Can the value and acceptability of a patient feedback tool for revalidating psychiatrists be improved for both patients and psychiatrists through its co-production? An action research approach.

Background: Co-production is often suggested as an alternative approach to patient feedback design. However, critical exploration of how co-production may affect the perceived value and acceptability of a patient feedback tool is severely limited, particularly in the context of revalidation for practising psychiatrists. Aim: This research sought to address four research questions: i) how are patients and the public involved in the design, delivery and evaluation of patient feedback tools for practising psychiatrists, if at all; ii) what are patient and psychiatrist perceptions, experiences and aspirations for patient feedback tools in revalidation; iii) how do these compare and iv) can co-production improve the perceived value and acceptability of a patient feedback tool for both patients and psychiatrists? Methods: Seven cycles of action research were conducted in co-production with a mental health patient-research partner. Results: Patients are rarely involved in the design, delivery or evaluation of patient feedback tools for practising psychiatrists. Comparison of 152 online reviews demonstrates that patients frequently describe different psychiatric care domains with different terminology to that used in existing feedback tools. Inductive thematic analysis of focus groups and interviews with 77 patients and 29 psychiatrists identified a number of shared concerns and suggestions that often related to improving existing feedback design, content and processes. Finally, following a co-production and refinement workshop with 28 participants, 16 patients and psychiatrists stated that co-production had improved the perceived value and acceptability of the patient feedback tool. Benefits of co-production identified by participants included enhanced relevance, provision of more accessible information and increased sense of ownership. Conclusion: Co-production can enhance the perceived value and acceptability of a patient feedback tool. However, the integration of co-produced knowledge ultimately remains at the organisations’ discretion. Research impacts include the national implementation of the feedback tool and international implementation of the co-produced response framework

An Environment and Cultural Heritage Workbook for Students and Teachers

The word heritage is one that means many things to many people. It often brings to mind things like food, language, clothing, or other traditions that are passed on from generation to generation. But it also includes places, buildings, art, values, and ways of making a living in particular environments. In Maya communities, as is the case elsewhere around the world, cultural practices and the environment are tightly connected, with one shaping the other.With this workbook we take a broad view of heritage, one that links cultural and environmental histories, landscapes, and practices together. A term that UNESCO and others often use is cultural landscapes to refer to a long and intimate relationship between peoples and their...environment (http://whc.unesco.org/en/culturallandscape/). This also reflects the ways many of the people who shared this information for the workbook view their own heritage

Sharing and Sustaining Maya Environmental Heritage in Southern Belize

This paper documents an approach to sharing and sustaining Maya environmental and cultural heritage through the development of a primary school curriculum and associated activities in order to bring cultural knowledge and practices to formal school settings. Methods include long-term ethnographic research on environmental knowledge and practices in two Maya communities in Toledo; participatory workshops with educators; iterative consultations with district educators, community leaders, and families; and community for a focus on discussions of how and whether such information could be integrated into formal schooling. Curricula and content for workbooks, radio shows, and field guides are comprised of both generalized and specific knowledge regarding environmental and cultural practices. Findings are presented on the effectiveness of the curriculum based on pilot testing with teachers and students describe their learning experiences using the lessons and the responses of teachers participating in workshops to gather feedback on the piloting testing with teachers and students at seven schools in the Toledo District in 2010-2012. In particular, we focus on how students describe their learning experiences using the lessons and the responses of teachers participating in workshops to gather feedback on piloting of the curriculum. These data are contextualized through a discussion about the need to conceptually link environmental and cultural heritages. In addition, we examine the challenges of linking informal practices with formal school settings, the need to carefully consider the ethics of bringing Maya environmental and cultural heritage into schools, and the complex roles of researchers and community members, organizations, and educators in creating heritage curricula. Researchers consistently point to the problematic nature of simply cataloguing environmental knowledge of cultural practices as static entities. We suggest that this project supports the dynamic nature of this knowledge by promoting sharing, discussion, collaboration, and experiential learning

Recess in the 21st Century Post-COVID World

The abrupt onset of the COVID-19 pandemic forced the world into frenzied action, creating a series of ongoing stressors: school/work closings, remote learning, canceled events, family strife, fear, and a significant loss of social interactions. It is now unsurprising to learn that children's mental health has suffered. As social connection is tightly entwined with children's mental health, supporting school-based spaces for quality social interactions is an important post-pandemic recovery strategy. The unstructured school recess space is ideal for supporting recovery. A large and growing body of evidence supports the important role of recess, yet evidence also suggests that recess is not always implemented in ways that fulfill its promise

