The National Institute of Clinical Excellence (NICE) traffic light system uses children's symptoms and signs to categorise acute infections into red, amber and green. To our knowledge, no study has ...described the proportion of children with acute undifferentiated illness who fall into these categories in primary care, which is important since red and amber children are considered at higher risk of serious illness requiring urgent secondary care assessment.
To estimate the proportion of acutely unwell children presenting to primary care classified by the NICE traffic light system as red, amber or green, and to describe their initial management.
Secondary analysis of the Diagnosis of Urinary Tract infection in Young children prospective cohort study.
6797 children under 5 years presenting to 225 general practices with acute undifferentiated illness were retrospectively mapped to the NICE traffic light system by a panel of general practitioners.
6406 (94%) children were classified as NICE red (32%) or amber (62%) with 1.6% red and 0.3%, respectively, referred the same day for hospital assessment; and 46% and 31%, respectively, treated with antibiotics. The remaining 385 (6%) were classified green, with none referred and 27% treated with antibiotics. Results were robust to sensitivity analyses.
The majority of children presenting to UK primary care with acute undifferentiated illness meet red or amber NICE traffic light criteria,with only 6% classified as low risk, making it unfit for use in general practice. Research is urgently needed to establish as triage system suitable for general practice.
Background
Cognitive–communication difficulties are often associated with dementia and can impact a person's ability to participate in meaningful conversations. This can create challenges to ...families, reflecting the reality that people living with dementia rarely have just one regular conversation partner, but interact with multiple family members. To date, there is limited evidence of the impact of changes in communication patterns in families. A family systems approach, with foundations in psychology, can be used to explore the impact of communication difficulties on multiple different family members, including the person living with dementia and potential coping strategies used by individuals, together with the family as a whole.
Methods & Procedures
A systematic review of primary qualitative research was conducted to identify and examine research exploring communication and interaction within families living with dementia. Studies were identified through a comprehensive search of major databases and the full‐text articles were subject to a quality appraisal. We conducted a thematic analysis on the literature identified to consider the role of families in supporting communication for people with dementia.
Outcomes & Results
The searches identified 814 possible articles for screening against the eligibility criteria. Nine articles were included in the final review. Three major themes emerged from the analysis of the included studies: (1) ‘identities changing’ reflected how interactions within the family systems impacted on identities; (2) ‘loss’ reflected the grief experienced by families due to changes in communication; and (3) ‘developing communication strategies’ highlighted strategies and approaches that families affected by dementia may use organically to engage in meaningful interactions and maintain connection. Only one study explicitly used a family systems approach to understand how families manage the changes in interaction resulting from dementia.
Conclusions & Implications
The findings may usefully inform the clinical practice of speech and language therapists in terms of communication strategies and coping mechanisms that may be advised to facilitate connection in families living with dementia. Further research using a family systems approach to exploring communication in dementia may help to support the implementation of family‐centred practice as recommended in policy.
What this paper adds
What is already known on the subject
There is increasing recognition of the impact of dementia on whole families and the need for family‐centred interventions to enhance quality of life. However, much of the research to date that explores communication within families affected by dementia examines interaction between dyads, largely overlooking the roles and skills of other familial communication partners. To the authors’ knowledge, there has been no previous review of the literature using a family systems approach, which has the potential to inform clinical practice of those working in dementia care.
What this paper adds to existing knowledge
The review examines and understands what is known about the approaches used by families affected by communication changes resulting from dementia to preserve connection. It collates the evidence from qualitative studies examining approaches and strategies used by individual conversation partners, including people with dementia, as well as the family system as a whole, to facilitate meaningful interactions, and proposes recommendations for clinicians working in this field. Furthermore, we consider the potential benefits of using a family systems approach to understand the context of people living with dementia and how this could enhance communication, personhood and well‐being.
What are the potential or actual clinical implications of this work?
This review highlights practical conversation strategies and interactional approaches that may serve to enhance communication and preserve relationships between people with dementia and their family members. Such techniques have the potential to be advised by Speech and Language Therapists working in dementia care as part of tailored, relationship‐centred care and support that they provide.
