How can we improve the use of essential evidence-based interventions?

Between 250,000-280,000 women die worldwide during pregnancy and childbirth each year and children in low- and middle-income countries are 56 times more likely to die before the age of 5 than children in high-income countries. This Editorial discusses the publishing of a supplement within Reproductive Health titled Essential interventions for maternal, newborn and child health which aims to provide a scientific basis to the recommended interventions along with implementation strategies and proposed packages of care.Fil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Salaria, Natasha. BioMed Central; Reino UnidoFil: Valanzasca, Pilar. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Mbizvo, Michael. University of Zimbabwe; Zimbabu

Advance Care Planning in Cancer Patient - Caregiver DYADS

For many, a cancer diagnosis signals death\u27s inevitability and elicits much existential concern. In the quest for life prolongation, many are offered or seek life-sustaining treatments, fail to appreciate a declining trajectory and lack the opportunity to seek information or plan meaningfully for their future. Advance care planning (ACP) provides an avenue for patients and their caregivers to plan for future care. ACP is defined ‘as a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals and preferences regarding future medical care’ and is a key quality indicator in cancer care. An increased emphasis is now placed on exploring values and beliefs to ensure alignment with the choices made relating to treatment decisions and end-of-life desirables. The uptake of ACP in cancer remains poor due to patient, caregiver, practitioner, and operational factors. For the clinician, the challenge remains as to how best to maintain hope, despite provoking and honest conversations. Increasingly, novel interventions are being developed to promote uptake in ACP. This includes the vignette technique (VT), whereby patients and/or caregivers are exposed to future scenarios in written or video material. My studies were the first to explore the use of video vignettes to explore values conversations between patient-caregiver dyads. These studies described older participants as more likely to identify with ACP and values conversations, the importance of ACP in improving patient-caregiver concordance in communication and that cancer patients concurrently postured vulnerability and resilience, despite conflicting emotions and experiences. I highlight that ACP requires contextualisation of individual situations and values and should focus on achieving meaningful outcomes beyond completing documents. Future research will focus on improving and measuring concordance in communication as an outcome for ACP and techniques to enhance ACP engagement in younger cancer patients

Seasonal facilitative and competitive trade‐offs between shrub seedlings and coastal grasses

Shrub expansion is occurring in grasslands globally and may be impacted by the balance of competition and facilitation with existing grasses. Along the mid‐Atlantic and Gulf coasts, the native shrub Morella cerifera (wax myrtle) is rapidly expanding and displacing other native coastal species. Recent research suggests that much of this expansion is due to warming winter temperatures, as temperatures below −15°C kill M. cerifera. The objective of this project was to understand the importance of species interactions with grasses on the growth and physiology of M. cerifera at the seedling life stage through both field and laboratory experiments. In the field, grasses were removed around seedlings and microclimate and shrub physiology and growth were measured. Seeds and seedlings were experimentally frozen to measure the freeze tolerance at both life stages. We found that grasses provided ~1.3°C insulation to shrubs during winter. A freezing threshold for M. cerifera seedlings was experimentally found between −6°C and −11°C, but seeds remained viable after being frozen to the coldest ecologically relevant temperatures. Seedlings competed for light with grasses during warm months and grew more where grasses were clipped, revealing a trade‐off between winter insulation and summer light competition. Morella cerifera exhibits ecosystem engineering at the seedling stage by significantly reducing summer maximum temperatures. When seedlings are very young (less than one year), grasses appear to improve germination and seedling survival. These phenomena enable rapid expansion of M. cerifera across the landscape and likely inform shrub expansion mechanisms in other systems. Although seedlings are small and relatively vulnerable, this life stage appears to have significant implications for ecosystem trajectory in grasslands undergoing shrub encroachment

Spectroscopic measurements of the ion velocity distribution at the base of the fast solar wind

In situ measurements of the fast solar wind reveal non-thermal distributions of electrons, protons, and minor ions extending from 0.3 au to the heliopause. The physical mechanisms responsible for these non-thermal properties and the location where these properties originate remain open questions. Here, we present spectroscopic evidence, from extreme ultraviolet spectroscopy, that the velocity distribution functions (VDFs) of minor ions are already non-Gaussian at the base of the fast solar wind in a coronal hole, at altitudes of <1.1 R ⊙. Analysis of Fe, Si, and Mg spectral lines reveals a peaked line-shape core and broad wings that can be characterized by a kappa VDF. A kappa distribution fit gives very small kappa indices off-limb of κ ≈ 1.9–2.5, indicating either (a) ion populations far from thermal equilibrium, (b) fluid motions such as non-Gaussian turbulent fluctuations or non-uniform wave motions, or (c) some combination of both. These observations provide important empirical constraints for the source region of the fast solar wind and for the theoretical models of the different acceleration, heating, and energy deposition processes therein. To the best of our knowledge, this is the first time that the ion VDF in the fast solar wind has been probed so close to its source region. The findings are also a timely precursor to the upcoming 2018 launch of the Parker Solar Probe, which will provide the closest in situ measurements of the solar wind at approximately 0.04 au (8.5 solar radii)

