Exploring the compassion deficit debate

Several recent high profile failures in the UK health care system have promoted strong debate on compassion and care in nursing. A number of papers articulating a range of positions within this debate have been published in this journal over the past two and a half years. These articulate a diverse range of theoretical perspectives and have been drawn together here in an attempt to bring some coherence to the debate and provide an overview of the key arguments and positions taken by those involved. In doing this we invite the reader to consider their own position in relation to the issues raised and to consider the impact of this for their own practice. Finally the paper offers some sense of how individual practitioners might use their understanding of the debates to ensure delivery of good nursing care

Migration timing and overwintering habitat of anadromous Arctic Char (Salvelinus alpinus) near Kugluktuk, Nunavut

Arctic Char (Salvelinus alpinus) is a key component of subsistence diets in Inuit communities across the Arctic. The Hamlet of Kugluktuk, in the Kitikmeot region of Nunavut, relies on the Coppermine River to support an important fishery of anadromous (i.e., sea-run) Arctic Char, which feed in the ocean in summer and return to freshwater in fall to spawn and overwinter. Arctic Char is a highly plastic species, and while the exhibited diversity of life history strategies and migration patterns likely contributes to their persistence across a challenging landscape, it also necessitates population level information to identify stressors and effectively manage subsistence fisheries. The migration patterns of Arctic Char using the Coppermine River and surrounding area are poorly understood, and overwintering movements and habitat use in fluvial environments in general are largely unknown for Arctic Char. To address these knowledge gaps, acoustic transmitting tags were surgically implanted in 164 healthy adult Arctic Char captured in the Coppermine River and Coronation Gulf in 2018 and 2019. An array of forty-seven acoustic receivers was deployed in freshwater and marine environments during the 2018 and 2019 ice-free seasons, with a subset left to detect 2018 winter movements in the Coppermine River. Consistent with local knowledge, telemetry data indicate that some Arctic Char do not overwinter in typical (i.e., lacustrine) habitats, and instead overwinter in the Coppermine River below Kugluk Falls (a substantial migration obstacle). Overwintering in fluvial environments is likely energetically costly and hazardous in a dynamic system such as the Coppermine River, which experiences substantial surface ice accumulation, slush, anchor ice, and hanging dams. Within the lower reaches of the Coppermine River, net downstream movement in winter was observed for ten (37%) individuals and five individuals were observed to enter the marine environment prior to river break-up in the spring. Under-ice movement into the marine environment has not been previously documented for Arctic Char, and this behavior suggests that the fitness benefit gained through early spring migration to rich ocean feeding grounds may outweigh the risks associated with fluvial overwintering. Following summer marine feeding, adult anadromous Arctic Char that migrated above Kugluk Falls entered freshwater earlier than those overwintering below Kugluk Falls, indicating that the length and difficulty of the migratory pathway affect fall migration timing. Particularly for those individuals overwintering below Kugluk Falls, smaller individuals entered freshwater later than larger individuals, likely due to the potential for proportionately greater gains in body condition for smaller individuals in the marine environment. This descriptive study helps further understanding of the variation in migration patterns and life history tactics employed by Arctic Char in the region. The high inter-individual and inter annual variability that was observed in migration destination and timing provide a basis for future research on drivers of these patterns, such as spawning status, environmental cues, and population dynamics. Results will help in the management of local fisheries and in ensuring the future sustainability of this important food source

Apo-Ghrelin Receptor Forms Heteromers with DRD2 in Hypothalamic Neurons and Is Essential for Anorexigenic Effects of DRD2 Agonism

SummaryWe identified subsets of neurons in the brain that coexpress the dopamine receptor subtype-2 (DRD2) and the ghrelin receptor (GHSR1a). Combination of FRET confocal microscopy and Tr-FRET established the presence of GHSR1a:DRD2 heteromers in hypothalamic neurons. To interrogate function, mice were treated with the selective DRD2 agonist cabergoline, which produced anorexia in wild-type and ghrelin−/− mice; intriguingly, ghsr−/− mice were refractory illustrating dependence on GHSR1a, but not ghrelin. Elucidation of mechanism showed that formation of GHSR1a:DRD2 heteromers allosterically modifies canonical DRD2 dopamine signaling resulting in Gβγ subunit-dependent mobilization of [Ca2+]i independent of GHSR1a basal activity. By targeting the interaction between GHSR1a and DRD2 in wild-type mice with a highly selective GHSR1a antagonist (JMV2959) cabergoline-induced anorexia was blocked. Inhibiting dopamine signaling in subsets of neurons with a GHSR1a antagonist has profound therapeutic implications by providing enhanced selectivity because neurons expressing DRD2 alone would be unaffected

Barriers and facilitators to physical activity promotion in eyecare: A qualitative study of eyecare professionals’ perceptions

Aim The aim of this study is to explore the barriers and facilitators to implementing physical activity promotion into eyecare services, from the perspective of eyecare professionals. Subject and methods Eleven eyecare professionals were recruited for qualitative interviews. Thematic analysis was used to identify key themes within the interview data. Results Five themes which represented barriers to physical activity promotion were identified in the interviews: lack of time available to discuss physical activity, health and safety concerns, fear of creating a negative experience for the patient, lack of knowledge, and resistance from patients. Facilitators to physical activity promotion identified in the interviews were categorised into two themes: easy access to information about physical activity, and organisational change. Conclusion To enable physical activity promotion in eyecare, individual and organisational change is required. Organisational change includes providing time and resources to enable physical activity promotion in eyecare. Individual change can be facilitated by providing training, which enables eyecare professionals to be confident providing physical activity advice