This work responds to the limited research about resilience when living with dementia and develops a conceptual model to inform service development and healthcare practices for this population.
An ...iterative process of theory building across four phases of activity (scoping review n = 9 studies), stakeholder engagement (n = 7), interviews (n = 11) generated a combined sample of 87 people living with dementia and their carers, including those affected by rare dementias to explore their lived experiences. An existing framework of resilience developed in other populations served as the starting point to analyse and synthesise the findings, inspiring a new conceptual model of resilience unique to the experience of living with dementia.
The synthesis suggests resilience encompasses the daily struggles of living with a dementia; people are not flourishing, thriving or 'bouncing back', but are managing and adapting under pressure and stress. The conceptual model suggests resilience may be achieved through the collective and collaborative role of psychological strengths, practical approaches to adapting to life with dementia, continuing with hobbies, interests and activities, strong relationships with family and friends, peer support and education, participating in community activities and support from healthcare professionals. Most of these themes are not reflected in resilience outcome measures.
Practitioners adopting a strengths-based approach utilising the conceptual model at the point of diagnosis and post-diagnosis support may help individuals achieve resilience through appropriately tailored services and support. This 'resilience practice' could also extend to other degenerative or debilitating chronic conditions a person faces in their life course.
Individual wintering strategies and patterns of winter site fidelity in successive years are highly variable among seabird species. Yet, an understanding of consistency in timing of movements and the ...degree of site fidelity is essential for assessing how seabird populations might be influenced by, and respond to, changing conditions on wintering grounds. To explore annual variation in migratory movements and wintering areas, we applied bird-borne geolocators on Thick-billed Murres (Uria lomvia, n = 19) and Common Murres (U. aalge, n = 20) from 5 colonies in the Northwest Atlantic for 2-4 consecutive years. Thick-billed Murres ranged widely and among-individual wintering strategies were highly variable, whereas most Common Murres wintered relatively near their colonies, with among-individual variation represented more by the relative use of inshore vs. offshore habitat. Within individuals, some aspects of the wintering strategy were more repeatable than others: colony arrival and departure dates were more consistent by individual Common than Thick-billed Murres, while the sizes of home ranges (95% utilization distributions) and distances travelled to wintering area were more repeatable for both species. In consecutive years, individual home ranges overlapped from 0-64% (Thick-billed Murres) and 0-95% (Common Murres); and the winter centroids were just 239 km and 169 km apart (respectively). Over the 3-4 year timescale of our study, individuals employed either fixed or flexible wintering strategies; although most birds showed high winter site fidelity, some shifted core ranges after 2 or 3 years. The capacity among seabird species for a combination of fidelity and flexibility, in which individuals may choose from a range of alternative strategies, deserves further, longer term attention.
Marine Spatial Planning (MSP) is becoming a key management approach throughout the world. The process includes the mapping of how humans and wildlife use the marine environment to inform the ...development of management measures. An integrated multi-species approach to identifying key areas is important for MSP because it allows managers a global representation of an area, enabling them to see where management can have the most impact for biodiversity protection. However, multi-species analysis remains challenging. This paper presents a methodological framework for mapping key areas for marine megafauna (seabirds, pinnipeds, cetaceans) by incorporating different data types across multiple species. The framework includes analyses of tracking data and observation survey data, applying analytical steps according to the type of data available during each year quarter for each species. It produces core-use area layers at the species level, then combines these layers to create megafauna core-use area layers. The framework was applied in the Falkland Islands. The study gathered over 750,000 tracking and at-sea observation locations covering an equivalent of 5495 data days between 1998 and 2015 for 36 species. The framework provides a step-by-step implementation protocol, replicable across geographic scales and transferable to multiple taxa. R scripts are provided. Common repositories, such as the Birdlife International Tracking Database, are invaluable tools, providing a secure platform for storing and accessing spatial data to apply the methodological framework. This provides managers with data necessary to enhance MSP efforts and marine conservation worldwide.
•Marine Spatial Planning informs sustainable development and protection.•Multi-species approach is important to identifying key areas for marine megafauna.•Core-use areas with 36 species (seabirds, seals) calculated in Falkland Islands water.•The methodological framework is replicable and simple, across species and data types.•Common data repositories enhance marine conservation efforts and decisions.