Graduate students share their experiences of building helping skills: A case study

Higher education needs individuals working with students to have the skills to handle a variety of issues related to success and well-being. Graduate programs preparing higher education professionals to work with students provide the opportunity for skill-building to occur. However, how do graduate students perceive their skill development in courses offered in a graduate program, specifically related to basic helping skills? This study, conducted in a College of Education at a university located in the southern United States posed two questions to find out more about the attributes graduate students contribute in the development of their knowledge of helping skills, and documenting the lived experiences of graduate students practicing helping skills. Five graduate students enrolled in a new course on helping skills were part of this case study. Three themes emerged after collecting and coding data during the course. The three themes were: building helping skills, confidence and comfortability, and multicultural, diversity and inclusion. The discussion section includes recommendations to always offer a helping skills course in graduation programs preparing individuals to work in higher education, any course on helping skills should have a multicultural focus, and the course curriculum should include a mix of clinical and practical elements

TOWARD THE EFFICIENT PRODUCTION OF THE DISCOMMODITY OF ANIMAL ODOR: A HEDONIC PRICE APPROACH TO ECONOMIES OF SCALE

Controversy surrounding confined animal feeding operations (CAFO) is becoming more commonplace. In several regions of the country CAFOs and local residents have had disputes over odors emanating from these operations. Viewing the CAFO as jointly producing products with utility (e.g., meat) and disutility (e.g., foul odor), it is possible to determine an efficient level of production for both products that is market-based. The authors propose a hedonic price model based upon real-estate transactions adjacent to CAFOs to establish a market-based estimate of the degree and extent of odor disutility. Using the results of the hedonic model, the authors suggest that a simple model of odor dispersal can be used to address the issue of economies of scale and the production of the disutility odor. Specifically, the final outcome should reveal if there is more or less disutility produced with an industry that is intensively or extensively managed.Livestock Production/Industries,

PreView: a Randomized Trial of a Multi-site Intervention in Diverse Primary Care to Increase Rates of Age-Appropriate Cancer Screening.

BackgroundWomen aged 50-70 should receive breast, cervical (until age 65), and colorectal cancer (CRC) screening; men aged 50-70 should receive CRC screening and should discuss prostate cancer screening (PSA). PreView, an interactive, individually tailored Video Doctor Plus Provider Alert Intervention, adresses all cancers for which average risk 50-70-year-old individuals are due for screening or screening discussion.MethodsWe conducted a randomized controlled trial in 6 clinical sites. Participants were randomized to PreView or a video about healthy lifestyle. Intervention group participants completed PreView before their appointment and their clinicians received a "Provider Alert." Primary outcomes were receipt of mammography, Pap tests (with or without HPV testing), CRC screening (FIT in last year or colonoscopy in last 10 years), and PSA screening discussion. Additional outcomes included breast, cervical, and CRC screening discussion.ResultsA total of 508 individuals participated, 257 in the control group and 251 in the intervention group. Screening rates were relatively high at baseline. Compared with baseline screening rates, there was no significant increase in mammography or Pap smear screening, and a nonsignificant increase (18% vs 12%) in CRC screening. Intervention participants reported a higher rate of PSA discussion than did control participants (58% vs 36%: P < 0.01). Similar increases were seen in discussions about mammography, cervical cancer, and CRC screening.ConclusionIn clinics with relatively high overall screening rates at baseline, PreView did not result in significant increases in breast, cervical, or CRC screening. PreView led to an increase in PSA screening discussion. Clinician-patient discussion of all cancer screenings significantly increased, suggesting that interventions like PreView may be most useful when discussion of the pros and cons of screening is recommended and/or with patients reluctant to undergo screening. Future research should investigate PreView's impact on those who are hesitant or reluctant to undergo screening.Trial registrationClinicalTrials.gov: NCT02264782

Introduced Species and the Issue of Animal Welfare

Recently, considerable debate has been heard about the control or elimination of introduced or exotic animals on publicly held U.S. lands. Species introductions, whether intentional or unintentional, seem to be an inevitable result of human activities. Still, they may result in economic and ecological problems: It has been estimated that over 90 percent of all such introductions have been harmful in some respect. Control of exotics can be accomplished through containment, shooting, poisoning, reintroduction of native predators, the introduction of disease organisms, live capture and removal, and reproductive inhibition