Barriers to the use of e-health technology in nurse practitioner_patient consultations

Purpose This paper examines primary care nurse practitioners' (NPs') use of information available via e-health technology (EHT) within consultations. It explores which information resources NPs use in clinical decision making, their comparative use of electronic versus paper-based and human information resources, the reasons behind their choices and how the use of different resources impacts on patient interactions. Methods Semi-structured interviews were undertaken with 12 NPs recruited from 11 different general practitioner (GP) practices and five primary care trusts (PCTs) within the West Midlands South Strategic Health Authority, UK. Findings The key finding was that for NPs an effective information resource is one that provides sufficient information to generate a patient management plan rapidly. Speed, familiarity and trust are vital ingredients for regular use. Paper-based information resources therefore retain a significant role, and together with human information resources are still more frequently used than most electronic, and particularly web-based, resources. The latter are not yet well established within the context of patient consultations. Electronic clinical support systems (such as Mentor, PRODIGY and GP notebook) are regularly used, however, because they are often linked electronically to patient records, and generate brief information in a form accessible to both nurses and patients. By contrast, searching for information from web-based resources was considered time-consuming, technically difficult and disruptive to patients. All NPs reported some negative effects on patients of using computers: mostly disrupted rapport and longer consultations. However, the majority had developed ways of working to overcome these difficulties and that helped them to maintain their patient-centred focus. Conclusions Study NPs had received only very limited information technology (IT) training, but nevertheless were enthusiastic about computer use. This suggests that with further training they could adapt their practice to embrace more EHT, which would enhance their ability to be more autonomous and to base their practice on sound clinical evidence

Automated phenotyping of mosquito larvae enables high-throughput screening for novel larvicides and offers potential for smartphone-based detection of larval insecticide resistance

Pyrethroid-impregnated nets have contributed significantly to halving the burden of malaria but resistance threatens their future efficacy and the pipeline of new insecticides is short. Here we report that an invertebrate automated phenotyping platform (INVAPP), combined with the algorithm Paragon, provides a robust system for measuring larval motility in Anopheles gambiae (and An. coluzzi) as well as Aedes aegypti with the capacity for high-throughput screening for new larvicides. By this means, we reliably quantified both time- and concentration-dependent actions of chemical insecticides faster than using the WHO standard larval assay. We illustrate the effectiveness of the system using an established larvicide (temephos) and demonstrate its capacity for library-scale chemical screening using the Medicines for Malaria Venture (MMV) Pathogen Box library. As a proof-of-principle, this library screen identified a compound, subsequently confirmed to be tolfenpyrad, as an effective larvicide. We have also used the INVAPP / Paragon system to compare responses in larvae derived from WHO classified deltamethrin resistant and sensitive mosquitoes. We show how this approach to monitoring larval response to insecticides can be adapted for use with a smartphone camera application and therefore has potential for further development as a simple portable field-assay with associated real-time, geo-located information to identify hotspots

Historical peat loss explains limited short-term response of drained blanket bogs to rewetting

This study assessed the short-term impacts of ditch blocking on water table depth and vegetation community structure in a historically drained blanket bog. A chronosequence approach was used to compare vegetation near ditches blocked 5 years, 4 years and 1 year prior to the study with vegetation near unblocked ditches. Plots adjacent to and 3 m away from 70 ditches within an area of blanket bog were assessed for floristic composition, aeration depth using steel bars, and topography using LiDAR data. No changes in aeration depth or vegetation parameters were detected as a function of ditch-blocking, time since blocking, or distance from the ditch, with the exception of non-Sphagnum bryophytes which had lower cover in quadrats adjacent to ditches that had been blocked for 5 years. Analysis of LiDAR data and the observed proximity of the water table to the peat surface led us to conclude that the subdued ecosystem responses to ditch-blocking were the result of historical peat subsidence within a 4–5 m zone either side of each ditch, which had effectively lowered the peat surface to the new, ditch-influenced water table. We estimate that this process led to the loss of around 500,000 m3 peat within the 38 km2 study area following drainage, due to a combination of oxidation and compaction. Assuming that 50% of the volume loss was due to oxidation, this amounts to a carbon loss of 11,000 Mg C over this area, i.e. 3 Mg C ha−1. The apparent ‘self-rewetting’ of blanket bogs in the decades following drainage has implications for their restoration as it suggests that there may not be large quantities of dry peat left to rewet, and that there is a risk of inundation (potentially leading to high methane emissions) along subsided ditch lines. Many peatland processes are likely to be maintained in drained blanket bog, including support of typical peatland vegetation, but infilling of lost peat and recovery of original C stocks are likely to take longer than is generally anticipated