Site use and connectivity of female grey seals (Halichoerus grypus) around Wales

The UK Natural Environment Research Council (NERC) provided core funding to the Sea Mammal Research Unit during this work and NERC Grant No. NE/G008930/1 to PP and LH to develop photo-ID use for grey seals. The Esmée Fairbairn Foundation provided additional funding to PP and LH for photo-ID work with grey seals. NRW funded survey work by MB, LM, SW and PS; contracted LH for survey design, software development and data management; IL and PP for work related to the production of this manuscript.Grey seals (Halichoerus grypus) are a qualifying feature of three special areas of conservation (SACs) in Wales, yet relatively little is known of their site use along this coastline. Since 1992, many individuals and organisations have contributed to a grey seal photographic identification database held by Natural Resources Wales, which is one of the largest and oldest of its kind, providing key information from grey seal haul-out sites around the Celtic and Irish Seas. Here, we investigated spatial connectivity of haul-out sites and fidelity of adult females to breeding sites. The minimum number of adult female grey seals using the area between 1992 and 2016 was 2688. Individual capture histories and relative spatial transition probabilities (Pij) between pairs of location groups were calculated. Adjacent locations were highly connected (e.g. Lleyn Peninsula and Bardsey, Pij = 0.7) but connections spanned the entire region, up to 230 km apart (e.g. Skomer and Dee Estuary, Pij = 0.004). Resights were recorded within SACs (e.g. Lleyn Peninsula and Bardsey [Lleyn Peninsula and the Sarnau SAC], Pij = 0.7), between SACs (e.g. Bardsey and Skomer [Pembrokeshire Marine], Pij = 0.03), between SACs and non-designated areas (e.g. Skerries and Bardsey, Pij = 0.09) and between sites outside any protected area (e.g. Dee Estuary and Anglesey, Pij = 0.5). While inter-annual fidelity to breeding sites was high (Pij = 0.82–1), individual female grey seals moved throughout the region. This evidence of extensive site use beyond protected areas is important for the management and conservation of grey seals around Wales.Publisher PDFPeer reviewe

Procalcitonin and Other Common Biomarkers Do Not Reliably Identify Patients at Risk for Bacterial Infection After Congenital Heart Surgery

Objectives: Following surgery, it is difficult to distinguish a postoperative inflammatory reaction from infection. This study examined the predictive value of the biomarkers; procalcitonin, C-reactive protein, lactate, neutrophils, lymphocytes, platelets, and the biphasic activated partial thromboplastin time waveform in diagnosing bacterial infection following cardiac surgery. Design: Prospective, observational study. Setting: A regional, PICU in the United Kingdom. Patients: Three-hundred sixty-eight children under the age of 16 admitted to the PICU for elective cardiac surgery were enrolled in the study. Interventions: All biomarker measurements were determined daily until postoperative day 7. Children were assessed for postoperative infection until day 28 and divided into four groups: bacterial infection, culture-negative sepsis, viral infection, and no infection. We used the Kruskal-Wallis test, chi-square test, analysis of variance, and area under the curve in our analysis. Measurements and Main Results: In total, 71 of 368 children (19%) developed bacterial infection postoperatively, the majority being surgical site infections. In those with bacterial infection, procalcitonin was elevated on postoperative days 1–3 and the last measurement prior to event compared with those without bacterial infection. The most significant difference was the last measurement prior to event; 0.72 ng/mL in the bacterial infection group versus 0.13 ng/mL in the no infection group (for all groups; p and#60; 0.001). Longitudinal profiles of all biomarkers were indistinct in the bacterial infection and nonbacterial infection groups except in those with culture-negative infections who had distinct procalcitonin kinetics on postoperative days 1–4. Children with culture-negative sepsis required longer ventilatory support and PICU stay and were more likely to develop complications than the other groups. Conclusions: None of the biomarkers studied within 3 days of infection distinguished between infection and postoperative inflammatory reaction. However, procalcitonin kinetics peaked on postoperative day 2 and fell more sharply than C-reactive protein kinetics, which peaked at postoperative day 3. The monitoring of procalcitonin kinetics following cardiac surgery may help guide rational antimicrobial use