Assessing the efficacy of coproduction to better understand the barriers to achieving sustainability in NHS chronic kidney services and create alternate pathways

CONTEXT: Too many people living with chronic kidney disease are opting for and starting on hospital‐based dialysis compared to a home‐based kidney replacement therapy. Dialysis services are becoming financially unsustainable. OBJECTIVE: This study aimed to assess the efficacy of coproductive research in chronic kidney disease service improvement to achieve greater sustainability. DESIGN: A 2‐year coproductive service improvement study was conducted with multiple stakeholders with the specific intention of maximizing engagement with the national health kidney services, patients and public. SETTING AND PARTICIPANTS: A national health kidney service (3 health boards, 18 dialysis units), patients and families (n = 50), multidisciplinary teams including doctors, nurses, psychologists, social workers, and so forth (n = 68), kidney charities, independent dialysis service providers and wider social services were part of this study. FINDINGS: Coproductive research identified underutilized resources (e.g., patients on home dialysis and social services) and their potential, highlighted unmet social care needs for patients and families and informed service redesign. Education packages were reimagined to support the home dialysis agenda including opportunities for wider service input. The impacts of one size fits all approaches to dialysis on specialist workforce skills were made clearer and also professional, patient and public perceptions of key sustainability policies. DISCUSSION AND CONCLUSIONS: Patient and key stakeholders mapped out new ways to link services to create more sustainable models of kidney health and social care. Maintaining principles of knowledge coproduction could help achieve financial sustainability and move towards more prudent adult chronic kidney disease services. PATIENT OR PUBLIC CONTRIBUTION: Involved in developing research questions, study design, management and conduct, interpretation of evidence and dissemination

The response of fish to novel prey: evidence that dietary conservatism is not restricted to birds

Foragers continually encounter new objects in their environment, some being potential food. Sampling new food resources carries risks of poisoning or injury and can reduce foraging efficiency. Foragers typically show a brief aversion to novel objects (neophobia). An additional persistent wariness of novel foods, termed dietary conservatism (DC), has been described only in birds and is exhibited by only a proportion of individuals in each of the populations studied so far. The rest of the individuals in each population are relatively adventurous consumers (AC), eating novel foods as soon as their neophobia has been overcome. The presence of DC foragers is important because it may alter the selection pressures on novel types of prey. We demonstrate both AC and DC in a previously untested predator taxon, fish (specifically, the three-spined stickleback, Gasterosteus aculeatus). The fish showed sufficient avoidance of novel prey colors to allow these prey to spread in 33% of prey populations, from being rare (5% of prey phenotypes) to fixation (100%). In the remaining prey populations, the novel morph became extinct. Numerical simulation models based on these empirical studies showed that the success of the novel color morph (independent of the color used) was best explained by DC rather than by drift or apostatic selection. This study provides the first evidence of AC and DC foraging strategies in fish, demonstrating that this phenomenon is not restricted to birds and suggesting that this mixture of strategies might be a more general feature of foragers than was previously appreciated. Copyright 2010, Oxford University Press.