‘Sink or Swim’: A Qualitative Study to Understand How and Why Nurses Adapt to Support the Implementation of Integrated Diabetes Care

Background: Integrated care, organising care delivery within and between services, is an approach to improve the quality of care. Existing specialist roles have evolved to work across settings and services to integrate care. However, there is limited insight into how these expanded roles are implemented, including how they may be shaped by context. This paper examines how new diabetes nurse specialists working across care boundaries, together with hospital-based diabetes nurse specialists, adapt to support the implementation of integrated care. Methods: We conducted semi-structured focus groups and interviews with diabetes nurse specialists purposively sampled by work setting and health service region (n = 30). Analysis was data-driven, coding actions or processes to stay closer to the data and using 'In Vivo' codes to preserve meaning. Findings: Community nurse specialists described facing a choice of “sink or swim” when appointed with limited guidance on their role. To ‘swim’ and implement their role, required them to use their initiative and adapt to the local context. When first appointed, both community and hospital nurse specialists actively managed misconceptions of their role by other staff. To establish clinics in general practices, community nurse specialists capitalised on professional contacts to access GPs who might utilise their role. They built GP trust by adopting practice norms and responding to individual needs. They adapted to the lack of a multidisciplinary team “safety net” in the community, by “practicing at a higher level”, working more autonomously. Developing professional links and pursuing on-going education was a way to create an alternative ‘safety net’ so as to feel confident in their clinical decision-making when working in the community. Workarounds facilitated information flow (i.e. patient blood results, treatment, and appointments) between settings in the absence of an electronic record shared between general practices and hospital settings. Conclusions: Flexibility and innovation facilitates a new way of working across boundaries. Successful implementation of nurse specialist-led integrated care requires strategies to address elements in the inner (differences in practice organisation, role acceptance) and outer (information systems) context

Linking agri-environment scheme habitat area, predation and the abundance of chick invertebrate prey to the nesting success of a declining farmland bird

1. Across Europe, farmland bird populations have continued to decline since the 1970s owing to the intensification of farming practices. Studies of such declines have tended to focus specifically on either the impacts of habitats (nesting and foraging), nest predators or prey availability on bird demographics. The study presented here provides new insights into the relative effects of each of these factors on Yellowhammer nest survival. The Yellowhammer was selected for this study as it is a UK red-listed bird species whose population is in decline across much of Europe.2. We use a long-term dataset of 147 nests, monitored between 1995 and 2007, to provide an insight into how Yellowhammer nest survival is influenced by nesting habitat (nest concealment and nest height), foraging habitats (habitat coverage within 100 m of nests), the removal of nest predators (Magpie Pica pica abundance as an inverse measure of avian predator removal through gamekeeping) and food availability (measured with a D-vac invertebrate suction sampler). 3. Our results indicated that Yellowhammer hatching success was negatively related to the coverage of spring agri-environment scheme habitats, a group which represents invertebrate-rich agri-environment habitats, but hatching success increased with nest height. Fledging success was positively related to the coverage of the seed-rich habitat Wild Bird Seed mixture. The farm-level abundance of Yellowhammer chick-food invertebrates declined over the study period. 4. Synthesis and application. Our results highlight the importance of simultaneously considering multiple agents that shape avian breeding success, i.e. their ability to produce offspring, to inform conservation management. Our key finding for land managers relates to the positive relationship between the proportion seed rich foraging habitat within the Yellowhammer’s average foraging range and Yellowhammer fledging success, which shows that a habitat intended primarily to provide winter food resources is also important to breeding birds. Chick food abundance in this habitat was, however, similar to broadleaf and cereal crops. We recommend that this habitat should be provided near to potential Yellowhammer nesting sites and adjacent to invertebrate-rich agri-environment scheme habitats such as beetle banks and conservation headlands to further boost invertebrate resources for a declining farmland bird

Genomic assessment of quarantine measures to prevent SARS-CoV-2 importation and transmission

Mitigation of SARS-CoV-2 transmission from international travel is a priority. We evaluated the effectiveness of travellers being required to quarantine for 14-days on return to England in Summer 2020. We identified 4,207 travel-related SARS-CoV-2 cases and their contacts, and identified 827 associated SARS-CoV-2 genomes. Overall, quarantine was associated with a lower rate of contacts, and the impact of quarantine was greatest in the 16–20 age-group. 186 SARS-CoV-2 genomes were sufficiently unique to identify travel-related clusters. Fewer genomically-linked cases were observed for index cases who returned from countries with quarantine requirement compared to countries with no quarantine requirement. This difference was explained by fewer importation events per identified genome for these cases, as opposed to fewer onward contacts per case. Overall, our study demonstrates that a 14-day quarantine period reduces, but does not completely eliminate, the onward transmission of imported cases, mainly by dissuading travel to countries with a quarantine requirement

