Implementation evaluation and refinement of an intervention to improve blunt chest injury management—A mixed-methods study

© 2017 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd. Aims and objectives: To investigate uptake of a Chest Injury Protocol (ChIP), examine factors influencing its implementation and identify interventions for promoting its use. Background: Failure to treat blunt chest injuries in a timely manner with sufficient analgesia, physiotherapy and respiratory support, can lead to complications such as pneumonia and respiratory failure and/or death. Design: This is a mixed-methods implementation evaluation study. Methods: Two methods were used: (i) identification and review of the characteristics of all patients eligible for the ChIP protocol, and (ii) survey of hospital staff opinions mapped to the Theoretical Domains Framework (TDF) to identify barriers and facilitators to implementation. The characteristics and treatment received between the groups were compared using the chi-square test or Fischer's exact test for proportions, and the Mann–Whitney U-test for continuous data. Quantitative survey data were analysed using descriptive statistics. Qualitative data were coded in NVivo 10 using a coding guide based on the TDF and Behaviour Change Wheel (BCW). Identification of interventions to change target behaviours was sourced from the Behaviour Change Technique Taxonomy Version 1 in consultation with stakeholders. Results: Only 68.4% of eligible patients received ChIP. Fifteen facilitators and 10 barriers were identified to influence the implementation of ChIP in the clinical setting. These themes were mapped to 10 of the 14 TDF domains and corresponded with all nine intervention functions in the BCW. Seven of these intervention functions were selected to address the target behaviours and a multi-faceted relaunch of the revised protocol developed. Following re-launch, uptake increased to 91%. Conclusions: This study demonstrated how the BCW may be used to revise and improve a clinical protocol in the ED context. Relevance to clinical practice: Newly implemented clinical protocols should incorporate clinician behaviour change assessment, strategy and interventions. Enhancing the self-efficacy of emergency nurses when performing assessments has the potential to improve patient outcomes and should be included in implementation strategy

A global review of green turtle diet: sea surface temperature as a potential driver of omnivory levels

To better understand dietary requirements, trophic shifts, and trophic interactions of the threatened green turtle (Chelonia mydas), we conducted a comprehensive global review and literature tabulation (177 studies) reporting diets of individuals & 25 cm carapace length. We analysed those studies involving natural sites and healthy animals that reported relative proportions of all diet components (67 studies, 89 datasets at 75 sites, 13 geographic sub-regions, 3 oceans). We compared diets by sub-region and foraging site relative to four diet components, i.e., seagrass, macroalgae, terrestrial plants (including mangroves) and animal matter. To assess sea surface temperature (SST) as an environmental driver, values were extracted from satellite data (single year) and site-specific observations (study durations) and examined relative to diet composition. Satellite data indicated that at warmer sites with temperatures & 25 °C (≥ 6 months annually), diet was predominantly herbivorous (mean = 92.97%; SE = 9.85; n = 69 datasets). At higher latitude sites and in cold-water currents with SST & 20 °C (≥ 6 months annually), dietary animal matter featured prominently (mean = 51.47%; SE = 4.84; n = 20 datasets). Site-specific observations indicated that SST had a small but significant effect on contributions of animal matter (r2 = 0.17, P =  & 0.001) and seagrass (r2 = 0.24, P =  & 0.001) but not macroalgae and terrestrial plants. Our study presents the first quantitative evidence at a global scale that temperature may be an important driver of omnivory, providing a new perspective on variations in green turtle diet, especially in light of global warming and climate change

The master builders: LAIRAH research on good practice in the construction of digital humanities projects

Although many digital humanities resources are being developed for online use, there is little understanding of why some become popular, whilst others are neglected. Through log analysis techniques, the LAIRAH project identified twenty-one popular and well-used digital humanities projects, and in order to ascertain the factors they had in common, which predisposed them to be well used, conducted in-depth interviews with the creators of these resources. This article presents the findings of the study, highlighting areas that developers should be aware of, and providing a set of recommendations for both funders and creators, which should ensure that a digital humanities resource will have the best possible chance of being used in the long term

