Knee-Joint Wounds at a Casualty Clearing Station.

n/

Development of a color display capability

Color display capabilities for digital computer

What are the health and well-being impacts of community gardening for adults and children: a mixed method systematic review protocol

Background Community gardening is defined by its shared nature; gardeners work collectively to manage a garden for shared benefit. Although communal gardening activities, and recognition of their perceived benefits have a long history, it is in recent years that interest has developed in assessing the potential of the approach to address many of the threats to health and wellbeing faced by global populations. Community gardening may address chronic and non-communicable disease through the provision of opportunities for physical activity, improved nutrition and reduced stress. Participation in the gardening activities may improve wellbeing through increased social contact, culturally valued activities and mitigation of food poverty. The benefits of community gardening are argued to extend beyond the participants themselves through more coherent and cohesive communities, improved physical environments and the sharing of the products of the labour. While there are many claims made and an emerging body of research, no previous systematic review has sought to identify and synthesise the evidence in a global context. Methods The objectives of the mixed method systematic review are to understand the health and wellbeing impacts of active participation in community gardening. Both quantitative and qualitative evidence will be sought using a broad and diverse search strategy to address the four review questions: 1) does active involvement in community gardening lead to improved health or wellbeing; 2) if so, how does active involvement in community gardening affect health and wellbeing; 3) are there different impacts for different population groups (for instance according to age, socio-economic status or sex); and 4) do different types of community gardening (for example producing vegetables or a flower garden) or in different contexts have different types of impacts? A theoretical framework, informed by an initial theory of change model, will illustrate the outcomes of participation and any mechanisms of action (i.e. how such impacts are achieved). The synthesis will be sensitive to factors which may affect the impacts, such as the context of the activities, the demographics of participants, and the implementation and specifics of the community gardening interventions.European Regional Development Fund Programme 2007 to 2013Social Fund Convergence Programme for Cornwall and the Isles of Scill

Improving screening recall services for women with false-positive mammograms: a comparison of qualitative evidence with UK guidelines.

Published onlineResearch Support, Non-U.S. Gov'tOBJECTIVES: To gain an understanding of the views of women with false-positive screening mammograms of screening recall services, their ideas for service improvements and how these compare with current UK guidelines. METHODS: Inductive qualitative content analysis of semistructured interviews of 21 women who had false-positive screening mammograms. These were then compared with UK National Health Service (NHS) guidelines. RESULTS: Participants' concerns about mammography screening recall services focused on issues of communication and choice. Many of the issues raised indicated that the 1998 NHS Breast Screening Programme guidelines on improving the quality of written information sent to women who are recalled, had not been fully implemented. This included being told a clear reason for recall, who may attend with them, the length of appointment, who they will see and what tests will be carried out. Additionally women voiced a need for: reassurance that a swift appointment did not imply they had cancer; choice about invasive assessment or watchful waiting; the offer of a follow-up mammogram for those uncertain about the validity of their all-clear and an extension of the role of the clinical nurse specialist, outlined in the 2012 NHS Breast Screening Programme (NHSBSP) guidelines, to include availability at the clinic after the all-clear for women with false-positive mammograms. CONCLUSIONS: It is time the NHSBSP 1998 recall information guidelines were fully implemented. Additionally, the further suggestions from this research, including extending the role of the clinical nurses from the 2012 NHSBSP guidelines, should be considered. These actions have the potential to reduce the anxiety of being recalled.This paper presents independent research funded by the National Institute for Health Research (NIHR). This was partially through their Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula and partially through the HTA Programme

A qualitative study into the difficulties experienced by healthcare decision makers when reading a Cochrane diagnostic test accuracy review.

