Living well with breathlessness: How clinicians can help

Non

Gender-based violence: Relevance for fisheries practitioners

Attention to human dimensions of capture fisheries involves understanding how harms and benefits are experienced and distributed among different groups or people. Yet, not all harms are well understood or adequately addressed. There is a general (mis)conception that gender-based violence (GBV) is not of relevance for fisheries management or a topic within the remit of practitioners. Through a global review of capture fisheries, we illustrate how five types of GBV—physical, sexual, psychological, economic and cultural—are pervasive and can be reinforced by fisheries policies, practices and institutions. Our synthesis shows a variety of activities associated with these forms of violence, such as labour and human rights abuses, unsafe working and living conditions for children, women and men, and the cultural acceptance of various forms of discrimination. We argue GBV cannot be disentangled from other actions taken to achieve equitable social outcomes through fisheries management. We provide seven recommendations to help practitioners understand and work towards addressing GBV in capture fisheries: (1) removing gender blindness and bias by investing in gender-sensitisation of the sector; (2) forming strategic partnerships; (3) improving policy and coordination between regulatory bodies; (4) increasing investments in labour rights and laws; (5) gender integrative programme design and implementation; (6) investing in specific programs for the empowerment of women; and (7) investing in specific programs for men seeking healthy models of masculinity

Living with breathlessness: a systematic literature review and qualitative synthesis

Question: What is the experience of people living with breathlessness due to medical conditions, those caring for and those treating them, with regard to quality of life and the nature of clinical interactions?Methods: Electronic databases (Ovid MEDLINE, Embase, CINAHL Plus, PsycINFO) were searched (1987 to October 2017; English language), for qualitative studies exploring the experience of chronic breathlessness (patients, carers, clinicians). Two independent reviewers screened titles, abstracts and papers retrieved against inclusion criteria. Disagreements were resolved with a third reviewer. Primary qualitative data were extracted and synthesised using thematic synthesis.Results: Inclusion and synthesis of 101/2,303 international papers produced four descriptive themes: 1) widespread effects of breathlessness, 2) coping, 3) help-seeking behaviour, and 4) clinicians’ responsiveness to the symptom of breathlessness. The themes were combined to form the concept of “Breathing Space”, to show how engaged coping and appropriate help-seeking (patient) and attention to symptom (clinician) helps maximise the patient’s quality of living with breathlessness.Answers: Breathlessness has widespread impact on patient and carer and affects Breathing Space. The degree of Breathing Space is influenced by interaction between the patient’s coping style, their help-seeking behaviour and their clinician’s responsiveness to breathlessness itself in addition to managing the underlying disease

Understanding hospital admissions close to the end of life (ACE) study.

BACKGROUND: Palliative care is a policy priority internationally. In England, policymakers are seeking to develop high quality care for all by focusing on reducing the number of patients who die in acute hospitals. It is argued that reducing 'inappropriate' hospital admissions will lead to an improvement in the quality of care and provide cost savings.Yet what is meant by an 'inappropriate' admission is unclear and is unlikely to be shared by all stakeholders. The decision process that leads to hospital admission is often challenging, particularly when patients are frail and elderly. The ACE study reopens the idea of 'inappropriate' hospital admissions close to the end of life. We will explore how decisions that result in inpatient admissions close to death are made and valued from the perspective of the decision-maker, and will consider the implications of these findings for current policy and practice. DESIGN/METHODS: The study focuses on the admission of patients with advanced dementia, chest disease or cancer who die within 72 hours of admission to acute hospitals. The study uses mixed methods with three data collection phases. Phase one involves patient case studies of admissions with interviews with clinicians involved in the admission and next-of-kin. Phase two uses vignette-based focus groups with clinical professionals and patients living with the conditions of interest. Phase three uses questionnaires distributed to clinical stakeholders. Qualitative data will be explored using framework analysis whilst the questionnaire data will be examined using descriptive statistical analysis. Findings will be used to evaluate current policy and literature. DISCUSSION: Significant ethical and validity issues arise due to the retrospective nature of phase one of the study. We are not able to gain consent from patients who have died, and the views of the deceased patients cannot be included directly, which risks privileging professional views. This phase also relies on the memories of the participants which may be unreliable. Later phases of the study attempt to compensate for the "absent voices" of the deceased patients by including next-of-kin and patient focus groups.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Transforming coastal and marine management: Deliberative democracy and integrated management in New South Wales, Australia

The integrated management (IM) of coastal and marine environments is an enduring problem, particularly in multi-sectoral and jurisdictional systems, with coastal management of New South Wales (NSW), Australia being no exception. Historically, NSW coastal and marine management was dominated by ecological and economic approaches, implemented in parallel through multiple government agencies with overlapping jurisdictions. A review in 2012 of NSW marine park management recommended addressing the unintended consequences of this management approach, and the Marine Estate Management Act (2014), was established to integrate management of the whole of the NSW coast. This paper discusses the role that a deliberative democratic approach has played in the approach to IM undertaken by the NSW Marine Estate Management Authority (MEMA). The NSW MEMA case study provides a robust reflection of the challenges identified by the literature in implementing effective integrated management, being the alignment of values, visions and methods of assessment, across multiple resources, ecosystems, stakeholders and administrative jurisdictions. Deliberative democratic approaches were used in reviewing the MEMA case to analyse its ability to address some of the challenges and realise benefits of IM. However, despite benefits being identified, a key finding is that achieving integration across multiple agencies with varied disciplinary approaches and organisational cultures, takes a significant amount of time. Even after several years, challenges remain in embedding cultural shifts and resource commitment at all levels to ensure the ongoing successful implementation of IM