Seagrass ecosystems of the Pacific Island countries and territories: a global bright spot

Seagrass ecosystems exist throughout Pacific Island Countries and Territories (PICTs). Despite this area covering nearly 8% of the global ocean, information on seagrass distribution, biogeography, and status remains largely absent from the scientific literature. We confirm 16 seagrass species occur across 17 of the 22 PICTs with the highest number in Melanesia, followed by Micronesia and Polynesia respectively. The greatest diversity of seagrass occurs in Papua New Guinea (13 species), and attenuates eastward across the Pacific to two species in French Polynesia. We conservatively estimate seagrass extent to be 1446.2 km2, with the greatest extent (84%) in Melanesia. We find seagrass condition in 65% of PICTs increasing or displaying no discernible trend since records began. Marine conservation across the region overwhelmingly focuses on coral reefs, with seagrass ecosystems marginalised in conservation legislation and policy. Traditional knowledge is playing a greater role in managing local seagrass resources and these approaches are having greater success than contemporary conservation approaches. In a world where the future of seagrass ecosystems is looking progressively dire, the Pacific Islands appears as a global bright spot, where pressures remain relatively low and seagrass more resilient

Hobson’s choice? Constraints on accessing spaces of creative production

Successful creative production is often documented to occur in urban areas that are more likely to be diverse, a source of human capital and the site of dense interactions. These accounts chart how, historically, creative industries have clustered in areas where space was once cheap in the city centre fringe and inner city areas, often leading to the development of a creative milieu, and thereby stimulating further creative production. Historical accounts of the development of creative areas demonstrate the crucial role of accessible low-cost business premises. This article reports on the findings of a case study that investigated the location decisions of firms in selected creative industry sectors in Greater Manchester. The study found that, while creative activity remains highly concentrated in the city centre, creative space there is being squeezed and some creative production is decentralizing in order to access cheaper premises. The article argues that the location choices of creative industry firms are being constrained by the extensive city centre regeneration, with the most vulnerable firms, notably the smallest and youngest, facing a Hobson’s choice of being able to access low-cost premises only in the periphery. This disrupts the delicate balance needed to sustain production and begs the broader question as to how the creative economy fits into the existing urban fabric, alongside the competing demands placed on space within a transforming industrial conurbation

Regulatory limits for pesticide residues in water (IUPAC Technical Report)

National governments introduced residue limits and guideline levels forpesticide residues in water when policies were implemented to minimize the con-tamination of ground and surface waters. Initially, the main attention was given todrinking water.Regulatory limits for pesticide residues in waters should have the followingcharacteristics: definition of the type of water, definition of the residue, a suitableanalytical method for the residues, and explanation for the basis for each limit. Limits may be derived by applying a safety factor to a no-effect-level, orfrom levels occurring when good practices are followed and also passing a safetyassessment, or from the detection limit of an analytical method, or directly by leg-islative decision

Recent trend reversal for declining European seagrass meadows

Seagrass meadows, key ecosystems supporting fisheries, carbon sequestration and coastal protection, are globally threatened. In Europe, loss and recovery of seagrasses are reported, but the changes in extent and density at the continental scale remain unclear. Here we collate assessments of changes from 1869 to 2016 and show that 1/3 of European seagrass area was lost due to disease, deteriorated water quality, and coastal development, with losses peaking in the 1970s and 1980s. Since then, loss rates slowed down for most of the species and fastgrowing species recovered in some locations, making the net rate of change in seagrass area experience a reversal in the 2000s, while density metrics improved or remained stable in most sites. Our results demonstrate that decline is not the generalised state among seagrasses nowadays in Europe, in contrast with global assessments, and that deceleration and reversal of declining trends is possible, expectingly bringing back the services they provide