Social prescribing in cardiology : rediscovering the nature of and within us

Personalised care is integral to the delivery of the NHSE Long Term Plan. Enabling choice and supporting patients to make decisions predicated on what matters to them, rather than what is the matter with them, is a fundamental part of the NHS vision. Social prescribing uses nonmedical, asset based, salutogenic approaches to promote this personalised paradigm, and places the patient central to decision making. We discuss how Personalised care can be used to help people with Cardiovascular Disease (CVD) using socially prescribed ‘nature-based’ interventions to support the prehabilitation and rehabilitation of patients with CVD. The concept of Personalised care outlined and the significance of salutogenic principles as complementary approach to the pathogenic model is discussed. We argue that this seemingly novel approach to using nature-based interventions can help promote wellbeing for people with CVD as part of the wider personalised agenda

Optimum Tariffs and Exhaustible Resources: Theory and Evidence for Gasoline

Domestic consumption taxes on oil products largely differ across countries, ranging from very high subsidies to very high taxes. The empirical literature on the issue has highlighted the role of revenue-raising (Ramsey commodity taxation) and externalitycorrection (Pigovian taxation) motives for national taxation. Isolatedly, the theoretical literature on non-renewable-resource taxation has emphasized the role of the optimumtariff dimension of excise taxes which reflects countries’ non-cooperative exercise of their market power. This paper reconciles these two strands by comprehensively addressing the issue. First, we propose a multi-country model of national taxation with oil – modeled as a polluting exhaustible resource – and some regular commodities. Domestic welfare is maximized with respect to domestic taxes under a revenue-collection constraint. The optimal domestic tax on oil consumption not only consists of a Ramsey inverse-elasticity term and of a Pigovian term, but also of an optimum-tariff component. In fact, resource exhaustibility implies a form of supply inelasticity that magnifies optimum-tariff arguments. Second, based on a multiple regression using a data set with a large number of countries, we test the power of the optimum-tariff tax component in explaining national gasoline taxes. We find strong evidence that this component plays a crucial role in countries’ taxation of gasoline

What approaches to social prescribing work, for whom, and in what circumstances? A realist review

This is the final version. Available from Wiley via the DOI in this record.The use of non-medical referral, community referral or social prescribing interventions has been proposed as a cost-effective alternative to help those with long-term conditions manage their illness and improve health and well-being. However, the evidence base for social prescribing currently lags considerably behind practice. In this paper, we explore what is known about whether different methods of social prescribing referral and supported uptake do (or do not) work. Supported by an Expert Advisory Group, we conducted a realist review in two phases. The first identified evidence specifically relating to social prescribing in order to develop programme theories in the form of ‘if-then’ statements, articulating how social prescribing models are expected to work. In the second phase, we aimed to clarify these processes and include broader evidence to better explain the proposed mechanisms. The first phase resulted in 109 studies contributing to the synthesis, and the second phase 34. We generated 40 statements relating to organising principles of how the referral takes place (Enrolment), is accepted (Engagement), and completing an activity (Adherence). Six of these statements were prioritised using web-based nominal group technique by our Expert Group. Studies indicate that patients are more likely to enrol if they believe the social prescription will be of benefit, the referral is presented in an acceptable way that matches their needs and expectations, and concerns elicited and addressed appropriately by the referrer. Patients are more likely to engage if the activity is both accessible and transit to the first session supported. Adherence to activity programmes can be impacted through having an activity leader who is skilled and knowledgeable or through changes in the patient's conditions or symptoms. However, the evidence base is not sufficiently developed methodologically for us to make any general inferences about effectiveness of particular models or approaches.National Institute for Health Research (NIHR

Routine gastric residual volume measurement and energy target achievement in the PICU: A comparison study