The contribution of semi-natural habitats to biological control is dependent on sentinel prey type

It is widely recognized that landscape factors affect the biological control of weed seeds and insect pests in arable crops, but landscape effects have been found to be inconsistent between studies. Here, we compare six different types of sentinels (surrogate prey that was either live insects or seeds) to measure the effects of semi-natural habitats at field to landscape scales on levels of biological control in winter wheat in the UK. Sentinels were located in fields adjacent to three boundary types: grassy margin, hedgerows or woodland to study the local scale effects and in landscapes of varying heterogeneity in study areas of 1-km radius. Overall, mean levels of predation were higher for most insect prey (60.8%) located on the ground compared to the crop (12.2%) and was lower for seeds (5.8%). Predation of sentinels on the ground was attributed to generalist predators. Semi-natural habitats had both positive and negative effects at field and landscape scales, but the response varied with the sentinel type. Herbaceous linear semi-natural habitats had positive effects at local scales for Calliphora vomitoria and Sitobion avenae sentinels and provide evidence that farmers can introduce linear herbaceous features to benefit biological control. In contrast, our distance-weighted kernel models identified a positive relationship between woody habitats and the predation of C. vomitoria and Chenopodium album. Natural aphid infestations were lower in landscapes with more semi-natural habitat. Synthesis and applications. Sentinels may be sensitive enough to detect variation in levels of biological control influenced by semi-natural habitats, but this study confirms that landscape effects differ for different types of sentinel prey. This implies that it may not be possible to categorize landscapes as pest suppressive using a single sentinel type. Future studies should therefore consider using multiple sentinels to give a better perspective on predation intensity. The resulting recommendations for farm management include planting woodland adjacent wheat fields infested with seed predators and positioning herbaceous linear habitats adjacent wheat fields infested with Sitobion avenae, particularly if fields are bordered by woody liner habitats due to their association with decreased S. avenae predation.</p

The contribution of semi-natural habitats to biological control is dependent on sentinel prey type

It is widely recognized that landscape factors affect the biological control of weed seeds and insect pests in arable crops, but landscape effects have been found to be inconsistent between studies. Here, we compare six different types of sentinels (surrogate prey that was either live insects or seeds) to measure the effects of semi-natural habitats at field to landscape scales on levels of biological control in winter wheat in the UK. Sentinels were located in fields adjacent to three boundary types: grassy margin, hedgerows or woodland to study local scale effects and in landscapes of varying heterogeneity in study areas of 1 km radius. Overall mean levels of predation were higher for most insect prey (60.8%) located on the ground compared to the crop (12.2%) and was lower for seeds (5.8%). Predation of sentinels on the ground was attributed to generalist predators. Semi-natural habitats had both positive and negative effects at field and landscape scales, but the response varied with the sentinel type. Herbaceous linear semi-natural habitats had positive effects at local scales for Calliphora vomitoria and Sitobion avenae sentinels and provides evidence that farmers can introduce linear herbaceous features to benefit biological control. In contrast our distance weighted kernel models identified a positive relationship between woody habitats and the predation of Caliphora vomitoria and Chenopodium album. Natural aphid infestations were lower in landscapes with more semi-natural habitat. Synthesis and applications. Sentinels may be sensitive enough to detect variation in levels of biological control influenced by semi-natural habitats, but this study confirms that landscape effects differ for different types of sentinel prey. This implies that it may not be possible to categorize landscapes as pest suppressive using a single sentinel type. Future studies should therefore consider using multiple sentinels to give a better perspective on predation intensity. The resulting recommendations for farm management include planting woodland adjacent wheat fields infested with seed predators and positioning herbaceous linear habitats adjacent wheat fields infested with Sitobion Avenae, particularly if fields are bordered by woody liner habitats due to their association with decreased Sitobion Avenae predation

Epidemiology of undiagnosed depression in people with diabetes mellitus: a comparative analysis of Ireland, England and the USA

Objectives Improving detection of depression in people with diabetes is recommended. However, little is known about how different health systems compare in depression detection. We estimated and compared the (1) prevalence of depression detection in people with and without diabetes, and (2) association between diabetes and undiagnosed depression across three health systems. Design Cross-sectional analysis of three nationally representative studies: The Irish Longitudinal Study on Ageing, the English Longitudinal Study on Ageing and the Health and Retirement Study. Setting Community-dwelling adults in Ireland, England and the USA