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Cost-effectiveness of two models of pessary care for pelvic organ prolapse: Findings from the TOPSY randomised controlled trial.
Get PDFObjectives Pelvic organ prolapse is the descent of one or more reproductive organs from their normal position, causing associated negative symptoms. One conservative treatment option is pessary management. The aim of this study was to investigate the cost-effectiveness of pessary self-management (SM) when compared to clinic-based care (CBC). A decision-analytic model was developed to extend the economic evaluation. Methods A randomised controlled trial with health economic evaluation. The SM group received: 30-minute self-management teaching session; information leaflet; 2-week follow-up call; and a local helpline number. The CBC group received routine outpatient pessary appointments, determined by usual practice. The primary outcome for the cost-effectiveness analysis was incremental cost per QALY, 18 months post-randomisation. Uncertainty was handled using nonparametric bootstrap analysis. In addition, a simple decision analytic model was developed using the trial data to extend the analysis over a 5-year period. Results There was no significant difference in the mean number of QALYs gained between SM and CBC (1.241 vs 1.221) but mean cost was lower for SM (£578 vs £728). The incremental net benefit estimated at a willingness to pay of £20,000 per QALY gained was £564, with an 80.8% probability of cost-effectiveness. The modelling results were consistent with the trial analysis: the incremental net benefit was estimated as £4,221 and the probability of SM being cost-effective at 5 years was 69.7%. Conclusions Results suggest that pessary self-management is likely to be cost-effective. The decision analytic model suggests this result is likely to persist over longer durations.Additional author; Ranee Thaka
Experiences of Newly Qualified Nurses' Engagement with Quality Improvement in Practice: A Qualitative Follow-Up Study
Get PDFBackground: Nurse education plays an essential role in preparing future nurses to engage with quality improvement (QI) initiatives in their organisations and improve patient care. However, frontline nurses continue to report that a lack of QI knowledge hinders their abilities to engage in improvement work. In the UK, student nurses are now trained in QI within their degree to enable them to contribute to improvements once qualified. Objectives: This qualitative follow-up study investigated the sustainability of QI engagement in nurses who undertook QI training and a QI project during their degree and explored the factors influencing their engagement in QI once qualified. Methods: This paper followed the COREQ criteria to report upon 10 semi-structured interviews undertaken with registered nurses and focuses on their experiences of QI engagement post-registration. The data were investigated using an inductive thematic analysis and Nvivo 14. Findings: Five themes emerged: transition to a newly qualified nurse, QI knowledge decline, influencing factors (hierarchy, leadership, COVID-19 pandemic, data access and location), and skill transferability. Conclusions: This study showed that qualified nurses can sustain their QI knowledge and remain engaged with QI where they experience positive QI leadership and were exposed to ongoing QI activity in their preceptorship year. However, a lack of QI opportunities and a culture which does not consider QI a responsibility of new nurses is seen to hinder engagement. Educational institutions and practice partners require careful collaboration to assess and develop ongoing QI learning activities that support new nurses to engage in QI
No future growth enhancement expected at the northern edge for European beech due to continued water limitation
Get PDFWith ongoing global warming, increasing water deficits promote physiological stress on forest ecosystems with negative impacts on tree growth, vitality, and survival. How individual tree species will react to increased drought stress is therefore a key research question to address for carbon accounting and the development of climate change mitigation strategies. Recent tree-ring studies have shown that trees at higher latitudes will benefit from warmer temperatures, yet this is likely highly species-dependent and less well-known for more temperate tree species. Using a unique pan-European tree-ring network of 26,430 European beech (Fagus sylvatica L.) trees from 2,118 sites, we applied a linear mixed-effects modeling framework to i) explain variation in climate-dependent growth and ii) project growth for the near future (2021-2050) across the entire distribution of beech. We modeled the spatial pattern of radial growth responses to annually varying climate as a function of mean climate conditions (mean annual temperature, mean annual climatic water balance, continentality). Over the calibration period (1952-2011) the model yielded high regional explanatory power (R2 = 0.38-0.72). Considering a moderate climate-change scenario (CMIP6 SSP2-4.5), beech growth is projected to decrease in the future across most of its distribution range. In particular, projected growth decreases by 12-18% (interquartile range) in northwestern Central Europe and by 11-21% in the Mediterranean region. In contrast, climate-driven growth