Relationships between riverine and terrestrial dissolved organic carbon: Concentration, radiocarbon signature, specific UV absorbance

The transfer of dissolved organic carbon (DOC) from land to watercourses plays a major role in the carbon cycle, and in the transport and fate of associated organic and inorganic contaminants. We investigated, at global scale, how the concentrations and properties of riverine DOC depend upon combinations of terrestrial source solutions. For topsoil, subsoil, groundwater and river solutions in different Köppen-Geiger climatic zones, we compiled published and new values of DOC concentration ([DOC]), radiocarbon signature (DO14C), and specific UV absorbance (SUVA). The average value of each DOC variable decreased significantly in magnitude from topsoil to subsoil to groundwater, permitting the terrestrial sources to be distinguished. We used the terrestrial data to simulate the riverine distributions of each variable, and also relationships between pairs of variables. To achieve good matches between observed and simulated data, it was necessary to optimise the distributions of water fractions contributed by each of the three terrestrial sources, and also to reduce the mean input terrestrial [DOC] values, to about 60% of the measured ones. One possible explanation for the required lowering of the modelled terrestrial [DOC] values might be unrepresentative sampling of terrestrial DOC, including dilution effects; another is the loss of DOC during riverine transport. High variations in simulated riverine DOC variables, which match observed data, are due predominantly to variations in source solution values, with a lesser contribution from the different combinations of source waters. On average, most DOC in rivers draining catchments with forest and/or grass-shrub land cover comes in similar amounts from topsoil and subsoil, with about 10% from groundwater. In rivers draining croplands, subsoil and groundwater solutions are the likely dominant DOC sources, while in wetland rivers most DOC is from topsoil

Program Innovations and Character in Cub Scouts: Findings from Year 1 of a Mixed-Methods, Longitudinal Study

Youth development programs seek to promote positive development through mentoring and engaging youth in opportunities for individual growth and community connectedness. We present findings from the initial phase of a mixed-methods, longitudinal study aimed at assessing the impact of one such program, Cub Scouts, on character development. We assessed if Scouting, and a recent innovation in Scouting focused on program quality, are associated with the development of character and other positive youth outcomes. Participants were 1,083 Scouts and non-Scouts, aged 5-12 years. At the start of the study, there was no difference in indicators of character between Scouts and non-Scouts, once matched through propensity score analyses. Through content analyses of interviews and short- answer questionnaires administered to leaders, we found that leaders’ views of character and of their roles corresponded to those envisioned by Cub Scouts. Implications for character development, and for the role of program components in character development, are discussed

Priorities for mitigating greenhouse gas and ammonia emissions to meet UK policy targets

Agriculture is essential for providing food and maintaining food security while concurrently delivering multiple other ecosystem services. However, agricultural systems are generally a net source of greenhouse gases and ammonia. They, therefore, need to substantively contribute to climate change mitigation and net zero ambitions. It is widely acknowledged that there is a need to further reduce and mitigate emissions across sectors, including agriculture to address the climate emergency and emissions gap. This discussion paper outlines a collation of opinions from a range of experts within agricultural research and advisory roles following a greenhouse gas and ammonia emission mitigation workshop held in the UK in March 2022. The meeting identified the top mitigation priorities within the UK’s agricultural sector to achieve reductions in greenhouse gases and ammonia that are compatible with policy targets. In addition, experts provided an overview of what they believe are the key knowledge gaps, future opportunities and co-benefits to mitigation practices as well as indicating the potential barriers to uptake for mitigation scenarios discussed