Seeking help for peritoneal dialysis-associated peritonitis: patients' and families' intentions and actions. A mixed methods study

Aims To examine patients’ and families’ help-seeking intentions and actions when suspecting peritoneal dialysis-associated peritonitis. Design A sequential explanatory mixed methods design was used, comprising a questionnaire and semi-structured interviews. Methods A questionnaire was designed, piloted and used with patients and family members (n=75) using peritoneal dialysis from six hospital sites in Wales and England. Questionnaire data were analysed using descriptive statistics. A purposive sample of questionnaire participants (n=30) then took part in telephone or face-to-face semi-structured interviews. Interview data were analysed thematically. Data were collected between September 2017 and August 2018. Ethical and governance approvals were obtained; the study was reported on national research portfolios. Results The quantitative data highlighted differences between participants’ knowledge of when they should seek help for suspected peritonitis and their actions when they subsequently experienced peritonitis. The interview data revealed the complexities involved with recognizing peritonitis, making the decision to seek help and accessing healthcare. Some participants struggled to recognize peritonitis when signs/symptoms started, leading to delays in deciding to seek help. Furthermore, some participants reported that they accessed help from renal or generic out-of-hours and were misadvised or misdiagnosed, delaying diagnosis and treatment. The data were integrated using conceptual analyses of help-seeking behaviour and access to healthcare, which informs understanding of the complexity of seeking help in this context. Conclusions This study revealed differences between participants’ help-seeking intentions and actions. Using the conceptual analyses of help-seeking behaviour and access to healthcare informs understanding of the complexity of the help-seeking process in this context. To safely use a home therapy, it is imperative that individuals recognize signs/symptoms of peritonitis, seek help promptly and are appropriately supported when they access healthcare. Further work is needed to examine how these individual and system changes can be enacted

Perceptions of peritonitis risk, prevention, diagnosis and stigma: findings from a mixed methods study with patients and relatives using peritoneal dialysis

Background: Peritonitis is the main treatment-related complication of peritoneal dialysis and a primary concern for patients and their relatives. Therefore, understanding their perceptions of peritonitis is important. Objectives: To explore patients' and relatives' perceptions of peritoneal dialysis-associated peritonitis risk, prevention measures and experiences of diagnosis, and experience of perceived stigma. Design: A sequential mixed methods study design was used, including a questionnaire and semi-structured interviews. Participants; Patients using peritoneal dialysis and relatives (n = 75) from six National Health Service organisations from the United Kingdom. Measurements: A structured questionnaire was administered with patients and relatives (n = 75) using peritoneal dialysis; data were analysed using descriptive statistics. Thirty questionnaire respondents were then purposively sampled and interviewed in-depth; data were analysed thematically. Data were collected 2017−2018. Ethical and governance approvals were gained. Results: Qualitative and quantitative analyses were integrated and three themes presented: • Perceptions of risk: participants assessed their risk of developing peritonitis and possible implications on their health and relatives. Participants felt greatly responsible for preventing infection. • Preventing peritonitis: participants reported similar and some differing measures to minimise their risk of developing peritonitis. Participants wanted to be seen as “clean”. • Diagnosis of peritonitis: peritonitis diagnosis was embarrassing and stigmatising for many individuals. This was influenced by the response of healthcare professionals and the cause of peritonitis. Conclusions: It is important that healthcare professionals are aware of how responsible patients and relatives feel about preventing peritonitis, the emotional effect of this responsibility and crucially the impact this may have on seeking help

