Background
End‐stage ankle osteoarthritis typically causes severe pain and impaired function. Surgical treatment involves total ankle replacement (TAR) or ankle fusion. Definitive evidence about ...which procedure is optimal is lacking. No previous studies have thoroughly explored patients' experiences across the entire TAR/ankle fusion pathway. This study aimed to address this gap by exploring perceptions of surgery, education, rehabilitation and outcomes among patients who had undergone TAR or ankle fusion.
Methods
Seven participants were purposively selected from an orthopaedic centre in northern England (3 females, 4 males). Participants had undergone primary TAR without revision (n = 2), TAR requiring revision (n = 3) or ankle fusion (n = 2). Each participant completed a single semi‐structured interview. Interviews were digitally recorded, transcribed verbatim and analysed thematically.
Results
Three themes, each with two subthemes, were identified: decision‐making (seeking help; surgical options), perceptions of support (information/education; clinical support) and impact on the individual (personal circumstances and beliefs; post‐operative outcomes). Pain affecting participants' valued activities was key to their decision to seek help. Participants' decision between TAR and ankle fusion was influenced by multiple factors. Concerns regarding the lack of joint flexibility following fusion were highlighted, with some participants perceiving TAR as a “proper ankle” that would enable them to avoid limping. Participants obtained information from various sources, with most feeling that the education from their care team was inadequate. Participants' individual circumstances and beliefs influenced their decision‐making and perceptions of their post‐operative outcomes. Finally, whilst most participants were pleased with their outcomes, some experienced substantial ongoing problems such as difficulty walking and chronic pain.
Conclusions
This study demonstrates the importance of providing adequate education about TAR and ankle fusion to enable patients to make informed decisions. Most participants felt that the education and clinical support they received did not fully meet their needs. Participants' personal circumstances and beliefs had a strong influence on their decision‐making and perceptions of their post‐operative outcomes, highlighting the need to personally tailor education and clinical support. Future work with a larger sample of patients and other key stakeholders is required to develop consensus‐based guidelines on pre‐ and post‐operative support for patients undergoing TAR/ankle fusion.
Reconciling food security, economic development and biodiversity conservation is a key challenge, especially in the face of the demographic transition characterizing many countries in the world. ...Fisheries and marine ecosystems constitute a difficult application of this bio‐economic challenge. Many experts and scientists advocate an ecosystem approach to manage marine socio‐ecosystems for their sustainability and resilience. However, the ways by which to operationalize ecosystem‐based fisheries management (EBFM) remain poorly specified. We propose a specific methodological framework—viability modelling—to do so. We show how viability modelling can be applied using four contrasted case‐studies: two small‐scale fisheries in South America and Pacific and two larger‐scale fisheries in Europe and Australia. The four fisheries are analysed using the same modelling framework, structured around a set of common methods, indicators and scenarios. The calibrated models are dynamic, multispecies and multifleet and account for various sources of uncertainty. A multicriteria evaluation is used to assess the scenarios’ outcomes over a long time horizon with different constraints based on ecological, social and economic reference points. Results show to what extent the bio‐economic and ecosystem risks associated with the adoption of status quo strategies are relatively high and challenge the implementation of EBFM. In contrast, strategies called ecoviability or co‐viability strategies, that aim at satisfying the viability constraints, reduce significantly these ecological and economic risks and promote EBFM. The gains associated with those ecoviability strategies, however, decrease with the intensity of regulations imposed on these fisheries.
Background:
Modifiable risk factors for dementia account for 40% of cases worldwide and exert impacts on risk across the life course. To have maximal public health impact, dementia risk-reduction ...initiatives need to reach a large and diverse audience, including people from a wide range of ages and socioeconomic backgrounds. Currently, dementia risk-reduction interventions primarily reach a narrow audience, consisting largely of highly educated older adults from high income countries.
Methods:
In this commentary, we review established dissemination models to identify strategies that could be used to extend and broaden the reach of dementia risk-reduction initiatives. Three potential reach-broadening strategies can be identified from these models: engaging with distinct user groups; focusing on interpersonal communication; and utilising dissemination agents.
Results:
Engaging with distinct user groups and utilising dissemination agents show promise for broadening the reach of dementia risk-reduction initiatives, while interpersonal communication has received limited attention in this context. Further evaluation of the impact of interpersonal communication may provide avenues to take advantage of this dissemination method.
Conclusions:
Based on the reviewed models and data from current risk-reduction initiatives, we suggest that utilising all three of these strategies may most effectively broaden the reach of dementia risk-reduction initiatives. This may promote risk reduction among a larger and more diverse audience, more equitably reducing the global impact of dementia.
Issue addressed: Encouraging people to adopt life-long habits that reduce dementia risk is necessary to manage the growing global prevalence of this condition and is, therefore, a global health ...priority. Current initiatives promoting risk-reducing behaviour primarily attract participants from a limited range of backgrounds, even if widely available. This may inadvertently increase health inequities, as the people who are most likely to develop dementia are the people who are least involved in risk-reduction initiatives. Interpersonal communication can effectively disseminate health messages to demographically diverse populations and may, therefore, broaden the reach of dementia risk-reduction information.
Methods: Coding reliability thematic analysis was used to categorise reports of information sharing provided by participants from one global online dementia risk education initiative, the Preventing Dementia Massive Open Online Course, or MOOC. These reports of information sharing were provided in response to the feedback question: "If you have already applied your MOOC learning, please tell us how."
Results: Information was reportedly shared with a wide range of people, including those from demographic groups that are under-represented among Preventing Dementia MOOC participants. Information about specific risk factors was shared, along with general information about the course and/or dementia risk reduction. Some participants also reported that the people they shared information with were initiating risk-reducing behaviours.