ABSTRACTBackground:Research reviews highlight methodological limitations and gaps in the evidence base for the arts in dementia care. In response, we developed a 12-week visual art program and ...evaluated the impact on people living with dementia through a mixed-methods longitudinal investigation.
One hundred and twenty-five people living with mild to severe dementia were recruited across three research settings in England and Wales (residential care homes, a county hospital, and community venues). Quantitative and qualitative data on quality of life (QoL), communication and perceptions of the program were obtained through interviews and self-reports with participants and their carers. Eight domains of well-being were measured using a standardized observation tool, and data compared to an alternative activity with no art.
Across all sites, scores for the well-being domains of interest, attention, pleasure, self-esteem, negative affect, and sadness were significantly better in the art program than the alternative condition. Proxy-reported QoL significantly improved between baseline and 3-month follow-up, but no improvements in QoL were reported by the participants with dementia. This was contrasted by their qualitative accounts, which described a stimulating experience important for social connectedness, well-being, and inner-strength. Communication deteriorated between baseline and follow-up in the hospital setting, but improved in the residential care setting.
The findings highlight the potential for creative aging within dementia care, the benefits of art activities and the influence of the environment. We encourage dementia care providers and arts and cultural services to work toward embedding art activities within routine care provision.
Accumulating evidence suggests that Atlantic populations of Leach's Storm-Petrels (Oceanodroma leucorhoa) are experiencing significant declines. To better understand possible causes of these ...declines, we used geolocators to document movements of these small (~50-g) pelagic seabirds during migration and the non-breeding period. During 2012 and 2013, movement tracks were obtained from two birds that traveled in a clock-wise direction from two breeding colonies in eastern Canada (Bon Portage Island, Nova Scotia, and Gull Island, Newfoundland) to winter in tropical waters. The bird from Bon Portage Island started its migration towards Cape Verde in October, arrived at its wintering area off the coast of eastern Brazil in January, and started migration back to Nova Scotia in April. The bird from Gull Island staged off Newfoundland in November and then again off Cape Verde in January before its geolocator stopped working. Movements of Leach's Storm-Petrels in our study and those of several other procellariiforms during the non-breeding period are likely facilitated by the prevailing easterly trade winds and the Antilles and Gulf Stream currents. Although staging and wintering areas used by Leach's Storm-Petrels in our study were characterized by low productivity, the West Africa and northeastern Brazilian waters are actively used by fisheries and discards can attract Leach's Storm-Petrels. Our results provide an initial step towards understanding movements of Leach's Storm-Petrels during the non-breeding period, but further tracking is required to confirm generality of their migratory routes, staging areas, and wintering ranges. La evidencia acumulada sugiere que las poblaciones del atlántico de Oceanodroma leucorhoa están experimentando una disminución significativa. En un esfuerzo para entender mejor las posibles causas de esta disminución, usamos geolocaliza-dores para documentar los movimientos de esta pequeña (~50-g) ave marina pelágica durante la migración y el periodo no reproductivo. Durante el 2012 y 2013, trayectorias de los movimiento fueron obtenidas basada en dos aves que viajaron en la dirección del reloj desde dos colonias al este de Canadá (isla Bon Portage, Nova Scotia, e isla Gull, Newfoundland) a pasar el invierno en aguas tropicales. El ave de la isla Bon Portage empezó su migración hacia cabo Verde en octubre, arribó a su área invernal en las afueras de la costa al este de Brasil en enero, y comenzó la migración de regreso a Nova Scotia en abril. El ave de la isla Gull salió de Newfoundland en noviembre y de nuevo desde cabo verde en enero antes de que su geolocaliza-dores dejada de funcionar. Los movimientos de O. leucorhoa en nuestro estudio y los de muchos otros procellariiformes durante los periodos no reproductivos están probablemente facilitados por la prevalencia de los vientos alisios del este y las corrientes de las Antillas y el golfo. Aunque O. leucorhoa utilizó áreas estacionarias y de invierno en nuestro estudio, estas se caracterizaron por tener una baja productividad, pero las aguas del oeste Africano y el noreste Brasilero son utilizadas activamente por pescadores y los desechos pueden atraer a O. leucorhoa. Nuestros resultados proveen un paso inicial hacia el entendimiento de los movimientos de O. leucorhoa durante el periodo no reproductivo, pero futuros rastreos son requeridos para confirmar la generalidad de sus rutas migratorias, áreas estacionarias y rangos de invierno.