Equity in Minnesota Farming and Farm to School Programs

Capstone paper for the fulfillment of the Master of Public Affairs degree.Black, Indigenous, and other People of Color (BIPOC) farmers are underrepresented in the farm to school (FTS) market and in all areas of farming in Minnesota. In partnership with the University of Minnesota Extension, a team of four graduate students from the University of Minnesota Humphrey School of Public Affairs conducted a research project on BIPOC farming in the FTS market in Minnesota. The project examined some of the reasons behind this underrepresentation, both historic and current, and brings recommendations forward from BIPOC farmers for possible improvements. Specifically, the group investigated why there are so few BIPOC farmers farming in Minnesota and around the U.S. and what can be done at the local, state, and federal level to improve representation in farming. A number of themes emerged in our research about barriers BIPOC farmers face, which contributes to why their presence in the field is scarce. Historical inequities in land use and distribution, the forced removal and pilfering of land from Indigenous people, and the systematic denial of land and money to BIPOC farmers have all led to current conditions that make entering or continuing to farm nearly impossible for BIPOC farmers. Requirements for things like refrigeration and transportation in larger markets are expensive and make entrance into these markets difficult for all small and mid-sized farmers. Coupled with historic inequities, entrance for BIPOC farmers is considerably more challenging. Because farming is hard work and the returns are marginal, younger people are not entering the industry, drying up the pipeline of future generations going into farming. Recommendations from BIPOC farmers on how to address barriers and increase participation in FTS and farming, in general, could not only improve racial equity in the sector, but also offer solutions to broader agricultural problems faced by farmers and policymakers alike

A New Application to Facilitate Post-Fire Recovery and Rehabilitation in Savanna Ecosystems

The U.S. government spends an estimated $3billion per year to fight forest fires in the United States. Post-fire rehabilitation activities represent a small but essential portion of that total. The Rehabilitation Capability Convergence for Ecosystem Recovery (RECOVER) system is currently under development for Savanna ecosystems in the western U.S. The prototype of this system has been built and will have realworld testing during the summer 2013 fire season. When fully deployed, the RECOVER system will provide the emergency rehabilitation teams with critical and timely information for management decisions regarding stabilization and rehabilitation strategies

Developing a competency-based approach to facilitate teaching and learning of antimicrobial stewardship as part of environmental sustainability in higher education.

The environmental impact of the inappropriate use of antimicrobials and antimicrobial resistance (AMR) is recognised by global organisations, such as the World Health Organisation and the European Union. Antimicrobial stewardship (AMS) is one strategy to promote appropriate use of antimicrobials to minimise AMR and is a priority for the NHS to ensure sustainable prescribing. It is therefore imperative to support and empower future health care professionals by providing them with the knowledge to be leaders in the field of AMS. National consensus-based competencies for teaching AMS to undergraduate healthcare professionals in the UK were launched in 2018. This generic framework includes competencies relating to specific aspects of antimicrobial prescribing and infection control, and also emphasizes the importance of collaborative interprofessional working. The aim of this project is to determine which AMS competencies are required to be met by student pharmacists. This pedagogic approach will provide a guiding tool for curricula development, and will allow identification of gaps and strengths within the undergraduate pharmacy curriculum. To enable the development of a UK-wide national AMS competency framework specifically for student pharmacists, a working group of academics and pharmacy practitioners with expertise in AMS was set up in September 2022. The diverse backgrounds of group members provide a healthy mix of ideas, with academics informing the group of what may be achievable within the constraints and professional requirements of the pharmacy curriculum, and pharmacy practitioners providing input into essential AMS competencies for early-career pharmacists. Student pharmacists from a national organisation are being invited to join the group to encourage co-designing of this curriculum. Considering the UN commitment to act on global antimicrobial resistance and the NHS Sustainable Development management plan, this project is timely and of great importance to support development of future pharmacists as leaders in environmental sustainability

Social science for conservation in working landscapes and seascapes

Biodiversity is in precipitous decline globally across both terrestrial and marine environments. Therefore, conservation actions are needed everywhere on Earth, including in the biodiversity rich landscapes and seascapes where people live and work that cover much of the planet. Integrative landscape and seascape approaches to conservation fill this niche. Making evidence-informed conservation decisions within these populated and working landscapes and seascapes requires an in-depth and nuanced understanding of the human dimensions through application of the conservation social sciences. Yet, there has been no comprehensive exploration of potential conservation social science contributions to working landscape and seascape initiatives. We use the Smithsonian Working Land and Seascapes initiative – an established program with a network of 14 sites around the world – as a case study to examine what human dimensions topics are key to improving our understanding and how this knowledge can inform conservation in working landscapes and seascapes. This exploratory study identifies 38 topics and linked questions related to how insights from place-based and problem-focused social science might inform the planning, doing, and learning phases of conservation decision-making and adaptive management. Results also show how conservation social science might yield synthetic and theoretical insights that are more broadly applicable. We contend that incorporating insights regarding the human dimensions into integrated conservation initiatives across working landscapes and seascapes will produce more effective, equitable, appropriate and robust conservation actions. Thus, we encourage governments and organizations working on conservation initiatives in working landscapes and seascapes to increase engagement with and funding of conservation social science

