Qualitative data sharing and re-use for socio-environmental systems research: A synthesis of opportunities, challenges, resources and approaches

Researchers in many disciplines, both social and natural sciences, have a long history of collecting and analyzing qualitative data to answer questions that have many dimensions, to interpret other research findings, and to characterize processes that are not easily quantified. Qualitative data is increasingly being used in socio-environmental systems research and related interdisciplinary efforts to address complex sustainability challenges. There are many scientific, descriptive and material benefits to be gained from sharing and re-using qualitative data, some of which reflect the broader push toward open science, and some of which are unique to qualitative research traditions. However, although open data availability is increasingly becoming an expectation in many fields and methodological approaches that work on socio-environmental topics, there remain many challenges associated the sharing and re-use of qualitative data in particular. This white paper discusses opportunities, challenges, resources and approaches for qualitative data sharing and re-use for socio-environmental research. The content and findings of the paper are a synthesis and extension of discussions that began during a workshop funded by the National Socio-Environmental Synthesis Center (SESYNC) and held at the Center Feb. 28-March 2, 2017. The structure of the paper reflects the starting point for the workshop, which focused on opportunities, challenges and resources for qualitative data sharing, and presents as well the workshop outputs focused on developing a novel approach to qualitative data sharing considerations and creating recommendations for how a variety of actors can further support and facilitate qualitative data sharing and re-use. The white paper is organized into five sections to address the following objectives: (1) Define qualitative data and discuss the benefits of sharing it along with its role in socio-environmental synthesis; (2) Review the practical, epistemological, and ethical challenges regarding sharing such data; (3) Identify the landscape of resources available for sharing qualitative data including repositories and communities of practice (4) Develop a novel framework for identifying levels of processing and access to qualitative data; and (5) Suggest roles and responsibilities for key actors in the research ecosystem that can improve the longevity and use of qualitative data in the future.This work was supported by the National Socio-Environmental Synthesis Center (SESYNC) under funding received from the National Science Foundation DBI-1052875

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Environmental Management for Malaria Control: Knowledge and Practices in Mvomero District, Tanzania

Malaria is the leading cause of death in Tanzania, killing 100,000-125,000 people annually, the majority of which are children under five. Environmental conditions play an important role in transmission of the disease, and therefore regulating these conditions can help to reduce disease burden. Environmental management practices for disease control (e.g. draining stagnant water and eliminating mosquito breeding habitats) can be implemented at the community level as a complement to other malaria control methods. This study assesses current knowledge and practices related to mosquito ecology and environmental management in Mvomero District, a rural, agricultural area in Tanzania. A total of 408 household surveys, 4 focus group discussions, and 3 in-depth interviews were conducted in 10 villages in the district. Results indicate that while most respondents understand the link between mosquitoes and malaria, many do not have an in-depth understanding of mosquito ecology. For example, 30% of respondents did not know where mosquito larvae live and nearly 40% incorrectly believed that cutting grasses and bushes around the home reduces mosquito abundance. Regarding environmental management practices, 50% of respondents reported cleaning residential surroundings to protect themselves from malaria and 18% drained stagnant water. Respondents with greater knowledge of mosquito ecology and environmental management were significantly more likely to perform these practices. Qualitative results highlighted community beliefs that environmental management is an important method for malaria control, and that education is necessary to increase community participation in these activities. The findings indicate that an educational program highlighting mosquito ecology and effective environmental management techniques would be an important step in increasing community participation in environmental management for malaria control in the region

Dams and tribal land loss in the United States

Indigenous peoples in the United States have faced continued land dispossession for centuries. Through the reservation system as well as policies including forced removal and allotment, colonial settlers and later the federal government acquired over two billion acres from Native Nations. We argue that another important, yet understudied and unquantified, contributor to tribal land loss is through the construction of dams. By restricting water flow in rivers or lakes, dams submerge land under reservoirs and disrupt aquatic and terrestrial ecosystems. This impacts livelihoods of local communities, destroys culturally important places and resources, and displaces people from their homes and land. To quantify the amount of tribal land lost as a result of dam construction, we engage in an innovative data linkage project. We use geospatial data on the boundaries of federal Indian reservations and Oklahoma Tribal Statistical Areas (OTSAs) and overlay these data with the locations of approximately 7,900 dams in the continental US. We estimate that 139 dams have submerged over 619 000 acres of land on 56 federal reservations and that 287 dams have inundated over 511 000 acres of land on 19 OTSAs. Taken together, our lower-bound estimate is that over 1.13 million acres of tribal land have been flooded under the reservoirs of 424 dams, which amounts to an area larger than Great Smokey Mountains National Park, Grand Teton National Park, and Rocky Mountain National Park combined. In light of recent federal legislation to address aging infrastructure in the US as well as the increasing risks to dam function and safety caused by climate change, dams that impact tribal land should be prioritized for removal. In cases where removal is not a preferred or viable option, alternatives include tribal ownership or funding for repairs and improvements