked to health in humans, with higher age residuals (i.e., higher DNAm age as compared to actual age) being associated with increased risk of morbidity and mortality. We compared dolphin age residuals with previously reported health scores that are predictive of one year mortality risk. Our findings suggest that analysis of DNA methylation patterns is a viable approach, not only for estimating age of dolphins, but potentially also to assess individual and population health.Peer reviewe