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Single-use versus multiple-use endotracheal suction catheters flushed with chlorhexidine in mechanically ventilated ICU patients: A study protocol of a feasibility randomized controlled trial with an embedded qualitative study
Get PDFBackground: Endotracheal suction catheters are often used multiple times during endotracheal suctioning procedures in resource-limited intensive care units (ICU). The impact of this practice on mechanically ventilated patients\u27 outcomes remains unclear. Aim: The aim of this feasibility randomized controlled trial (fRCT) is to assess the feasibility and acceptability of single-use versus multiple-use endotracheal suction catheters flushed with chlorhexidine in mechanically ventilated ICU patients. Study Design: This study is a three-armed fRCT with an embedded qualitative study. Results: The trial involves three groups. One group includes endotracheal suctioning using a single-use catheter; the second group includes a multiple-use endotracheal suction catheter flushed with chlorhexidine and the control group includes a multiple-use endotracheal suction catheter flushed with normal saline. Sixty adult ICU patients (20 in each group) will be recruited, along with 12–16 ICU nurses delivering the interventions, and 12–16 patients\u27 next-of-kin for semi-structured interviews. The study protocol has been approved by two ethics committees. Study recruitment will be conducted over an 8-month period with an expected start date of 12 April 2024. Conclusion: The feasibility outcome measures will be recruitment, retention, and follow-up measures as well as the identification of clinical outcomes such as Ventilator-Associated Pneumonia (VAP) using the modified clinical pulmonary infection score, and ICU length-of-stay. Relevance to Clinical Practice: This study will help ICU nurses to understand how different methods of endotracheal suctioning affects patients in ICUs with limited resources. The findings could influence clinical practice and improve patient outcomes
Work-based learning and an investigation into racial hostility, an autoethnographic study
Get PDFThe purpose of this research enquiry was to explore autoethnography as a useful and valid form of sociological research. To gain an understanding of its complex ethical considerations that differ from other methodologies and create an autoethnographical focus on experiences within a work based learning environment. This enquiry explores the thoughts, emotions and reactions provoked by a critical incident relating to racial hostility that stemmed from reactions to the days top news story. Investigating racism from biological and cultural aspects and examining critical race theory creates a perspective on how racist events can occur, develop and be maintained or reproduced. Combined with an investigation into embodied knowledge it was possible to recognise racism as being deeply embedded within society. Further reflection of my actions towards combatting racism on a personal level led to a realisation that I may be contributing to perpetuating racial stereotypes rather than challenging them. This pivotal moment of transformation, while being uncomfortable, was also enlightening and confirmed the validity of autoethnography as a method of research
How confident are final year students with the speech and language interventions utilised for the educational and social development of children with autism in one mainstream school in South Devon?
Get PDFThe aim of my research was to discover what speech and language intervention strategies are used in a mainstream school to assist children with autism, and how confident student teachers feel about these particular strategies. My method was to conduct semi-structured interviews with teachers from a mainstream school and online questionnaires for final year student teachers. This approach was adopted in order to position questionnaires for student teachers into a real context and compare their ideas about interventions to the strategies actually used in a school. After completing my research, a significant conclusion reached is that student teachers need more experience with intervention systems in order to be better prepared for their NQT year. I also found that teachers in a mainstream school have different opinions on the most useful intervention strategy, and that preferred choices depend upon individual children’s development. The implications for my practice are to ensure I am prepared for implementing various interventions, be flexible and take advice from fellow colleagues
Abandoning young people to the dark places they can find elsewhere’: The implications of the anti-radicalisation policies in UK secondary schools
Get PDFThe rise of extremist groups in the United Kingdom has led to the introduction of new policies, created by the Home Office, Home Department and Department for Education. These policies are designed to reduce the risk of radicalisation in young people and schools are required to adhere and promote these policies within their educational institutions. This means that both staff and students are to be protected from the risk of radicalisation, with potential threats being identified and escalated. The legislation covers all types of radicalisation; however, this research is focussing on the way in which it has been used to prevent far-right extremism and the effects this has had on other groups in schools. Whilst these policies are created to protect, there have been some significant negative implications including students experiencing higher levels of prejudice and staff struggling with their identity as educator vs surveillance agent. This case study explores the practices schools are required to follow while analysing the concerns of those affected and proposing more sustainable solutions