increases are limited to around 13% of the current occurrence, where historical mean annual temperature was below ~6°C. More specifically, the model predicts a 3-24% growth increase in the high-elevation clusters of the Alps and Carpathian Arc. Notably, we find little potential for future growth increases (-10 to +2%) at the poleward leading edge in southern Scandinavia. Because in this region beech growth is found to be primarily water-limited, a northward shift in its distributional range will be constrained by water availability.Additional authors: Ana-Maria Cretan, Katarina Čufar, Martin de Luis, Isabel Dorado-Liñán, Choimaa Dulamsuren, Josep Maria Espelta, Balazs Garamszegi, Michael Grabner, Jozica Gricar, Andrew Hacket-Pain, Jon Kehlet Hansen, Claudia Hartl, Andrea Hevia, Martina Hobi, Pavel Janda, Jakub Kašpar, Marko Kazimirović, Srdjan Keren, Juergen Kreyling, Alexander Land, Nicolas Latte, François Lebourgeois, Christoph Leuschner, Mathieu Lévesque, Luis A. Longares, Edurne Martinez del Castillo, Annette Menzel, Maks Merela, Martin Mikoláš, Renzo Motta, Lena Muffler, Anna Neycken, Paola Nola, Momchil Panayotov, Any Mary Petritan, Ion Catalin Petritan, Ionel Popa, Peter Prislan, Tom Levanič, Catalin-Constantin Roibu, Álvaro Rubio-Cuadrado, Raúl Sánchez-Salguero, Pavel Šamonil, Branko Stajić, Miroslav Svoboda, Roberto Tognetti, Elvin Toromani, Volodymyr Trotsiuk, Ernst van der Maaten, Marieke van der Maaten-Theunissen, Astrid Vannoppen, Ivana Vašíčková, Georg von Arx, Martin Wilmking, Robert Weigel, Tzvetan Zlatanov, Christian Zang, Allan Bura
Understanding the intersectional stigma of ageing, disability, and place: a systematic literature mapping review
Get PDFStigma is a key concept for social scientists interested in how certain groups in society are judged and treated negatively. Within housing studies this scholarship reflects longstanding interests within the discipline regarding the spatial impacts of social and urban policies on both people, and the places in which they live. We augment these debates by advocating for a more intersectional understanding of how stigma is shaped by identity. It presents findings from a systematic literature mapping review of research that has a combined focus on ageing, disability, place, and stigma across OECD countries. Given global trends around ageing populations and the impacts for health, this is an important, but often neglected aspect to stigma research. Our review highlights the advantages of combining a spatial approach to stigma with intersectional insights foregrounded in age and disability. This includes the further development of stigma as a concept from the perspective of under-represented groups: older and disabled people.Full version of paper available open access (gold route
Parents’ Perception of Risk in Play: Associations with Parent and Child Gender
Get PDFAllowing children the opportunity to take risks in their play may provide learning experiences that benefit children’s health and well-being. Parents’ perception of risk in children’s play may affect their behaviour and, in turn, their child’s risk-taking opportunities. This paper examines whether parent and child gender are associated with parents’ perceptions of risk in children’s play and whether any gender differences hold after controlling for parent anxiety. Data were collected from 88 parent dyads who were parents to preschool-aged children in England. Parent gender differences were found, with mothers perceiving greater risk in children’s risky play activities than fathers. Child gender was not significantly related to parents’ perception of risk. These findings are important for informing the development of programmes and advice designed to encourage parents to support their children’s outdoor, risky play. Specifically, they indicate that, for mothers in particular, support around perceiving risk and risk-reframing might help parents to give their child the opportunity to play in this way
Vegetable omega-3 and omega-6 fatty acids differentially modulate the antiviral and antibacterial immune responses of Atlantic salmon
Get PDFThe immunomodulatory effects of omega-3 and omega-6 fatty acids are a crucial subject of investigation for sustainable fish aquaculture, as fish oil is increasingly replaced by terrestrial vegetable oils in aquafeeds. Unlike previous research focusing on fish oil replacement with vegetable alternatives, our study explored how the omega-6 to omega-3 polyunsaturated fatty acid (PUFA) ratio in low-fish oil aquafeeds influences Atlantic salmon's antiviral and antibacterial immune responses. Atlantic salmon were fed aquafeeds rich in soy oil (high in omega-6) or linseed oil (high in omega-3) for 12 weeks and then challenged with bacterial (formalin-killed Aeromonas salmonicida) or viral-like (polyriboinosinic polyribocytidylic acid) antigens. The head kidneys of salmon fed high dietary omega-3 levels exhibited a more anti-inflammatory fatty acid profile and a restrained induction of pro-inflammatory and neutrophil-related genes during the immune challenges. The high-omega-3 diet also promoted a higher expression of genes associated with the interferon-mediated signaling pathway, potentially enhancing antiviral immunity. This research highlights the capacity of vegetable oils with different omega-6 to omega-3 PUFA ratios to modulate specific components of fish immune responses, offering insights for future research on the intricate lipid nutrition-immunity interplay and the development of novel sustainable low-fish oil clinical aquaculture feeds
