Time for a Nappy Change: beliefs and attitudes towards modern cloth nappies.

The United Nations Environment Programme highlights how the use of disposable nappies has become unsustainable, yet the practice of using modern cloth nappies (MCN) is niche. This study uses mixed methods of survey, story completion and focus group methods to explore how behaviour beliefs and attitudes to behaviour contribute to families’ decision making regarding the nappy system they use for their children. 1588 responded to the survey; 38 completed story completion activity; 24 participated in groups. This study finds that beliefs about the performance as a nappy, environmental credentials, financial considerations, laundry, effort, and hygiene differ according to the level of personal experience of using MCN. While beliefs about the environmentalcredentials of MCN create powerful drivers for the intention to use MCN, other beliefs about the upfront costs, laundry and effort contribute a negative attitude to MCN overall if their support network of other MCN users is not established. Current MCN users found using cloth nappy retailer websites, nappy libraries, and social media groups, including pre-loved and-sell groups, to be beneficial in improving attitude to MCN. This study concludes that interventions that simultaneously reduce or remove perceived barriers such as upfront costs, financial risks and too much effort, paired with campaigns which increase the likelihood of finding support, are more likely, than individual interventions, to be effective in increasing the number of families using MCN.Further study is needed to investigate the potential of interventions which reduce the financial risks such as, easy to access hire kits, spread the cost of MCN and pre-natal and newborn public services such as midwives and health visitors being well informed and encouraging of the use of MCN.<br/

Time for a Nappy Change: controls affecting families’ nappy choices

Lifecycle assessments suggest that modern cloth nappies have fewer environmental impacts than their disposablecounterparts in terms of GHG, plastic and landfill (UNEP 2021). However, despite these apparent environmentalbenefits consumers still use predominantly disposable nappies. This paper will use theories of plannedbehaviour to explore the differences in perceived and actual behaviours between disposable and cloth nappyusers. A self-selecting web-based survey was used to recruit participants with children up to the age of fiveand explore their decision-making in this regard. The findings of the survey reveal that disposable nappy usersare more likely to prioritise convenience and to cite additional laundry loads as the main reasons for not usingcloth nappies. This is despite tending to have the necessary infrastructure (such as disposable income, spaceand washing facilities) to enable them to do so. This indicates that the perceptions of home-laundered clothnappies as inconvenient makes families more likely to opt for disposable nappies. Whilst cloth nappies weregenerally assumed to be more environmentally friendly and aesthetically pleasing by all parents irrespectiveof their choices, this was not enough to overcome the convenience and ease of use for the majority of participants.This study concludes that many disposable nappy users select disposable nappies with the assumptionthat they are easier and more convenient when this may not be the case. The implication of this study is thatinterventions which improve the convenience of cloth nappies and the perception of ease of use will encouragegreater uptake of cloth nappies.References.UNEP. (2021) Recommendations from Life Cycle Assessments Single-use nappies and their alternatives hostedby. United Nations Environment Programme

The clinically extremely vulnerable to COVID: identification and changes in healthcare while self-isolating (shielding) during the coronavirus pandemic.

In March 2020, the government of Scotland identified people deemed clinically extremely vulnerable to COVID due to their pre-existing health conditions. These people were advised to strictly self-isolate (shield) at the start of the pandemic, except for necessary healthcare. We examined who was identified as clinically extremely vulnerable, how their healthcare changed during isolation, and whether this process exacerbated healthcare inequalities. We linked those on the shielding register in NHS Grampian, a health authority in Scotland, to healthcare records from 2015-2020. We described the source of identification, demographics, and clinical history of the cohort. We measured changes in out-patient, in-patient, and emergency healthcare during isolation in the shielding population and compared to the general non-shielding population. The register included 16,092 people (3% of the population), clinically vulnerable primarily due to a respiratory disease, immunosuppression, or cancer. Among them, 42% were not identified by national healthcare record screening but added ad hoc, with these additions including more children and fewer economically-deprived. During isolation, all forms of healthcare use decreased (25%-46%), with larger decreases in scheduled care than in emergency care. However, people shielding had better maintained scheduled care compared to the non-shielding general population: out-patient visits decreased 35% vs 49%; in-patient visits decreased 46% vs 81%. Notably, there was substantial variation in whose scheduled care was maintained during isolation: younger people and those with cancer had significantly higher visit rates, but there was no difference between sexes or socioeconomic levels. Healthcare changed dramatically for the clinically extremely vulnerable population during the pandemic. The increased reliance on emergency care while isolating indicates that continuity of care for existing conditions was not optimal. However, compared to the general population, there was success in maintaining scheduled care, particularly in young people and those with cancer. We suggest that integrating demographic and primary care data would improve identification of the clinically vulnerable and could aid prioritising their care

The clinically extremely vulnerable to COVID : Identification and changes in healthcare while self-isolating (shielding) during the coronavirus pandemic

Peer reviewe

The clinically extremely vulnerable to COVID: Identification and changes in healthcare while self-isolating (shielding) during the coronavirus pandemic.