Environmental history in Western Anatolia (Turkey) since the Last Glacial Maximum
No full textMediterranean landscapes have been shaped by complex interactions between climate, land use and fire overmulti-millennial timescales. Understanding past trajectories of change provides knowledge of how modernlandscapes emerged, which can be valuable for their sustainable management. The aim of this study is toreconstruct environmental change in Western Anatolia (Turkey) through palaeoecological analysis of sedimentfrom Buldan Yayla Lake (Denizli-Buldan) from the Last Glacial Maximum (LGM) to the present, using a high-resolutionand multi-proxy dataset. To this end, fossil pollen, micro-charcoal, non-pollen palynomorphs, micro(μ)-XRF and radiocarbon analyses were applied to an ~18 m sediment core from Buldan Yayla Lake (Denizli-Buldan). According to the fossil pollen record, forest presence was low during the LGM (21000-18000 cal. BP),with the lowest value recorded at 5 % during this period due to cold and dry climatic condition. Forest presencebegan to increase with the transition to the Post-LGM period. Rapid forest development and high forest presencewere observed in the lake record from the transition to the LGM until the late Holocene. Forest development inWestern Anatolia occurred approximately 4,000 years earlier than in Europe according to the age-depth modeldeveloped for this record, though if a hiatus exists, this could reflect a shift of at least 1,300 years. High forestabundance during the late Glacial period was interrupted during the Younger Dryas (YD) and during the dryclimatic periods of 9250–8900 and 7700 cal. BP. The late Holocene period was characterized by intensive landuse, specifically olive cultivation, which reached its highest level in the Roman Imperial Period (during theancient city of Tripolis era), and the highest olive percentage recorded in Anatolia (38.4 %) was reached. Forestswere generally dominated by oaks, with pine forests replacing oak forests in the last 1350 (cal. BP) years. Microcharcoaland non-pollen palynomorph data were low in concentration between the LGM and Holocene and beganto increase with the Holocene transition reaching their highest values during the late Holocene. This studyprovides a reconstruction of long-term environmental change in Western Anatolia and reveals a significantrelationship between climate variability and shifts in vegetation patterns, particularly highlighting the increasingfrequency of fires and changes in land use during certain periods. This finding serves as an important example forunderstanding the relationships between climate, vegetation, fire, and land use in the Mediterranean Basin
Tropical forests in the Americas are changing too slowly to track climate change
Get PDFUnderstanding the capacity of forests to adapt to climate change is of pivotal importance for conservation science, yet this is still widely unknown. This knowledge gap is particularly acute in high-biodiversity tropical forests. Here, we examined how tropical forests of the Americas have shifted community trait composition in recent decades as a response to changes in climate. Based on historical trait-climate relationships, we found that, overall, the studied functional traits show shifts of less than 8% of what would be expected given the observed changes in climate. However, the recruit assemblage shows shifts of 21% relative to climate change expectation. The most diverse forests on Earth are changing in functional trait composition but at a rate that is fundamentally insufficient to track climate change
The Impact of LED Light Spectra on the Growth, Yield, Physiology, and Sweetness Compound of Stevia rebaudiana
Get PDFThis study investigated the effects of several light spectra on Stevia rebaudiana, analysing growth parameters, yield, and physiological responses within a controlled-environment agriculture (CEA) system. The experimental design involved different light treatments, including specific combinations of blue (435 nm and 450 nm), red (663 nm), and ultraviolet (UV) wavelengths (365 nm), to determine their impact on morphological development and biochemical properties, particularly focusing on the production of the sweetening compounds stevioside and rebaudioside A. Stevia rebaudiana plants cultivated from cuttings sourced from a reputable UK nursery (Gardener’s Dream Ltd., Glasgow, UK) were subjected to these spectral treatments over a period of five weeks under vertical farming conditions. Physiological measurements, such as chlorophyll fluorescence (Fv/Fm), stomatal conductance, and leaf temperature, were recorded, alongside growth metrics (plant height, leaf area, and biomass). This study also incorporated high-performance liquid chromatography (HPLC) to quantitatively analyse the influence of the light treatments on the sweetener concentration. The results demonstrated that targeted LED spectra, particularly those that include UV light and blue light (435 nm), significantly nhanced both the quantitative and qualitative attributes of stevia growth, indicating that strategic light management can markedly improve the nutritional and commercial yields of Stevia rebaudiana. This research contributes to the optimisation of light conditions in vertical farming systems, aiming to enhance agricultural efficiency and reduce the reliance on imported stevia by maximising local production capabilities
Assessment and monitoring of treatment fidelity in a multiple behaviour change intervention for smokers wishing to reduce but not quit.