Risk assessment to interpret the physiological host range of Hydrellia egeriae, a biocontrol agent for Egeria densa

Egeria densa Planchon (Hydrocharitaceae) is a submerged macrophyte native to South America. It forms part of a new suite of invasive aquatic plants that has benefited from open nutrient-rich freshwater systems following the successful biological control of floating aquatic plants in South Africa. The specificity of the leaf-mining fly, Hydrellia egeriae Rodrigues (Diptera: Ephydridae) was tested, using traditional laboratory host-specificity testing (i.e., no-choice and paired choice). Only one non-target species, Lagarosiphon major Deeming (Hydrocharitaceae) supported larval development during pair-choice tests. In order to avoid the rejection of a safe and potentially effective agent, continuation (i.e., multiple generations) tests were conducted to measure the ability of the non-target species to nutritionally support a population indefinitely. None of these species could sustain a viable agent population for more than three generations. Laboratory host-specificity tests are limited as they exempt certain insect-host behaviours. To enhance the interpretation of host-specificity results, a risk assessment was conducted using agent preference (i.e., choice tests) and performance (i.e., choice and continuation tests) results. The feeding and reproductive risk that H. egeriae poses to non-target species is below 2%. Based on these findings, permission for its release in South Africa has been obtained

Assessing and predicting adolescent and early adulthood common mental disorders using electronic primary care data:analysis of a prospective cohort study (ALSPAC) in Southwest England

OBJECTIVES: We aimed to examine agreement between common mental disorders (CMDs) from primary care records and repeated CMD questionnaire data from ALSPAC (the Avon Longitudinal Study of Parents and Children) over adolescence and young adulthood, explore factors affecting CMD identification in primary care records, and construct models predicting ALSPAC-derived CMDs using only primary care data. DESIGN AND SETTING: Prospective cohort study (ALSPAC) in Southwest England with linkage to electronic primary care records. PARTICIPANTS: Primary care records were extracted for 11 807 participants (80% of 14 731 eligible). Between 31% (3633; age 15/16) and 11% (1298; age 21/22) of participants had both primary care and ALSPAC CMD data. OUTCOME MEASURES: ALSPAC outcome measures were diagnoses of suspected depression and/or CMDs. Primary care outcome measure were Read codes for diagnosis, symptoms and treatment of depression/CMDs. For each time point, sensitivities and specificities for primary care CMD diagnoses were calculated for predicting ALSPAC-derived measures of CMDs, and the factors associated with identification of primary care-based CMDs in those with suspected ALSPAC-derived CMDs explored. Lasso (least absolute selection and shrinkage operator) models were used at each time point to predict ALSPAC-derived CMDs using only primary care data, with internal validation by randomly splitting data into 60% training and 40% validation samples. RESULTS: Sensitivities for primary care diagnoses were low for CMDs (range: 3.5%–19.1%) and depression (range: 1.6%–34.0%), while specificities were high (nearly all >95%). The strongest predictors of identification in the primary care data for those with ALSPAC-derived CMDs were symptom severity indices. The lasso models had relatively low prediction rates, especially in the validation sample (deviance ratio range: −1.3 to 12.6%), but improved with age. CONCLUSIONS: Primary care data underestimate CMDs compared to population-based studies. Improving general practitioner identification, and using free-text or secondary care data, is needed to improve the accuracy of models using clinical data

Longevity and neutralisation activity of secretory IgA following SARS-CoV-2 infection

The mucosal barrier is a primary defence against inhaled pathogens, comprising secretory antibodies which have the potential to block viral entry and neutralise infection. There is an ongoing need for greater understanding of the mucosal immunity to SARS-CoV-2 infection. In this study, we investigated mucosal IgA through non-invasive saliva sampling of healthcare workers. A total of 551 saliva samples were collected from staff at Great Ormond Street Children’s Hospital who previously tested positive for COVID-19. Participant metadata included age, gender, ethnicity and symptoms. IgA titres were measured by ELISA against viral antigens spike protein, nucleocapsid protein, and spike receptor-binding domain. SARS-CoV-2 neutralisation was measured using a VERO E6 cell culture infection assay. We found that approximately 30% of saliva samples contained detectable IgA specific for at least one of the SARS-CoV-2 antigens. IgA levels in saliva decreased with the time post-infection, and were largely undetectable after six months. IgA titres specific to SARS-CoV-2 were lowest in participants over 60 years old. Specific saliva samples were identified which effectively neutralised SARS-CoV-2 virus infection of epithelial cells. Our results suggest secretory IgA specific to SARS-CoV-2 can be detected in saliva following infection, an accessible sample type for testing, although titres decreased over time. Some saliva samples were able to neutralise SARS-CoV-2 infectivity against cultured epithelial cells. This data could be used to assess the risk of re-infection with SARS-CoV-2, as well as accelerate efforts to develop effective mucosal vaccination with longer lasting protection