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Seascape connectivity: evidence, knowledge gaps and implications for temperate coastal ecosystem restoration practice and policy
No full textTemperate coastal marine ecosystems have undergone severe global loss and degradation. We provide a framework for considering ecological connectivity in marine systems and evidence for ecological connectivity across temperate coastal seascapes, developed through expert consensus and structured review. We demonstrate that ecosystem functioning and the delivery of ecosystem services require the existence of a healthy mosaic of coastal habitats, maintained by the exchanges of matter and energy between them. We advocate a seascape approach, that restores connectivity and optimal structure-function relationships, is crucial for successful ecosystem restoration. Consequently, we provide recommendations to deliver seascape restoration of coastal habitats to support the targets set by the 2021-30 UN Decades of Ocean Science and Ecosystem Restoration. Acknowledging the interconnected nature of coastal ecosystems has implications for policy. We identify opportunities and actions to support nature recovery and integrate policy frameworks across climate and biodiversity agendas to achieve international goals for planetary resilience
Moving through migrant psychiatry: asylum seeking in Europe, forced mobility, and anthropology as interdisciplinary intervention
No full textThis Perspective reflects on the relationship between migrant psychiatry and asylum seeking in Europe, drawing on anthropological fieldwork in a public migrant psychiatry clinic and mobile psychiatry teams serving asylum seekers, refused asylum seekers, and homeless migrants in France. Restrictive EU migration policies have produced protracted forms of 'wandering' which may last for years; a sedentarist emphasis in national migrant services has generally not kept pace. Calls by international agencies to protect the mental health of refugees and displaced people are conflicting with a hostile policy backlash by national governments, delimiting a contradictory situation. This Perspective discusses ways movements of migrants across countries, and discontinuous and uneven healthcare and asylum infrastructures, are shaping clinical expressions of illness and intervention, and the asylum clinic as a critical site of inquiry. It develops on anthropology as an interdisciplinary intervention that can more roundly align ways in which migrant patients, clinical services, and professionals move across sectoral boundaries, account for contested political fields and multiple registers of interpretation, and answer some questions arising at their juncture
Top 10 research priorities for sepsis research determined by patients, carers and clinicians
No full textINTRODUCTION: Sepsis is a high burden syndrome associated with increased morbidity and mortality in both the acute and longer-term phases of illness. Multiple treatment uncertainties remain that require resolution through high-quality research. This study aimed to identify the top 10 research priorities for sepsis research in the UK.METHODS: We conducted a priority setting partnership study co-produced by sepsis survivors, carers and clinicians. This included five stages: initiation of steering group formation and confirmation of the scope of the priority setting partnership; identification of clinical uncertainties through an electronic survey; analysis and verification of uncertainties; interim prioritisation to the top 25 ranked questions; and final prioritisation to determine the top 10 research priorities, using the nominal group technique.RESULTS: Our initial survey respondents comprised 447/718 (62.3%) people who had survived sepsis, their friends and family members; 218/718 (30.4%) clinicians; and 53/718 (7.1%) multiple/other roles who identified 53 distinct research uncertainties. Our interim prioritisation survey comprised 429/941 (45.8%) people who had survived sepsis, their friends and family members; 431/941 (46.0%) clinicians; and 73/941 (8.2%) multiple/other roles, with the top 25 ranked summary questions taken forwards for final prioritisation. From these, final workshop participants (n = 27) agreed a top 10 list of research priorities. Improved sepsis diagnosis; characterisation and management of the post-sepsis syndrome; and non-antibiotic treatment of sepsis were the top three priorities.DISCUSSION: We establised priorities for sepsis research through a rigorous process of consensus involving sepsis survivors, carers and clinicians. These priorities will support future delivery of meaningful research to improve outcomes from sepsis.</p
Beyond numbers:Unpacking the lived experiences, cold homes, and complex realities of energy poverty in rural northern China