Critically ill children frequently fail to achieve adequate energy intake and some care practices, such as the measurement of gastric residual volume (GRV) may contribute to this problem. We compared outcomes in two similar European Pediatric Intensive Care Units (PICUs): one which routinely measures GRV (PICU-GRV) to one unit that does not (PICU-noGRV). An observational pilot comparison study was undertaken. 87 children were included in the study, 42 (PICU-GRV) and 45 (PICU-noGRV). There were no significant differences in the percentage of energy targets achieved in the first four days of PICU admission although PICU-noGRV showed more consistent delivery of median (and IQR) energy targets, and less under and over feeding for PICU-GRV and PICU-noGRV Day 1 37 (14-72) vs 44 (0-100); Day 2 97 (53-126) vs 100 (100-100), Day 3 84 (45-112) vs 100 (100-100) , Day 4 101 (63-124) vs 100 (100-100). The incidence of vomiting was higher in PICU-GRV. No necrotising enterocolitis was confirmed in either unit and ventilator acquired pneumonia rates were not significantly different (7.01 vs 12 5.31 per 1000 ventilator days; p=0.70) between PICU-GRV and PICU-noGRV units. Conclusions: The practice of routine gastric residual measurement did not significantly impair energy targets in the first four days of PICU admission. However, not measuring GRV did not increase vomiting, ventilator acquired pneumonia or necrotising enterocolitis, which is the main reason clinicians cite for measuring GRV. What is known?•The practice of routinely measuring gastric residual volume is widespread in critical care units•This practice is increasingly being questioned in critically ill patients, both as a practice that increases •the likelihood of delivering inadequate enteral nutrition amounts and as a tool to assess feeding tolerance What is new? •Not routinely measuring gastric residual volume did not increase adverse events of ventilator acquired pneumonia, necrotising enterocolitis or vomiting •In the first four days of PICU stay, energy target achievement was not significantly different, but the rates of under and over feeding were higher in the routine GRV measurement uni

The democracy of Green Infrastructure

With the understanding of nature in terms of ecosystem services and the recognition of the vital role these play for human wellbeing (Millennium Assessment, 2005), the value of the natural realm is scientifically and socially defined while at the same time institutionalised. Within this frame of interpretation, nature is a supplier of provision-ing, regulating, supporting welfare and cultural services, thus becoming not only a life-enabling factor for humanity but also a conceptual construct comparable to cornerstones of democracy, such as equality, freedom and citizenship. The idea of green infrastructure is another recently coined term envisioning nature in cities in the form of a net-work and enabling a broad life-furthering vision of society. Standards for green open spaces embedded in some planning frameworks further state the right for all to a common good. Yet, evidence shows that this common right is not always met. Within the current context of advanced and neoliberal capitalism, green areas are sometimes used as an added financial value for real estate, thus increasing restrictions to their free access and full utilization. In developing countries with young democracies, such as Brazil, this process implies another significant factor of social inequality insofar the restricted access to nature by the poorest people means also diminished food safety, and the jeopardizing of certain cultural practices. In developed countries, loss of land for food production and movements reclaiming the right to the city by squatting unoccupied open spaces to initiate community gar-dens, demonstrates that the access to green spaces is also problematic, although in different ways if compared to developing countries. This chapter contributes to this topic by discussing the inequality in provision of green spaces in informal settlements and social housing development in Brazil, as well as in the globalised north. The chapter concludes with recommendations to enhance democracy through a just provision of nature in cities

Social media in undergraduate medical education: A systematic review.

INTRODUCTION: There are over 3.81 billion worldwide active social media (SoMe) users. SoMe are ubiquitous in medical education, with roles across undergraduate programmes, including professionalism, blended learning, well being and mentoring. Previous systematic reviews took place before recent explosions in SoMe popularity and revealed a paucity of high-quality empirical studies assessing its effectiveness in medical education. This review aimed to synthesise evidence regarding SoMe interventions in undergraduate medical education, to identify features associated with positive and negative outcomes. METHODS: Authors searched 31 key terms through seven databases, in addition to references, citation and hand searching, between 16 June and 16 July 2020. Studies describing SoMe interventions and research on exposure to existing SoMe were included. Title, abstract and full paper screening were undertaken independently by two reviewers. Included papers were assessed for methodological quality using the Medical Education Research Study Quality Instrument (MERSQI) and/or the Standards for Reporting Qualitative Research (SRQR) instrument. Extracted data were synthesised using narrative synthesis. RESULTS: 112 studies from 26 countries met inclusion criteria. Methodological quality of included studies had not significantly improved since 2013. Engagement and satisfaction with SoMe platforms in medical education are described. Students felt SoMe flattened hierarchies and improved communication with educators. SoMe use was associated with improvement in objective knowledge assessment scores and self-reported clinical and professional performance, however evidence for long term knowledge retention was limited. SoMe use was occasionally linked to adverse impacts upon mental and physical health. Professionalism was heavily investigated and considered important, though generally negative correlations between SoMe use and medical professionalism may exist. CONCLUSIONS: Social media is enjoyable for students who may improve short term knowledge retention and can aid communication between learners and educators. However, higher-quality study is required to identify longer-term impact upon knowledge and skills, provide clarification on professionalism standards and protect against harms

Effects of a demand-led evidence briefing service on the uptake and use of research evidence by commissioners of health services: protocol for a controlled before and after study.