Sit-ins Blockades And Lock-ons: Do Protesters Commit Moral Blackmail
No full textSit-ins, blockades, and lock-ons are common protest tactics. They work partly because continuing the operation or attempting quickly to remove activists risks injuring or killing them. Injuring or killing the activists is morally wrong, so the targets of the protest must (temporarily) yield to the activists. This appears to be a case of moral blackmail: The blackmailer makes it so that the blackmailed must either do what the blackmailer wants or do something morally wrong. Here, protestors appear to exploit the targets’ tendency to be moral. Can such tactics be justified? I contend that they can insofar as such activists merely add further reason to what their targets already have decisive reason to do. The problem of moral blackmail, however, complicates the morality of primarily communicative civil disobedience
Optimising management practices to secure grassland agroecosystems' sustainability
Get PDFGlobally, the escalating and diverse pressures on natural and modified ecosystems urgently necessitate a paradigm shift in agricultural practices. In this new paradigm enhancing soil health and biodiversity is pivotal to guarantee global food security. Traditional agricultural systems, while effective historically, have shown limitations in sustaining productivity and ecological balance under contemporary societal challenges. This is especially true for grassland agroecosystems, which are vital for sustainable agriculture due to their ability to improve soil health, sequester carbon, and support biodiversity. Grassland farming, integrating grasses and legumes, offers multifaceted benefits, such as reducing soil and water erosion, providing high-quality livestock feed, enhancing soil fertility, and facilitating carbon sequestration. These advantages are critical for ensuring the productivity, sustainability, and resilience of agroecosystems, particularly in the face of climate change. This Research Topic aims to address the urgent need for optimized management practices in grassland agroecosystems to ensure sustainable agriculture and efficient resource use. The focus includes strategies like how management of grassland forage genetic diversity, grazing-density, and fertilizer application can help mitigate climate and environmental change and augment soil microbial diversity, tolerance, and soil function. This Research Topic seeks to answer critical questions on the adaptability and resilience of these systems
Expanding knowledge of institutional complexity through the hyphen-spaces opened up by participant videography
Get PDFDespite the success of videographic methods, they have not been used to expand the range of contexts where institutional complexity informs marketing theory. In applying participant videography to such a study, however, we can also better understand how both methods and researchers themselves are variously embedded in the institutional complexity being studied. We explore this through the idea of hyphen-spaces amongst researchers, between researcher and participants, and involving the technologies used in research. We show how video helps researchers to understand institutional complexity in contexts where consumption practices may be difficult for participants to reflect on and articulate. We then further explain how interpreting video data opens up hyphen-spaces in which the research team can reflect on their own institutional embeddedness and implicit political aims
Religious Tension and Ethnic Consciousness in the Later Russian Empire
Get PDFThe Russian Empire collapsed because it failed to assimilate non-Russian minorities, and did not provide a coherent national narrative to unite the Russian population. Its religious policies were key contributors to these failures, and this article examines their impact in order to shine a new light on the religious background to the empire’s demise. The Orthodox Church was supposed to provide the means to assimilate non-Russians and offer up the core cultural component for a Russian national consciousness. Its inability to do so became clear in the 1860s–1880s when, in the liminal regions of the empire, Orthodoxy fragmented along ethnic lines. Russians deserted churches for the dissenting Old Believer movement, and non-Russians returned to their ancestral faiths of animism and Islam. This was partly down to an inconsistency in government, which meant that religious repression overlapped with the principle of toleration; however, an exploration of the dynamics of apostasy at a parish level shows that where Russians and non-Russians were compelled to worship together, religious tensions emerged and churches lost their sacred character. As well as providing new insights into how the empire alienated its subjects at a local level, this exploration reveals pathways to ethnic consciousness from below. Ethnicization was the process that separated ethnicity from religion, and places of worship possessed characteristics, most importantly the performance of communal historical memory, that made them into key sites of ethnic boundary formation
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