No full textEnergy poverty significantly impacts individual and community well-being. It is critical to understand the factors influencing its emergence as well as the interactions between them to inform effective policy interventions. While research in China has identified factors using quantitative methods, little research has explored them qualitatively. This research explores the emergence of energy poverty through a lived experience approach. Utilizing interviews, observations, and thematic analysis it asks, how do intersecting cultural and social, economic, material, regulatory and geographical factors contribute to the development of energy poverty in rural Northern China? Five key findings are provided. First, cultural and social factors play a significant role in either alleviating or exacerbating energy poverty, depending on the family dynamics of energy-poor households and their social relations. Second, income and its sources are crucial economic contributors to energy poverty. Third, unique features of Chinese traditional rural houses lead to lower indoor temperatures, partial heating, and limitations in improving domestic energy infrastructure. Fourth, modern energy services (especially heating) are often too expensive for households with only one older individual. Fifth, local energy infrastructure delays can push households into energy poverty during the transition due to energy service vacuums and the extra costs associated with temporary resource expenditure. These findings contribute to existing literature by expanding knowledge and informing policy-making efforts to address energy poverty, whilst presenting empirical material focused on both a neglected geographical context, and a neglected, qualitative perspective. We also contribute to understandings of how energy poverty drivers interact to create distinctive outcomes
Donor embryonic stem cells displace host cells of 8-cell-stage chimeras to the extra-embryonic lineages by spatial crowding and FGF4 signalling
No full textFollowing mouse embryo compaction, outer cells become trophectoderm, while inner cells form the inner cell mass (ICM), later differentiating into primitive endoderm and epiblast during blastocyst formation. Trophectoderm specification is driven by position-governed polarisation, while primitive endoderm specification is positively regulated by FGF4 signalling from the unspecified ICM and epiblast. When injected into an 8-cell-stage morula, embryonic stem cells (ESCs; derived from pre-implantation epiblast cells in vitro) can exclude host cells from the epiblast, leading to mice derived entirely from these cells. While evidence suggests roles for ESC-produced FGF4 and physical crowding in host cell displacement from the ICM, the interplay between these possible mechanisms has yet to be dissected, in part due to the lack of studies using Fgf4-/- ESCs. Here, we combine chimera titration assays with mathematical modelling to study these mechanisms of host cell displacement. Both Fgf4+/+ and Fgf4-/- ESCs displaced host cells from the epiblast, while only Fgf4-/- ESC-injected embryos reduced primitive endoderm and increased trophectoderm, indicating sequential exclusion by displacement crowding followed by FGF4 signalling
Navigating cultural intimacies:Long-lasting friendships in the Scottish South Asian diasporas
No full textIn research on the UK’s South Asian communities, the family has generally been taken to be a ‘self-fulfilling’ unit and the existence of friendships within and across these communities remains empirically unexplored and conceptually under-theorised. This is even more so the case for friendships among older South Asians. This article therefore explores the workings of decades-long friendships of the Scottish South Asian diasporas, particularly those that are formed outside these communities, to ask: how and why do friendships last across sometimes deep cultural differences? Taking inspiration from Lynn Jamieson’s theorisation of ‘practices of intimacy’, yet in a relative departure, this article positions intimate relationships as socially situated, wherein cultural and racial difference is embodied by the individuals in these friendships, even as the friendships are themselves also embedded within wider racial and socio-cultural hierarchies. Drawing on in-depth interviews with 40 male and female participants (50+ years) from the Indian Sikh and Pakistani Muslim communities, I offer three main arguments that: cultural or racial difference is not contingent to these friendships but inherently constitutive of the relationships; deep ‘value-navigations’ which cut across differences can both cultivate and sustain long-lasting friendships; and what I term practices of cultural intimacy are at the core of how and why these friendships last.</p
Robustly measuring multimorbidity using disparate linked datasets
