Promotion of physical activity for adolescents with cystic fibrosis: a qualitative study of UK multi disciplinary cystic fibrosis teams

Background: The Cystic Fibrosis Trust recently published a standards of care document which stated that patients should be given a physical activity (PA) programme based on their motivations, fitness, and willingness to be active. However, there remains much debate regarding the roles and responsibilities for PA promotion, as well as “optimal” recommendations and advice. This study aimed to qualitatively explore cystic fibrosis (CF) multidisciplinary teams (MDTs) advice, recommendations and practices relating to PA promotion for adolescents with CF. / Method: Semi-structured interviews were conducted with fifteen members of CF MDTs (11 physiotherapists, two dieticians and two paediatricians). Thematic analysis was used to analyse the data. / Results: Major themes identified were: (1) structure of MDTs, (2) recommendations relating to intensities, durations and types of PA, and (3) use of exercise testing. Participants reported variation between MDTs in terms of who is responsible for promoting and supporting PA, the nature of advice given to patients, and the use of exercise testing. Participants consistently lacked confidence in their own or others’ knowledge to provide standardised recommendations to patients and highlighted that PA promotion and support was often overlooked during busy periods. / Conclusions: Despite its importance, PA support and promotion is not always prioritised. MDTs lack confidence in their ability to promote PA. Standardised advice and training relating to optimal intensities, durations and types of PA would provide a baseline from which to individualise advice to each patient and could increase confidence in PA promotion among MDTs

Morphology of the Faial Island shelf (Azores): the interplay between volcanic, erosional, depositional, tectonic and mass-wasting processes

[1] The extents of volcanic island shelves result from surf erosion, which enlarges them, and volcanic progradation, which reduces them. However, mass‐wasting, tectonics and sediment deposition also contribute to their morphology. In order to assess the relative significance of these various processes, we have mapped in detail Faial Island's shelf in the Azores archipelago based on interpretation of geophysical and geological data. The nearshore substrates of the island, down to 30–50 m depth, are rocky and covered by volcaniclastic boulder deposits formed by surf action on now‐submerged lava flows. Below those depths, sandy and gravel volcaniclastic beds dominate, building clinoforms up to the shelf edge. In some sectors of the coast, prograding lava has narrowed the shelf, but, in contrast to nearby Pico Island, we find fewer submarine‐emplaced lavas on the shelf. In this island, we interpret the distance between the coastline and the shelf edge as almost entirely a result of a straightforward competition between surf erosion and lava progradation, in which erosion dominates. Therefore shelf width can be used as a proxy for coastline age as well as for wave energy exposure. The stratigraphy of shelf deposits in boomer seismic data is examined in detail to assess the roles of different sediment sources, accommodation space and wave exposure in creating these deposits. We also show evidence of mass‐wasting at the shelf edge and discuss the possible origins of slope instability. Finally, we discuss the contributing role of tectonics for the development of the shelf.publishe

The Effect of a Care Transition Intervention on the Patient Experience of Older Multi-Lingual Adults in the Safety Net: Results of a Randomized Controlled Trial

Background: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Care Transitions Measure (CTM-3) scores are patient experience measures used to determine hospital value-based purchasing reimbursement. Interventions to improve 30-day readmissions have met with mixed results, but less is known about their potential to improve the patient experience among older ethnically and linguistically diverse adults receiving care at safety-net hospitals. In this study, we assessed the effect of a nurse-led hospital-based care transition intervention on discharge-related patient experience in an older multilingual population of adults hospitalized at a safety-net hospital. Methods: We randomized 700 inpatients aged 55 and older at an academic urban safety-net hospital. In addition to usual care, intervention participants received inpatient visits by a language-concordant study nurse and post-discharge phone calls from a language-concordant nurse practitioner to reinforce the care plan and to address acute complaints. We measured HCAHPS nursing, medication, and discharge communication domain scores and CTM-3 scores at 30 days after hospital discharge. Results: Of 685 participants who survived to 30 days, 90 % (n = 616) completed follow-up interviews. The mean age was 66.2 years; over half (54.2 %) of the participants had cognitive impairment, and 33.8 % had moderate to severe depression. The majority (62.1 %) of interviews were conducted in English; 23.3 % were conducted in Chinese and 14.6 % in Spanish. Study nurses spent an average of 157 min with intervention participants. Between intervention and usual care participants, CTM-3 scores (80.5 % vs 78.5 %; p = 0.18) and HCAHPS discharge communication domain scores (74.8 % vs 68.7 %; p = 0.11) did not differ, nor did HCAHPS scores in medication (44.5 % vs 53.1 %; p = 0.13) and nursing domains (67.9 % vs 64.9 %; p = 0.43). When stratified by language, no significant differences were seen. Conclusion: An inpatient standalone transition-of-care intervention did not improve patient discharge experience. Older multi-lingual and cognitively impaired populations may require higher-intensity interventions post-hospitalization to improve discharge experience outcomes

Using models to bridge the gap between land use and algal blooms: an example from the Loweswater catchment, UK

The goods and services that lakes provide result from complex interactions between meteorology, hydrology, nutrient-loads and in-lake processes. Hydrology and nutrient loads are, in turn, influenced by socio-economic factors such as human habitation, water abstraction and land-management, within their catchments. Models provide a means of linking these different domains and also of forecasting and evaluating the effects of different management scenarios on lakes. This paper describes the application of such models to Loweswater, a well-studied lake with water quality problems in the English Lake District, where a community-based approach to catchment management is being undertaken. Three models were linked. Firstly, PLANET (Planning Land Applications of Nutrients for Efficiency and the environmenT), an ‘off the shelf’ farm nutrient budgeting model, was supplemented by local information on septic tanks and used to produce an annual nutrient load to the lake. Secondly, GWLF (Generalized Watershed Loading Function), a generic nutrient runoff model, was used to generate daily nutrient runoff values using input from PLANET plus additional information on land-cover, air temperature and rainfall within the catchment. Thirdly PROTECH (Phytoplankton RespOnses To Environmental CHange), driven by input from GWLF and locally measured meteorology, was used to forecast the abundance of different algal types within the lake. The linked models were used to describe the current impact of catchment management on lake water quality, validated by in situ measurements, and to explore the potential impact of a number of alternative catchment management scenarios. Issues surrounding the use of generic modelling applications for catchment management and relevance for stakeholders living in and/or managing land within the catchment are discussed

'Have you seen Bloomberg?': satellite news channels as agents of the new visibility

With the proliferation of transnational television flows, viewers can see their national affairs, traditionally covered predominantly by national news, portrayed by cross-border news channels. This article examines how transnational satellite news coverage of national events enhances nations' global visibility, and influences national public debate over national narratives. An analysis of the public debates in Spain and France over transnational channels' coverage of the March 2004 terror bombings in Madrid and the October 2005 French riots, respectively, provides the basis for discussing the implications of the `new visibility' (Thompson, 2005) of nations, in today's media age. The analysis demonstrates how transnational networks' coverage of these events generated estrangement, de-familiarized and cast doubt on national narratives and commonsensical discourses of us/them, thereby offering viewers an alternative distance from their national unit and encouraging a self-reflexive process of introspection and critical discussion. This process may open up the possibility for a more inclusive national space and strengthen democratic culture, but at the same time it triggers instabilities, which might contribute to citizens' loss of trust in the news media — a dangerous scenario for democracy