Conclusion: Interpersonal communication has the potential to disseminate dementia risk reduction information to, and promote behaviour change among, a broad group of people at risk of dementia, thereby increasing equity in dementia risk education.
Some unsustainable consumer behaviours have proved extremely hard to change or even challenge. Despite the fact that flying can be more damaging than any other activity that an individual can ...undertake, many otherwise green consumers still choose to fly, offering an opportunity to elicit narratives about the differences between their attitudes and behaviours. Qualitative interview data were gathered from self-selected green consumers and set within a cognitive dissonance analytical framework. Four strategies were uncovered: not changing travel behaviour (but offering justifications related to travel product, travel context or personal identity); reducing or restricting flights; changing other behaviours to compensate for flying; and stopping flying. This analysis furthers research on green consumer rationales for (un)sustainable behaviours and suggests several avenues for sustainable marketing management.
Background:
The concept of palliative care consisting of five distinct, clinically meaningful, phases (stable, unstable, deteriorating, terminal and bereavement) was developed in Australia about 20 ...years ago and is used routinely for communicating clinical status, care planning, quality improvement and funding.
Aim:
To test the reliability and acceptability of revised definitions of Palliative Care Phase.
Design:
Multi-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase.
Setting/participants:
Clinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service.
Results:
A total of 102 nursing and medical clinicians participated, undertaking 595 paired assessments of 410 patients, of which 90.7% occurred within 2 h. Clinicians rated 54.8% of patients in the stable phase, 15.8% in the unstable phase, 20.8% in the deteriorating phase and 8.7% in the terminal phase. Overall agreement between clinicians’ rating of Palliative Care Phase was substantial (kappa = 0.67; 95% confidence interval = 0.61–0.70). A moderate level of inter-rater reliability was apparent across all participating sites. The results indicated that Palliative Care Phase was an acceptable measure, with no significant difficulties assigning patients to a Palliative Care Phase and a good fit between assessment of phase and the definition of that phase. The most difficult phase to distinguish from other phases was the deteriorating phase.
Conclusion:
Policy makers, funders and clinicians can be confident that Palliative Care Phase is a reliable and acceptable measure that can be used for care planning, quality improvement and funding purposes.
Leaves display a remarkable range of forms, from flat sheets with simple outlines to cup-shaped traps. Although much progress has been made in understanding the mechanisms of planar leaf development, ...it is unclear whether similar or distinctive mechanisms underlie shape transformations during development of more complex curved forms. Here, we use 3D imaging and cellular and clonal analysis, combined with computational modelling, to analyse the development of cup-shaped traps of the carnivorous plant Utricularia gibba. We show that the transformation from a near-spherical form at early developmental stages to an oblate spheroid with a straightened ventral midline in the mature form can be accounted for by spatial variations in rates and orientations of growth. Different hypotheses regarding spatiotemporal control predict distinct patterns of cell shape and size, which were tested experimentally by quantifying cellular and clonal anisotropy. We propose that orientations of growth are specified by a proximodistal polarity field, similar to that hypothesised to account for Arabidopsis leaf development, except that in Utricularia, the field propagates through a highly curved tissue sheet. Independent evidence for the polarity field is provided by the orientation of glandular hairs on the inner surface of the trap. Taken together, our results show that morphogenesis of complex 3D leaf shapes can be accounted for by similar mechanisms to those for planar leaves, suggesting that simple modulations of a common growth framework underlie the shaping of a diverse range of morphologies.
With over 100 million humanitarian migrants globally, there is increasing pressure on high-income countries to offer resettlement opportunities. Humanitarian migrants face many challenges during ...pre-settlement and resettlement. One challenge is food insecurity (FI). The Building a New Life in Australia (BNLA) longitudinal cohort study gathered data from migrating units, that is, a group of humanitarian migrants included on the same visa application (n = 1599). Data were gathered in five annual waves (2013–2018). Data included food security status in four pre-settlement situations and during resettlement. The results of this secondary analysis of BNLA Wave One indicate that FI was highest in refugee camps (71%), followed by bridging visas (30%), community detention (17%), immigration detention (11%), and during early resettlement (9%). During early resettlement, respondents who were male, those from Afghanistan or Iran, and those living in a single person household reported the highest prevalence of FI. An association was found between having spent time on a bridging visa and FI during early resettlement (p < 0.01). This study's results are an important step in understanding the scale of FI and which sub-groups are most vulnerable, so the resources and policies of high-income countries can better meet food security needs during resettlement.
Concern exists that the growing over-representation of Aboriginal and Torres Strait Islander children and young people in out-of-home care (OOHC) across Australia is perpetuating historical, ...discriminatory child removal policies and practices. The disproportionate number of Indigenous children in OOHC is increasing at the same time as growing multi-jurisdictional policy and legal mandate for Indigenous self-determination, leadership, and cultural connectedness in the OOHC space. This study aims to provide evidence and instruction to social work educators, policymakers and practitioners in Australia's complex child protection, wellbeing, and justice systems about why and how Aboriginal and Torres Strait Islander-controlled organizations are best placed to lead OOHC service delivery for Indigenous children, their family and community. The qualitative research, located in Queensland, engages the knowledge and experience of Elders, Indigenous child safety professionals and Aboriginal and Torres Strait Islander young adults who have recently exited OOHC to explore the importance of Indigenous-led OOHC service provision for generating genuine, intergenerational systemic change. Ten themes or authoritative Directives to non-Indigenous stakeholders are elicited and discussed. The paper concludes with three recommendations that press for a shift in the Western values and practices that underscore the monitoring and evaluation of Indigenous-led OOHC service providers by government.
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