Background: Clinical Commissioning Groups (CCGs) are mandated to use research evidence effectively to ensure optimum use of resources by the National Health Service (NHS), both in accelerating innovation and in stopping the use of less effective practices and models of service delivery. We intend to evaluate whether access to a demand-led evidence service improves uptake and use of research evidence by NHS commissioners compared with less intensive and less targeted alternatives. Methods/design: This is a controlled before and after study involving CCGs in the North of England. Participating CCGs will receive one of three interventions to support the use of research evidence in their decision-making: 1) consulting plus responsive push of tailored evidence; 2) consulting plus an unsolicited push of non-tailored evidence; or 3) standard service unsolicited push of non-tailored evidence. Our primary outcome will be changed at 12 months from baseline of a CCGs ability to acquire, assess, adapt and apply research evidence to support decision-making. Secondary outcomes will measure individual clinical leads and managers’ intentions to use research evidence in decision making. Documentary evidence of the use of the outputs of the service will be sought. A process evaluation will evaluate the nature and success of the interactions both within the sites and between commissioners and researchers delivering the service. Discussion: The proposed research will generate new knowledge of direct relevance and value to the NHS. The findings will help to clarify which elements of the service are of value in promoting the use of research evidence. Those involved in NHS commissioning will be able to use the results to inform how best to build the infrastructure they need to acquire, assess, adapt and apply research evidence to support decision-making and to fulfil their statutory duties under the Health and Social Care Act

Muscle and flesh quality traiys in wild and farmed Atlantic salmon

Muscle characteristics that are important for flesh quality traits were assessed in populations of wild and farmed Atlantic salmon (Salmo salar L.). The wild fish were obtained from a commercial fishery on the North Esk, Scotland in 2001 and 2003. The farmed fish comprised 7 families from the Stofiifiskur breeding programme (Stofiifiskur A/S, Iceland) gown in 5 in x 5 in x 5 in net pen sea cages in a dedicated trial unit on South Uist, Scotland. Total carotenoid pigment (mgkg(-1) wet mass flesh) concentrations were higher in farmed (7.68 and 8.43 for grilse and salmon, respectively) than wild fish (5.53 and 6.44 for grilse and salmon, respectively). In contrast, the average flesh colour, measured with a SalmonFan (TM), was similar for all groups (27.4 to 28.0), indicating a superior colour visualisation per unit pigment concentration in wild fish. The flesh lipid content was 46%-higher (grilse) and 84%-higher (salmon) in farmed than wild fish. Vitamin E concentrations per unit wet mass lipid were similar in wild and farmed salmon and in the range (208-259 mgkg(-1)). Fillet firmness was measured using a shear test and instrumental texture analyser. The work done (WD) to shear standardised post-rigor muscle samples was higher in grilse than salmon and was significantly greater for the wild (710 and 811 mJ, respectively) than farmed (415 and 602mJ, respectively) fish, indicating a firmer texture in the wild fish. The grilse and salmon sampled had stopped recruiting fast muscle fibres and both wild and farmed fish had around 650,000 fibres per trunk cross-section. Thus differences in fillet texture and colour between these populations could not be explained by the muscle cellularity which was similar between groups. Hydroxyproline (HYP) was used to estimate collagen concentration. Alkaline-insoluble HYP was 72.5% higher in wild than farmed salmon (14.0 vs. 8.1 mu molg(-1) dry mass, respectively) whereas alkaline-soluble HYP was 5.2-fold higher in farmed than wild salmon (31.0 vs. 6.0 mu molg(-1) dry mass, respectively). The alkaline-insoluble collagen fraction is thought to be enriched with reducible and non-reducible cross-linked collagen. There was a significant positive correlation between pyridinoline (PYD) crosslink concentration and WD, explaining 25% of the within population variation in firmness. However, PYD concentration (mu mol mu(-1) dry mass) was similar between wild (476) and farmed (445) salmon and cannot explain the differences in flesh firmness observed between populations. It was hypothesised that the higher average values of firmness in the wild than farmed salmon flesh can in part be attributed to higher concentrations of reducible immature collagen crosslinks. (c) 2006 Elsevier B.V. All rights reserved.</p

Corrigendum to “Dietary synbiotic application modulates Atlantic salmon (Salmo salar) intestinal microbial communities and intestinal immunity” [Fish Shellfish Immunol. 35 (2013) 1948–1956]

Corrigendu