RECOVER: An Automated Cloud-Based Decision Support System for Post-fire Rehabilitation Planning

RECOVER is a site-specific decision support system that automatically brings together in a single analysis environment the information necessary for post-fire rehabilitation decision-making. After a major wildfire, law requires that the federal land management agencies certify a comprehensive plan for public safety, burned area stabilization, resource protection, and site recovery. These burned area emergency response (BAER) plans are a crucial part of our national response to wildfire disasters and depend heavily on data acquired from a variety of sources. Final plans are due within 21 days of control of a major wildfire and become the guiding document for managing the activities and budgets for all subsequent remediation efforts. There are few instances in the federal government where plans of such wide-ranging scope and importance are assembled on such short notice and translated into action more quickly. RECOVER has been designed in close collaboration with our agency partners and directly addresses their high-priority decision-making requirements. In response to a fire detection event, RECOVER uses the rapid resource allocation capabilities of cloud computing to automatically collect Earth observational data, derived decision products, and historic biophysical data so that when the fire is contained, BAER teams will have a complete and ready-to-use RECOVER dataset and GIS analysis environment customized for the target wildfire. Initial studies suggest that RECOVER can transform this information-intensive process by reducing from days to a matter of minutes the time required to assemble and deliver crucial wildfire-related data

Sleep disturbance in dementia or mild cognitive impairment: a realist review of general practice

Background: Sleep disturbance (SD) is a prevalent condition among people living with dementia (PLwD) or mild cognitive impairment (MCI). Its assessment and management within primary care is complex due to the comorbidities, older age and cognitive impairment typical of this patient group. Aim: This study aimed to explore how primary care clinicians assess, understand, and manage SD for PLwD or MCI; if and why such initiatives work; and how people and their carers experience SD and its treatment. Design and setting: A realist review of existing literature was conducted in 2022. Methods: Six bibliographic databases were searched. Context-Mechanism-Outcome Configurations (CMOCs) were developed and refined. Results: Sixty records were included from 1,869 retrieved hits and 19 CMOCs were developed. Low awareness of and confidence in the treatment of SD among primary care clinicians and service users, combined with time and resource constraints, meant that identifying SD was difficult and not prioritised. Medication was perceived by clinicians and service users as the primary management tool, resulting in inappropriate or long-term prescription. Rigid nursing routines in care homes were reportedly not conducive to good quality sleep. Conclusion: In primary care, SD among PLwD or MCI is not adequately addressed. Over-reliance on medication, under-utilisation of non-pharmacological strategies, and inflexible care home routines were reported due to low confidence and resource constraints. This does not constitute effective and person-centred care. Future work should consider ways to tailor the assessment and management of SD to the needs of individuals and their informal carers without overstretching services

Forces Shaping the Fastest Evolving Regions in the Human Genome

Comparative genomics allow us to search the human genome for segments that were extensively changed in the last ~5 million years since divergence from our common ancestor with chimpanzee, but are highly conserved in other species and thus are likely to be functional. We found 202 genomic elements that are highly conserved in vertebrates but show evidence of significantly accelerated substitution rates in human. These are mostly in non-coding DNA, often near genes associated with transcription and DNA binding. Resequencing confirmed that the five most accelerated elements are dramatically changed in human but not in other primates, with seven times more substitutions in human than in chimp. The accelerated elements, and in particular the top five, show a strong bias for adenine and thymine to guanine and cytosine nucleotide changes and are disproportionately located in high recombination and high guanine and cytosine content environments near telomeres, suggesting either biased gene conversion or isochore selection. In addition, there is some evidence of directional selection in the regions containing the two most accelerated regions. A combination of evolutionary forces has contributed to accelerated evolution of the fastest evolving elements in the human genome