Published onlineResearch Support, Non-U.S. Gov'tBACKGROUND: Cochrane reviews are one of the best known and most trusted sources of evidence-based information in health care. While steps have been taken to make Cochrane intervention reviews accessible to a diverse readership, little is known about the accessibility of the newcomer to the Cochrane library: diagnostic test accuracy reviews (DTARs). The current qualitative study explored how healthcare decision makers, who varied in their knowledge and experience with test accuracy research and systematic reviews, read and made sense of DTARs. METHODS: A purposive sample of clinicians, researchers and policy makers (n = 21) took part in a series of think-aloud interviews, using as interview material the first three DTARs published in the Cochrane library. Thematic qualitative analysis of the transcripts was carried out to identify patterns in participants' 'reading' and interpretation of the reviews and the difficulties they encountered. RESULTS: Participants unfamiliar with the design and methodology of DTARs found the reviews largely inaccessible and experienced a range of difficulties stemming mainly from the mismatch between background knowledge and level of explanation provided in the text. Experience with systematic reviews of interventions did not guarantee better understanding and, in some cases, led to confusion and misinterpretation. These difficulties were further exacerbated by poor layout and presentation, which affected even those with relatively good knowledge of DTARs and had a negative impact not only on their understanding of the reviews but also on their motivation to engage with the text. Comparison between the readings of the three reviews showed that more accessible presentation, such as presenting the results as natural frequencies, significantly increased participants' understanding. CONCLUSIONS: The study demonstrates that authors and editors should pay more attention to the presentation as well as the content of Cochrane DTARs, especially if the reports are aimed at readers with various levels of background knowledge and experience. It also raises the question as to the anticipated target audience of the reports and suggests that different groups of healthcare decision-makers may require different modes of presentation.RG is partially supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula and by the European Regional Development Fund and the European Social Fund Convergence Program for Cornwall and the Isles of Scilly. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health in England, or the European Union

Phytoplankton growth at the shelf-break front in the Middle Atlantic Bight

The summertime front near the shelf break in the Middle Atlantic Bight is both thermohaline and baroclinic. Near the surface, large gradients of temperature (T) and salinity (S) exist with little cross-frontal variation in density. At depths \u3e50 m, an isopycnal boundary separates Slope Water from colder, fresher shelf water. Higher concentrations of chlorophyll are found in the upper part of the front, between water types of shelf and Slope Water origin. Calculations show also that the front is a region of enhanced phytoplankton growth. It is proposed that the relative fertility of the front is the result of large-scale deformations of the T/S boundary between shelf and Slope Water. The entrainment of deep shelf water along the shallowing, seaward-sloping, isopycnals in the deeper part of the front by these large-scale perturbations bring turbid, nutrient-rich water into clearer water that is also nutrient poor. The combination of this nutrient enrichment and a well-lighted water column makes the front more productive than elsewhere

How do older people describe their sensory experiences of the natural world? a systematic review of the qualitative evidence

This is the final version of the article. Available from the publisher via the DOI in this record.BACKGROUND: Despite the increased scholarly interest in the senses and sensory experiences, the topic of older people's sensory engagement with nature is currently under researched. This paper reviews and synthesises qualitative research evidence about how older people, including those living with dementia, describe their sensory engagement with the natural world. METHODS: Ten databases were searched from 1990 to September 2014: MEDLINE (Ovid), MEDLINE-in-Process (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), GreenFILE (EBSCO), ProQuest Sociology, ASSIA (ProQuest), International Bibliography of the Social Sciences (ProQuest); HMIC (Ovid); Social Policy and Practice (Ovid). Forward and backward citation chasing of included articles was conducted; 20 organizations were contacted to identify unpublished reports. Screening was undertaken independently by two reviewers. RESULTS: Twenty seven studies were included. Thematic analysis revealed that descriptions of sensory experiences are encompassed within six themes: descriptions from 'the window'; sensory descriptions that emphasise vision; descriptions of 'being in nature'; descriptions of 'doing in nature'; barriers to sensory engagement; and meanings of being and doing in nature. CONCLUSIONS: Older people derive considerable pleasure and enjoyment from viewing nature, being and doing in nature which, in turn has a positive impact on their wellbeing and quality of life. Future research could usefully explore how sensory engagement with nature could be used to stimulate reminiscences of places and people, and evoke past sensory experiences to enrich everyday life and maintain a sense of self. The protocol was registered with PROSPERO ( CRD42015020736 ).The research for this systematic review was supported by the European Centre for Environment and Human Health which is in part financed by the European Regional Development Fund Programme 2007 to 2013 and European Social Fund Convergence for Cornwall and Isles of Scilly. RG is partially supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula

Understanding the challenge of weight loss maintenance: A systematic review and synthesis of qualitative research on weight loss maintenance