Objective In March 2020, Scottish government identified people clinically extremely vulnerable to COVID due to pre-existing health conditions. These people were advised to strictly self-isolate (shield) at home. We examined who was identified as clinically extremely vulnerable, how their healthcare changed during isolation, and whether this process exacerbated healthcare inequalities. Approach We linked all individuals on the shielding register in NHS Grampian to their in-patient and out-patient healthcare records from 2015 through 2020. We analysed the method of patients’ identification as clinically extremely vulnerable (via an algorithmic NHS record scan or designated ad hoc by their care-providers). We measured out-patient, in-patient, and emergency healthcare attendances, and compared use rates between two 3-month periods before and during the first strict isolation period. We evaluated changes in care use between those shielding and the general non-shielding population, and differences between shielding sub-populations (by clinical reason for shielding, age, sex, and socio-economic deprivation). Results The shielding register included 16,092 people (3% of the population). 42% of people on the register were not identified by national healthcare record screening, including the majority of cancer and immunocompromised patients. People added to the register by their care-providers were more likely to be young and less economically-deprived. Shielders’ healthcare use decreased during isolation (rate compared to pre-isolation: 0.65 out-patient, 0.54 scheduled in-patient; 0.75 emergency in-patient; 0.71 A&E). However, people shielding had better maintained care than the non-shielding population (e.g. RR 2.9 for scheduled in-patient care). There were inequalities in whose scheduled care was maintained while shielding: younger people and those with cancer had significantly higher visit rates. However, there were no differences in care-preservation between men and women or between socioeconomic deprivation levels. Conclusions The reliance on emergency care while shielding indicates that, overall, continuity of care for existing conditions was not optimal. However, there was notable success in maintaining care for cancer. We suggest that integrating demographic and primary care data would improve identification of the clinically vulnerable and help equitably prioritise care

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Restoring a Sense of Wellness Following Colorectal Cancer: a Grounded Theory.

Aim: This study aimed to develop a grounded theory to explain the experience of recovery following surgery for colorectal cancer. Background: Studies have adopted a biomedical framework to measure quality of life and symptom distress scores following surgery for colorectal cancer. These studies suggest physical symptoms of pain, insomnia and fatigue may persist for many months following treatment. Fewer studies have considered the individual's experiences and perspectives of the emotional, social and cultural aspects of recovery. Methods: A longitudinal study using grounded theory was conducted with 12 individuals, who had received surgery for colorectal cancer. Semi-structured interviews were conducted at 4 time points over one year following surgery, between 2007 and 2009. Grounded theory analysis was undertaken using Strauss and Corbin's framework. Findings: Recovery is described in three phases: disrupting the self; repairing the self; restoring the self. The core category is Restoring a sense of wellness; fostered through awareness and enjoyment of the physical, emotional, spiritual and social aspects of life. A sense of wellness exists as a duality with a sense of illness, where both perspectives may co-exist but one usually taking precedence. A sense of illness pervades when the individual is preoccupied with illness and the illness continues to disrupt their daily life. Conclusion: Recovery takes time and energy, particularly when the individual is at home and in relative isolation from health professionals. Opportunities exist for nurses to provide information and support to facilitate the individual in their progress towards achieving a sense of wellness

Restoring a Sense of Wellness Following Colorectal Cancer: a Grounded Theory.

Aim: This study aimed to develop a grounded theory to explain the experience of recovery following surgery for colorectal cancer. Background: Studies have adopted a biomedical framework to measure quality of life and symptom distress scores following surgery for colorectal cancer. These studies suggest physical symptoms of pain, insomnia and fatigue may persist for many months following treatment. Fewer studies have considered the individual's experiences and perspectives of the emotional, social and cultural aspects of recovery. Methods: A longitudinal study using grounded theory was conducted with 12 individuals, who had received surgery for colorectal cancer. Semi-structured interviews were conducted at 4 time points over one year following surgery, between 2007 and 2009. Grounded theory analysis was undertaken using Strauss and Corbin's framework. Findings: Recovery is described in three phases: disrupting the self; repairing the self; restoring the self. The core category is Restoring a sense of wellness; fostered through awareness and enjoyment of the physical, emotional, spiritual and social aspects of life. A sense of wellness exists as a duality with a sense of illness, where both perspectives may co-exist but one usually taking precedence. A sense of illness pervades when the individual is preoccupied with illness and the illness continues to disrupt their daily life. Conclusion: Recovery takes time and energy, particularly when the individual is at home and in relative isolation from health professionals. Opportunities exist for nurses to provide information and support to facilitate the individual in their progress towards achieving a sense of wellness

Applying the Violent Extremist Risk Assessment (VERA) to a sample of terrorist case studies

PurposeThis paper seeks to evaluate the usefulness of the violent extremist risk assessment (VERA) by assessing how easily the criteria can be applied to case studies of five terrorists, and to determine whether it is more applicable to terrorists who work alone or as part of a group.Design/methodology/approachCase studies of five terrorists were constructed through online research. Evidence of each factor outlined in the VERA was rated and a total score for each category was calculated.FindingsThe majority of factors were easy to apply and were equally applicable to individuals within the sample regardless of whether they worked alone or as part of a group. The results tend to support theory and research about characteristics of violent extremists. This suggests that the factors are relevant and, therefore, that the VERA is a useful risk assessment guide.Research limitations/implicationsAs the research is based on case studies, the findings may not generalise beyond the sample selected. In addition, some sources used to construct the case studies may be less reliable. Future research should include larger, more varied and more recent samples.Practical implicationsIf future research confirms the present findings, the VERA may help to identify terrorists at risk of committing future offences. The factors may be incorporated into intervention strategies to prevent such offences.Originality/valueCurrently, the VERA is mainly for consultation purposes. This study applies it to real individuals, as it could be of great use in the risk assessment of terrorists.</jats:sec