Architecture of Kepler's Multi-transiting Systems: II. New investigations with twice as many candidates

We report on the orbital architectures of Kepler systems having multiple planet candidates identified in the analysis of data from the first six quarters of Kepler data and reported by Batalha et al. (2013). These data show 899 transiting planet candidates in 365 multiple-planet systems and provide a powerful means to study the statistical properties of planetary systems. Using a generic mass-radius relationship, we find that only two pairs of planets in these candidate systems (out of 761 pairs total) appear to be on Hill-unstable orbits, indicating ~96% of the candidate planetary systems are correctly interpreted as true systems. We find that planet pairs show little statistical preference to be near mean-motion resonances. We identify an asymmetry in the distribution of period ratios near first-order resonances (e.g., 2:1, 3:2), with an excess of planet pairs lying wide of resonance and relatively few lying narrow of resonance. Finally, based upon the transit duration ratios of adjacent planets in each system, we find that the interior planet tends to have a smaller transit impact parameter than the exterior planet does. This finding suggests that the mode of the mutual inclinations of planetary orbital planes is in the range 1.0-2.2 degrees, for the packed systems of small planets probed by these observations.Comment: Accepted to Ap

Planet Hunters: New Kepler planet candidates from analysis of quarter 2

We present new planet candidates identified in NASA Kepler quarter two public release data by volunteers engaged in the Planet Hunters citizen science project. The two candidates presented here survive checks for false-positives, including examination of the pixel offset to constrain the possibility of a background eclipsing binary. The orbital periods of the planet candidates are 97.46 days (KIC 4552729) and 284.03 (KIC 10005758) days and the modeled planet radii are 5.3 and 3.8 R_Earth. The latter star has an additional known planet candidate with a radius of 5.05 R_Earth and a period of 134.49 which was detected by the Kepler pipeline. The discovery of these candidates illustrates the value of massively distributed volunteer review of the Kepler database to recover candidates which were otherwise uncatalogued.Comment: Accepted to A

Terrestrial Planet Occurrence Rates for the Kepler GK Dwarf Sample

We measure planet occurrence rates using the planet candidates discovered by the Q1-Q16 Kepler pipeline search. This study examines planet occurrence rates for the Kepler GK dwarf target sample for planet radii, 0.75<Rp<2.5 Rearth, and orbital periods, 50<Porb<300 days, with an emphasis on a thorough exploration and identification of the most important sources of systematic uncertainties. Integrating over this parameter space, we measure an occurrence rate of F=0.77 planets per star, with an allowed range of 0.3<F<1.9. The allowed range takes into account both statistical and systematic uncertainties, and values of F beyond the allowed range are significantly in disagreement with our analysis. We generally find higher planet occurrence rates and a steeper increase in planet occurrence rates towards small planets than previous studies of the Kepler GK dwarf sample. Through extrapolation, we find that the one year orbital period terrestrial planet occurrence rate, zeta_1=0.1, with an allowed range of 0.01<zeta_1<2, where zeta_1 is defined as the number of planets per star within 20% of the Rp and Porb of Earth. For G dwarf hosts, the zeta_1 parameter space is a subset of the larger eta_earth parameter space, thus zeta_1 places a lower limit on eta_earth for G dwarf hosts. From our analysis, we identify the leading sources of systematics impacting Kepler occurrence rate determinations as: reliability of the planet candidate sample, planet radii, pipeline completeness, and stellar parameters.Comment: 19 Pages, 17 Figures, Submitted ApJ. Python source to support Kepler pipeline completeness estimates available at http://github.com/christopherburke/KeplerPORTs

Detection of Potential Transit Signals in the First Three Quarters of Kepler Mission Data

We present the results of a search for potential transit signals in the first three quarters of photometry data acquired by the Kepler Mission. The targets of the search include 151,722 stars which were observed over the full interval and an additional 19,132 stars which were observed for only 1 or 2 quarters. From this set of targets we find a total of 5,392 detections which meet the Kepler detection criteria: those criteria are periodicity of the signal, an acceptable signal-to-noise ratio, and a composition test which rejects spurious detections which contain non-physical combinations of events. The detected signals are dominated by events with relatively low signal-to-noise ratio and by events with relatively short periods. The distribution of estimated transit depths appears to peak in the range between 40 and 100 parts per million, with a few detections down to fewer than 10 parts per million. The detected signals are compared to a set of known transit events in the Kepler field of view which were derived by a different method using a longer data interval; the comparison shows that the current search correctly identified 88.1% of the known events. A tabulation of the detected transit signals, examples which illustrate the analysis and detection process, a discussion of future plans and open, potentially fruitful, areas of further research are included