This is the author accepted manuscript. The final version is available from Taylor & Francis via the DOI in this record.Behaviour change interventions can be effective in helping people to lose weight, but weight is often regained. Effective interventions are required to prevent this. We conducted a systematic review and synthesis of qualitative research on people's experiences of weight loss maintenance. We searched bibliographic databases for qualitative studies about the experience of currently or previously overweight adults trying to maintain weight loss. We thematically synthesised study findings to develop a model of weight loss maintenance. Twenty six studies from five countries with 710 participants were included. The model developed through our synthesis proposes that making the behaviour changes required for weight loss maintenance generates psychological "tension" due to the need to override existing habits, and incompatibility of the new behaviours with the fulfilment of psychological needs. Successful maintenance involves management or resolution of this tension. Management of tension can be achieved through self-regulation, renewing of motivation and managing external influences, although this can require constant effort. Resolution may be achieved through changing habits, finding non obesogenic methods for addressing needs, and potentially through change in self-concept. Implications for the development of weight loss maintenance interventions are explored.This report is independent research supported by the UK’s National Institute for Health Research (Career Development Fellowship CDF-2012-05-259) and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care of the South West Peninsula (PenCLAHRC). Dr R Garside’s time is partly financed by the European Regional Development Fund Programme and European Social Fund Convergence Programme for Cornwall and the Isles of Scilly. The views expressed are those of the authors and not necessarily those of EU, NIHR or the UK Department of Health

A qualitative synthesis of diabetes self-management strategies for long term medical outcomes and quality of life in the UK

Open access article available from the publisher via doi: 10.1186/1472-6963-14-348BACKGROUND: Qualitative research on self-management for people with Type 2 Diabetes Mellitus (T2DM) has typically reported one-off retrospective accounts of individuals' strategies. The aim of this research was to identify the ways in which self-management strategies are perceived by people with T2DM as being either supportive or unsupportive over time, by using qualitative findings from both longitudinal intervention studies and usual care. METHODS: A systematic review of qualitative literature, published between 2000 and 2013, was conducted using a range of searching techniques. 1374 prospective qualitative papers describing patients' experiences of self-management strategies for T2DM were identified and screened. Of the 98 papers describing qualitative research conducted in the UK, we identified 4 longitudinal studies (3 intervention studies, 1 study of usual care). Key concepts and themes were extracted, reviewed and synthesised using meta-ethnography techniques. RESULTS: Aspects of self-management strategies in clinical trials (e.g. supported exercise regimens) can be perceived as enabling the control of biomarkers and facilitative of quality of life. In contrast, aspects of self-management strategies outwith trial conditions (e.g. self-monitoring) can be perceived of as negative influences on quality of life. For self-management strategies to be sustainable in the long term, patients require a sense of having a stake in their management that is appropriate for their beliefs and perceptions, timely information and support, and an overall sense of empowerment in managing their diabetes in relation to other aspects of their life. This enables participants to develop flexible diabetes management strategies that facilitate quality of life and long term medical outcomes. CONCLUSIONS: This synthesis has explored how patients give meaning to the experiences of interventions for T2DM and subsequent attempts to balance biomarkers with quality of life in the long term. People with T2DM both construct and draw upon causal accounts as a resource, and a means to counter their inability to balance medical outcomes and quality of life. These accounts can be mediated by the provision of timely and tailored information and support over time, which can allow people to develop a flexible regimen that can facilitate both quality of life and medical outcomes.National Institute for Health Research (NIHR

A systematic review of the health and well-being impacts of school gardening: synthesis of quantitative and qualitative evidence

Background: School gardening programmes are increasingly popular, with suggested benefits including healthier eating and increased physical activity. Our objectives were to understand the health and well-being impacts of school gardens and the factors that help or hinder their success. Methods: We conducted a systematic review of quantitative and qualitative evidence (PROSPERO CRD42014007181). We searched multiple databases and used a range of supplementary approaches. Studies about school gardens were included if they reported on physical or mental health or well-being. Quantitative studies had to include a comparison group. Studies were quality appraised using appropriate tools. Findings were narratively synthesised and the qualitative evidence used to produce a conceptual framework to illustrate how benefits might be accrued. Results: Evidence from 40 articles (21 quantitative studies; 16 qualitative studies; 3 mixed methods studies) was included. Generally the quantitative research was poor. Evidence for changes in fruit and vegetable intake was limited and based on self-report. The qualitative research was better quality and ascribed a range of health and well-being impacts to school gardens, with some idealistic expectations for their impact in the long term. Groups of pupils who do not excel in classroom activities were thought to particularly benefit. Lack of funding and over reliance on volunteers were thought to threaten success, while involvement with local communities and integration of gardening activities into the school curriculum were thought to support success. Conclusion: More robust quantitative research is needed to convincingly support the qualitative evidence suggesting wide ranging benefits from school gardens