Purpose
This paper aims to share how the Centre for Ageing and Dementia Research co-designs research within a national programme of work to improve the lives of older adults and those affected by ...dementia. Through examples of this work, the authors identify the barriers and enablers to participatory approaches and lessons to inform future involvement activities.
Design/methodology/approach
This study reflects on implementing the UK National Standards for Public Involvement into practice. Of international relevance, the observations span the research process from research prioritisation and design to research implementation and knowledge exchange.
Findings
This study demonstrates the importance of using a relational approach, working toward a common purpose and engaging in meaningful dialogue. Only through offering choice and flexibility and actively learning from one another can co-design lead to synergistic relationships that benefit everyone.
Research limitations/implications
Key implications for researchers engaged in patient and public involvement are be receptive to other people’s views and acknowledge expertise of those with lived experience alongside those with academic expertise. Training, resources and time are required to effectively support involvement and meaningful relationships. A nominated contact person enables trust and mutual understanding to develop. This is an ongoing collective learning experience that should be embedded throughout the entire research process.
Originality/value
This paper demonstrates how the standards are implemented with people who are often excluded from research to influence a national programme of work.
Abstract
Background
Homeothermic marine animals in Polar Regions face an energetic bottleneck in winter. The challenges of short days and cold temperatures are exacerbated for flying seabirds with ...small body size and limited fat stores. We use biologging approaches to examine how habitat, weather, and moon illumination influence behaviour and energetics of a marine bird species, thick-billed murres (
Uria lomvia
).
Methods
We used temperature-depth-light recorders to examine strategies murres use to survive winter in the Northwest Atlantic, where contrasting currents create two distinct marine habitats: cold (−0.1 ± 1.2 °C), shallower water along the Labrador Shelf and warmer (3.1 ± 0.3 °C), deep water in the Labrador Basin.
Results
In the cold shelf water, murres used a high-energy strategy, with more flying and less diving each day, resulting in high daily energy expenditure and also high apparent energy intake; this strategy was most evident in early winter when day lengths were shortest. By contrast, murres in warmer basin water employed a low-energy strategy, with less time flying and more time diving under low light conditions (nautical twilight and night). In warmer basin water, murres increased diving at night when the moon was more illuminated, likely taking advantage of diel vertically migrating prey. In warmer basin water, murres dove more at night and foraging efficiency increased under negative North Atlantic Oscillation (calmer ocean conditions).
Conclusions
The proximity of two distinct marine habitats in this region allows individuals from a single species to use dual (low-energy/high-energy) strategies to overcome winter energy bottlenecks.
In a warming Arctic, circumpolar long-term monitoring programs are key to advancing ecological knowledge and informing environmental policies. Calls for better involvement of Arctic peoples in all ...stages of the monitoring process are widespread, although such transformation of Arctic science is still in its infancy. Seabirds stand out as ecological sentinels of environmental changes, and priority has been given to implement the Circumpolar Seabird Monitoring Plan (CSMP). We assessed the representativeness of a pan-Arctic seabird monitoring network focused on the black-legged kittiwake (Rissa tridactyla) by comparing the distribution of environmental variables for all known versus monitored colonies. We found that with respect to its spatiotemporal coverage, this monitoring network does not fully embrace current and future environmental gradients. To improve the current scheme, we designed a method to identify colonies whose inclusion in the monitoring network will improve its ecological representativeness, limit logistical constraints, and improve involvement of Arctic peoples. We thereby highlight that inclusion of study sites in the Bering Sea, Siberia, western Russia, northern Norway, and southeastern Greenland could improve the current monitoring network and that their proximity to local populations might allow increased involvement of local communities. Our framework can be applied to improve existing monitoring networks in other ecoregions and sociological contexts.
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