A nurse-led sleep service for children and young people with disability

Aim: To evaluate the outcomes from a nurse-led, community-based sleep hygiene service for children and young people, which was designed and implemented in a community NHS trust. The project aimed to provide evidence for wider implementation of such a service across the trust. Method: The project recruited 22 participants to an eight-week programme over six months and collected quantitative and qualitative data. It included evaluating service costs and collecting information about how the child’s sleep problem affected the carer and family pre- and post-intervention. Findings: There was a significant, positive effect on quality-of-life measures, with two thirds of participants achieving 40% of their expectations by the end of the eight weeks. Parents said they felt ‘less helpless’ and they valued the support given in the home setting. Conclusion: Cost and benefit analysis showed that the service could reduce costs associated with high-cost prescriptions. It could also positively affect community paediatric waiting lists and clinic appointments

An exploration of occupational therapists' views and experiences of using evidence-based practice to develop professional knowledge in a local authority setting

Introduction: Occupational therapists are expected to engage in evidence-based practice and to be aware of the importance of research as the foundation of the profession's evidence base. This appears to be the first study that has explored local authority occupational therapists' views and experiences of evidence-based practice and how they use it to develop professional knowledge. Method: A focus group data collection method was employed. Two focus groups, comprising seven occupational therapists each were conducted. Occupational therapists who participated in the study had been working in the local authority setting from between six months to thirty years. Findings: Occupational therapists did not draw on research evidence to build their knowledge. Therapists valued the evidence of the lived experience of clients, their own and other's knowledge and experience, including the perceived evidence-based knowledge of health colleagues. Therapists developed their knowledge using these sources of evidence, through reflection and participation in wide communities of practice. Therapists looked to others to lead on developing evidence-based practice in the local setting. Conclusion: Occupational therapists did not use an evidence-based practice approach to develop professional knowledge. Peer learning and role modelling strategies may enable occupational therapists to become more evidence-based in order to enhance their practice and meet professional standards

Innovation and adaptation in the Ontario grape and wine industry: An integrated, transdisciplinary response to climate change

With scientific consensus supporting a 4oC increase in global mean temperature over the next century and increased frequency of severe weather events, adaptation to climate change is critical. Given the dynamic and complex nature of climate change, a transdisciplinary approach toward adaptation can create an environment that supports knowledge sharing and innovation, improving existing strategies and creating new ones. The Ontario wine industry provides a case study to illustrate the benefits of this approach. We describe the formation and work of the Ontario Grape and Wine Research Network within this context, and present some preliminary results to highlight the opportunities for innovation that will drive the successful adaption of the Ontario grape and wine industry.Thank you to all our partners in The Ontario Grape and Wine Research Network. The support of the Ontario Research Fund for Research Excellence Funding (Round 5), Ontario Grape and Wine Research Inc., the Wine Council of Ontario, the Grape Growers of Ontario, and the Winery and Growers Alliance of Ontario is gratefully acknowledged

Is your system fit for purpose? Female athlete health considerations for rugby injury and illness surveillance systems

This review discusses female-specific health considerations in injury and illness surveillance and provides rugby-specific recommendations for future surveillance. Identifying priority injury and illness problems by determining those problems with the highest rates within women's rugby may highlight different priorities than sex comparisons between men's and women's rugby. Whilst sports exposure is the primary risk for health problems in sports injury and illness surveillance, female athletes have health domains that should also be considered. Alongside female athlete health domains, studies investigating rugby injuries and illnesses highlight the need to broaden the health problem definition typically used in rugby injury and illness surveillance. Using a non-time-loss health problem definition, recording female-specific population characteristics, embedding female athlete health domains and having up-to-date injury and illness coding systems should be prioritized within surveillance systems to begin to shed light on potential interactions between sports exposure, health domains and, injuries and illnesses. We call for a collaborative approach across women's rugby to facilitate large injury and illness datasets to be generated and enable granular level categorization and analysis, which may be necessary for certain female athlete health domains. Applying these recommendations will ensure injury and illness surveillance systems improve risk identification and better inform injury and illness prevention strategies in women's rugby

Model of Tooth Morphogenesis Predicts Carabelli Cusp Expression, Size, and Symmetry in Humans

The patterning cascade model of tooth morphogenesis accounts for shape development through the interaction of a small number of genes. In the model, gene expression both directs development and is controlled by the shape of developing teeth. Enamel knots (zones of nonproliferating epithelium) mark the future sites of cusps. In order to form, a new enamel knot must escape the inhibitory fields surrounding other enamel knots before crown components become spatially fixed as morphogenesis ceases. Because cusp location on a fully formed tooth reflects enamel knot placement and tooth size is limited by the cessation of morphogenesis, the model predicts that cusp expression varies with intercusp spacing relative to tooth size. Although previous studies in humans have supported the model's implications, here we directly test the model's predictions for the expression, size, and symmetry of Carabelli cusp, a variation present in many human populations.In a dental cast sample of upper first molars (M1s) (187 rights, 189 lefts, and 185 antimeric pairs), we measured tooth area and intercusp distances with a Hirox digital microscope. We assessed Carabelli expression quantitatively as an area in a subsample and qualitatively using two typological schemes in the full sample. As predicted, low relative intercusp distance is associated with Carabelli expression in both right and left samples using either qualitative or quantitative measures. Furthermore, asymmetry in Carabelli area is associated with asymmetry in relative intercusp spacing.These findings support the model's predictions for Carabelli cusp expression both across and within individuals. By comparing right-left pairs of the same individual, our data show that small variations in developmental timing or spacing of enamel knots can influence cusp pattern independently of genotype. Our findings suggest that during evolution new cusps may first appear as a result of small changes in the spacing of enamel knots relative to crown size