Get PDFBackgroundIntervention fidelity considers the extent to which a behavioural intervention has been designed, delivered, and experienced as intended. The National Institute of Health’s Behaviour Change Consortium (NIH-BCC) provides a leading framework to examine fidelity across five domains: design, training, delivery, receipt, and enactment. This thesis presents a programme of research to develop methods for monitoring and assessing fidelity in multiple health behaviour change (MHBC) interventions across these five domains. Methods developed are presented and tested using data from a Trial of physical Activity assisted Reduction of Smoking (TARS), a multi-site NIHR-HTA funded MHBC intervention.MethodsA mixed methods approach was adopted and comprised of five studies in which developed methods were tested. Study one assessed design fidelity through a qualitative assessment of the quality and coverage of the interventions underlying theory/core components as presented in an intervention manual. Study two assessed skill acquisition (one aspect of training fidelity) through semi-structured interviews with practitioners (n=7). Study three assessed the quality of delivery of the components of the intervention through an assessment of audio recorded delivery sessions (n=24) and semi-structured interviews with practitioners (n=8). Studies four and five assessed receipt and enactment fidelity, respectively, through semi-structuredinterviews with intervention participants (n=8). ResultsMethods developed and presented here further our understanding of and approach to monitoring and assessing fidelity in MHBC interventions across the five NIH-BCC domains. All five domains need to be monitored and assessed in order to reflect the domain’s interdependency and interaction.The utility of the developed methods were demonstrated through application to the TARS data and provided insight into the fidelity of TARS, for example, why and how physical activity was given less focus than smoking reduction within the delivery, receipt, and enactment domains.ConclusionsFidelity domains should be viewed as a dynamic, interdependent, and interactive processes that need to be assessed interdependently rather than as singular entities. Careful consideration of the timings for the monitoring and assessment of fidelity should be integrated into the design of intervention evaluation plans
Setting Sail for Resilience and Ocean Sustainability
Get PDFThis paper makes a valuable contribution to the emerging field of marine social sciences by focusing on the potential contribution of learning theory and praxes in promoting Ocean Literacy, Marine Identity and Marine Citizenship. These are advocated as important social dimensions of the changes and outcomes required to promote sustainability and resilience of marine environments and, by extension, terrestrial environments, across a range of scales from local through to planetary. This is because the factors that compromise marine resilience are largely anthropogenic, and negative outcomes of human disassociation from the ocean. From another perspective, the paper is equally concerned with how to promote personal resilience and ocean stewardship as positive personal and social outcomes exhibited by people, especially young people. A synergy is noted between Outdoor Adventurous Education and Inquiry-based Science Learning in marine contexts, with sail training being identified as particularly effective as a marine-oriented experiential learning approach and context. These insights are exemplified through a case study of sail training programmes developed and operated in the United Kingdom. Preliminary findings from trainee questionnaires support the contention that sail training is a powerful vehicle for personal growth across the range of learning dimensions (upward, outward, inward and downward personal growth). Feedback also indicates the development of Ocean Literacy, Marine Identity and Marine Citizenship amongst some participating trainees which, together, promote personal resilience and a commitment to marine stewardship (advocates of, and active agents for promoting ocean sustainability)
Connecting to the sea: A place-based study of the potential of digital engagement to foster marine citizenship
Get PDFThe Sustainable Development Goals for creating sustainable, resilient cities and addressing human impacts upon coastal waters and marine environments create a mandate for coastal cities to empower local communities to value city seascapes. One key way to achieve this is through more inclusive pathways to connect to the sea using participatory methods. This research used a participatory co‐design approach in Plymouth—the UK’s first national marine park—to explore the potential for place‐based digital engagement to connect people with the sea, especially for deprived neighbourhoods. We sought to answer the research question of whether place‐based digital technologies can engage communities with marine spaces and make coastal areas more accessible. Using the collaborative community‐led concept of a city marine park, we explored the requirements for digital technologies needed to create marine citizenship and address the challenge of building coastal resilience. We describe a participatory action research study that took place in an urban coastal community, run in collaboration with a local organisation, the Rockpool Project, over a period of six months. Through a baseline survey, we identified some of the barriers to accessing the sea and ways in which the sea was perceived as a space in the city. We also ran a series of co‐design workshops using creative prototyping with local families to help define the requirements for a digital toolkit that could enable them to access the sea. The results found that by enabling access to temporal and biodiverse marine spaces such as rocky shores, place‐based digital technologies can create new ways for communities to access and engage with the sea. Place‐based digital technologies have the potential to create marine citizenship by building a connection between people and marine environments to care for the sea as a shared resource. We propose this can help establish a sense of place and contribute to marine stewardship in coastal communities