Using Cognitive Pre-Testing Methods in the Development of a New Evidenced-Based Pressure Ulcer Risk Assessment Instrument

Background: Variation in development methods of Pressure Ulcer Risk Assessment Instruments has led to inconsistent inclusion of risk factors and concerns about content validity. A new evidenced-based Risk Assessment Instrument, the Pressure Ulcer Risk Primary Or Secondary Evaluation Tool - PURPOSE-T was developed as part of a National Institute for Health Research (NIHR) funded Pressure Ulcer Research Programme (PURPOSE: RP-PG-0407-10056). This paper reports the pre-test phase to assess and improve PURPOSE-T acceptability, usability and confirm content validity. Methods: A descriptive study incorporating cognitive pre-testing methods and integration of service user views was undertaken over 3 cycles comprising PURPOSE-T training, a focus group and one-to-one think-aloud interviews. Clinical nurses from 2 acute and 2 community NHS Trusts, were grouped according to job role. Focus group participants used 3 vignettes to complete PURPOSE-T assessments and then participated in the focus group. Think-aloud participants were interviewed during their completion of PURPOSE-T. After each pre-test cycle analysis was undertaken and adjustment/improvements made to PURPOSE-T in an iterative process. This incorporated the use of descriptive statistics for data completeness and decision rule compliance and directed content analysis for interview and focus group data. Data were collected April 2012-June 2012. Results: Thirty-four nurses participated in 3 pre-test cycles. Data from 3 focus groups, 12 think-aloud interviews incorporating 101 PURPOSE-T assessments led to changes to improve instrument content and design, flow and format, decision support and item-specific wording. Acceptability and usability were demonstrated by improved data completion and appropriate risk pathway allocation. The pre-test also confirmed content validity with clinical nurses. Conclusions: The pre-test was an important step in the development of the preliminary PURPOSE-T and the methods used may have wider instrument development application. PURPOSE-T proposes a new approach to pressure ulcer risk assessment, incorporating a screening stage, the inclusion of skin status to distinguish between those who require primary prevention and those who require secondary prevention/treatment and the use of colour to support pathway allocation and decision making. Further clinical evaluation is planned to assess the reliability and validity of PURPOSE-T and it’s impact on care processes and patient outcomes

Remote detection of invasive alien species

The spread of invasive alien species (IAS) is recognized as the most severe threat to biodiversity outside of climate change and anthropogenic habitat destruction. IAS negatively impact ecosystems, local economies, and residents. They are especially problematic because once established, they give rise to positive feedbacks, increasing the likelihood of further invasions and spread. The integration of remote sensing (RS) to the study of invasion, in addition to contributing to our understanding of invasion processes and impacts to biodiversity, has enabled managers to monitor invasions and predict the spread of IAS, thus supporting biodiversity conservation and management action. This chapter focuses on RS capabilities to detect and monitor invasive plant species across terrestrial, riparian, aquatic, and human-modified ecosystems. All of these environments have unique species assemblages and their own optimal methodology for effective detection and mapping, which we discuss in detail

Losses, inefficiencies and waste in the global food system

Losses at every stage in the food systeminfluence the extent towhich nutritional requirements of a growing global population can be sustainablymet. Inefficiencies and losses in agricultural production and consumer behaviour all play a role. This paper aims to understand better themagnitude of different losses and to provide insights into how these influence overall food system efficiency.We take a systems view fromprimary production of agricultural biomass through to human food requirements and consumption. Quantities and losses over ten stages are calculated and compared in terms of drymass, wetmass, protein and energy. The comparison reveals significant differences between these measurements, and the potential for wet mass figures used in previous studies to be misleading. The results suggest that due to cumulative losses, the proportion of global agricultural dry biomass consumed as food is just 6% (9.0% for energy and 7.6% for protein), and 24.8% of harvest biomass (31.9% for energy and 27.8% for protein). The highest rates of loss are associatedwith livestock production, although the largest absolute losses of biomass occur prior to harvest. Losses of harvested crops were also found to be substantial, with 44.0% of crop dry matter (36.9% of energy and 50.1% of protein) lost prior to human consumption. If human overconsumption, defined as food consumption in excess of nutritional requirements, is included as an additional inefficiency, 48.4% of harvested cropswere found to be lost (53.2% of energy and 42.3% of protein). Over-eatingwas found to be at least as large a contributor to food systemlosses as consumer foodwaste. The findings suggest that influencing consumer behaviour, e.g. to eat less animal products, or to reduce per capita consumption closer to nutrient requirements, offer substantial potential to improve food security for the rising global population in a sustainable manner

Adaptation of global land use and management intensity to changes in climate and atmospheric carbon dioxide

Land use contributes to environmental change, but is also influenced by such changes. Climate and atmospheric carbon dioxide (CO2) levels\u27 changes alter agricultural crop productivity, plant water requirements and irrigation water availability. The global food system needs to respond and adapt to these changes, for example, by altering agricultural practices, including the crop types or intensity of management, or shifting cultivated areas within and between countries. As impacts and associated adaptation responses are spatially specific, understanding the land use adaptation to environmental changes requires crop productivity representations that capture spatial variations. The impact of variation in management practices, including fertiliser and irrigation rates, also needs to be considered. To date, models of global land use have selected agricultural expansion or intensification levels using relatively aggregate spatial representations, typically at a regional level, that are not able to characterise the details of these spatially differentiated responses. Here, we show results from a novel global modelling approach using more detailed biophysically derived yield responses to inputs with greater spatial specificity than previously possible. The approach couples a dynamic global vegetative model (LPJ-GUESS) with a new land use and food system model (PLUMv2), with results benchmarked against historical land use change from 1970. Land use outcomes to 2100 were explored, suggesting that increased intensity of climate forcing reduces the inputs required for food production, due to the fertilisation and enhanced water use efficiency effects of elevated atmospheric CO2 concentrations, but requiring substantial shifts in the global and local patterns of production. The results suggest that adaptation in the global agriculture and food system has substantial capacity to diminish the negative impacts and gain greater benefits from positive outcomes of climate change. Consequently, agricultural expansion and intensification may be lower than found in previous studies where spatial details and processes consideration were more constrained

Integrating Landscape Ecology and Geoinformatics to Decipher Landscape Dynamics for Regional Planning

We used remote sensing and GIS in conjunction with multivariate statistical methods to: (i) quantify landscape composition (land cover types) and configuration (patch density, diversity, fractal dimension, contagion) for five coastal watersheds of Kalloni gulf, Lesvos Island, Greece, in 1945, 1960, 1971, 1990 and 2002/2003, (ii) evaluate the relative importance of physical (slope, geologic substrate, stream order) and human (road network, population density) variables on landscape composition and configuration, and (iii) characterize processes that led to land cover changes through land cover transitions between these five successive periods in time. Distributions of land cover types did not differ among the five time periods at the five watersheds studied because the largest cumulative changes between 1945 and 2002/2003 did not take place at dominant land cover types. Landscape composition related primarily to the physical attributes of the landscape. Nevertheless, increase in population density and the road network were found to increase heterogeneity of the landscape mosaic (patchiness), complexity of patch shape (fractal dimension), and patch disaggregation (contagion). Increase in road network was also found to increase landscape diversity due to the creation of new patches. The main processes involved in land cover changes were plough-land abandonment and ecological succession. Landscape dynamics during the last 50 years corroborate the ecotouristic-agrotouristic model for regional development to reverse trends in agricultural land abandonment and human population decline and when combined with hypothetical regulatory approaches could predict how this landscape could develop in the future, thus, providing a valuable tool to regional planning