No full textBackground: Measurement of multimorbidity, the co-occurrence of two or more conditions in the same individual, is highly variable which limits the consistency and reproducibility of research. Methods: Using data from 172,563 UK Biobank (UKB) participants and a cross-sectional approach, we examined how choice of data source affected estimated prevalence of 80 individual long-term conditions (LTCs) and multimorbidity. We developed code-list-based algorithms to determine the prevalence of 80 LTCs in (1) primary care records, (2) UKB baseline assessment, (3) hospital/cancer registry records, and (4) all three data sources together. Results: Using records from all three data sources, 146,811 (85.1%) participants have at least one and 109,609 (63.5%) have at least two LTCs at baseline. A median of 4.7% (IQR 1.0–16.6) of participants with a condition are identified by all three data sources. Agreement is highest for endocrine, nutritional and metabolic disorders, with a median of 32.9% (IQR 20.5–34.1) of individuals with a condition identified by all three data sources. Agreement is lowest for diseases of the genitourinary system and mental and behavioural disorders where perfect agreement varies from zero to 4.9% and zero to 12.3% across conditions, respectively. The low agreement between data sources is accompanied by high proportions of individuals with a condition identified only in primary care data (i.e., not in either of the other two sources), with a median of 59.3% (IQR 47.4–75.9) for diseases of the genitourinary system and 66.9% (IQR 42.8–79.2) for mental and behavioural disorders. Conclusions: Our study highlights the impact of the choice of which data source is used in research on individual LTCs and multimorbidity, and the importance of clearly justifying choices made.<br/
(Re)acting (to) the crisis:A comparative analysis of crisis framing in obesity, climate change, antimicrobial resistance, and the UK cost-of-living crisis
No full textAcross human and planetary health, the concept of crisis provokes a sense of exceptionalism and sudden diversion from a supposed 'normal' state of affairs. By approaching crises as socially constructed phenomena, we open up paths of enquiry that can help us to understand what it means to promote, use, or suppress the framing of an issue as a crisis. Actors can create or exploit crisis narratives to define the crisis and specific solution(s) in their interest. Identifying and critically interrogating different crisis framings, however, represents a key challenge. In this paper, we analyse four case studies from across human and planetary health: obesity, climate change, antimicrobial resistance, and the cost-of-living. Adopting an interpretive lens to interrogate these ‘crisis imaginaries’, we interrogate how crises are constructed through, and reflected in, discourse. We build on existing frameworks to better develop methods to critically evaluate crisis conceptions and understand how these may drive (and be driven by) the commodification of narratives in public health. In paying particular attention to power dynamics, we demonstrate how crisis narratives may obscure longstanding inequities. We conclude by providing recommendations to better inform consideration of the drivers, trade-offs, and wider implications of crisis framing
Exploring the SHIFT-SHARE Framework: Conversations on Strategic Task Shifting and Sharing in Healthcare
No full textTask shifting and task sharing are workforce optimisation strategies in healthcare delivery, valuable in resource-constrained settings. They involve the delegation and collaborative distribution of specific tasks among different cadres of healthcare professionals to maximize efficiency and extend service reach. My poster displays the Strategic Healthcare Implementation Framework for Task Shifting, Sharing and Resource Enhancement (SHIFT-SHARE), built through my PhD research at the Usher Institute. With its six cyclical stages: Environmental Scanning, Priming, Risk Signal, Capacity Building, Monitoring and Evaluation, and Maintenance and Diffusion, SHIFT-SHARE is a practical approach to task reallocation and workforce optimisation in resource-constrained settings. SHIFT-SHARE draws on popular change management theories, including Lewin's Three-stage Model, Kotter's Eight-step Process of Leading Change, principles of Lean Management and Diffusion of Innovation, alongside implementation frameworks such as the RE-AIM, CFIR, and the Calderdale Framework. The framework development has been informed by fieldwork in India, where task shifting and sharing implementations across primary care, emergency medical services, and mental health sectors have been examined. Ongoing stakeholder experiences and feedback from these real-world applications continue to refine the framework's components. The poster facilitates engagement with attendees through prompts around the SHIFT-SHARE, enabling identification of task shifting and sharing opportunities within participants’ own programs or services. These discussions allow for real-time mapping of implementation considerations using the framework-based approach
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