Strengthening nursing, midwifery and allied health professional leadership in the UK - a realist evaluation

Purpose: This paper aims to share the findings of a realist evaluation study that set out to identify how to strengthen nursing, midwifery and allied health professions (NMAHP) leadership across all health-care contexts in the UK conducted between 2018 and 2019. The collaborative research team were from the Universities of Bangor, Ulster, the University of the West of Scotland and Canterbury Christ Church University. Design/methodology/approach: Realist evaluation and appreciative inquiry were used across three phases of the study. Phase 1 analysed the literature to generate tentative programme theories about what works, tested out in Phase 2 through a national social media Twitter chat and sense-making workshops to help refine the theories in Phase 3. Cross-cutting themes were synthesised into a leadership framework identifying the strategies that work for practitioners in a range of settings and professions based on the context, mechanism and output configuration of realist evaluation. Stakeholders contributed to the ongoing interrogation, analysis and synthesis of project outcomes. Findings: Five guiding lights of leadership, a metaphor for principles, were generated that enable and strengthen leadership across a range of contexts. – “The Light Between Us as interactions in our relationships”, “Seeing People’s Inner Light”, “Kindling the Spark of light and keeping it glowing”, “Lighting up the known and the yet to be known” and “Constellations of connected stars”. Research limitations/implications: This study has illuminated the a-theoretical nature of the relationships between contexts, mechanisms and outcomes in the existing leadership literature. There is more scope to develop the tentative programme theories developed in this study with NMAHP leaders in a variety of different contexts. The outcomes of leadership research mostly focussed on staff outcomes and intermediate outcomes that are then linked to ultimate outcomes in both staff and patients (supplemental). More consideration needs to be given to the impact of leadership on patients, carers and their families. Practical implications: The study has developed additional important resources to enable NMAHP leaders to demonstrate their leadership impact in a range of contexts through the leadership impact self-assessment framework which can be used for 360 feedback in the workplace using the appreciative assessment and reflection tool. Social implications: Whilst policymakers note the increasing importance of leadership in facilitating the culture change needed to support health and care systems to adopt sustainable change at pace, there is still a prevailing focus on traditional approaches to individual leadership development as opposed to collective leadership across teams, services and systems. If this paper fails to understand how to transform leadership policy and education, then it will be impossible to support the workforce to adapt and flex to the increasingly complex contexts they are working in. This will serve to undermine system integration for health and social care if the capacity and capability for transformation are not attended to. Whilst there are ambitious global plans (WHO, 2015) to enable integrated services to be driven by citizen needs, there is still a considerable void in understanding how to authentically engage with people to ensure the transformation is driven by their needs as opposed to what the authors think they need. There is, therefore, a need for systems leaders with the full skillset required to enable integrated services across place-based systems, particularly clinicians who are able to break down barriers and silo working across boundaries through the credibility, leadership and facilitation expertise they provide. Originality/value: The realist evaluation with additional synthesis from key stakeholders has provided new knowledge about the principles of effective NMAHP leadership in health and social care, presented in such a way that facilitates the use of the five guiding lights to inform further practice, education, research and policy development

Shining new light on mammalian diving physiology using wearable near-infrared spectroscopy

Investigation of marine mammal dive-by-dive blood distribution and oxygenation has been limited by a lack of non-invasive technology for use in freely diving animals. Here, we developed a non-invasive near-infrared spectroscopy (NIRS) device to measure relative changes in blood volume and haemoglobin oxygenation continuously in the blubber and brain of voluntarily diving harbour seals. Our results show that seals routinely exhibit preparatory peripheral vasoconstriction accompanied by increased cerebral blood volume approximately 15 s before submersion. These anticipatory adjustments confirm that blood redistribution in seals is under some degree of cognitive control that precedes the mammalian dive response. Seals also routinely increase cerebral oxygenation at a consistent time during each dive, despite a lack of access to ambient air. We suggest that this frequent and reproducible reoxygenation pattern, without access to ambient air, is underpinned by previously unrecognised changes in cerebral drainage. The ability to track blood volume and oxygenation in different tissues using NIRS will facilitate a more accurate understanding of physiological plasticity in diving animals in an increasingly disturbed and exploited environment

Public Health Implications of Evictions: Modeling the Costs for Landlords, Tenants, and Society

In the United States, more than 13% of renters experience a formal or informal eviction in their lifetime. Forced moves contribute to a decline in job status, mental and physical health, material possessions, safety, social networks, housing aid, and neighborhood stability. Previous research has explored the risk factors, causes, and costs to those burdened by evictions. However, the costs of evictions incurred by all stakeholders involved in the process of evictions and homelessness remain largely unexplored. The homeownership rate in New Haven is less than 30%, and more than 52% of households are ‘cost-burdened,’ meaning more than 30% of income “is spent on housing costs associated with owning or renting a home.” Thus, this project set out to analyze the contributing burdens of costs within New Haven, Connecticut.https://elischolar.library.yale.edu/ysph_pbchrr/1016/thumbnail.jp