Conservation conflict: Managing forestry versus hen harrier species under Europe's Birds Directive.

In this paper we examine an example of a conservation conflict that is encountered in Ireland arising from the designation of Special Protection Areas (SPAs) for the Hen Harrier under the European Birds Directive (Directive, 2009/147/EC) and the consequent restrictions that are placed on forestry activities within these SPAs. We examine the causes of the Hen Harrier-forestry conflict; identify what stakeholders believe are the policy instruments and management strategies that may be useful in managing the conflict and finally identify plausible solutions that may be relevant to similar conflicts around multi-functional forests elsewhere in Europe and globally. Semi-structured interviews were conducted with key actors in this conflict. Drawing on Walker and Daniels' conflict triangle theory, a qualitative analysis of the transcripts of these interviews revealed that the conflict between Hen Harrier conservation and forestry in Ireland has a number of deep-rooted dimensions including those relating to the substance (e.g. restrictions on forest management activity in the SPAs), as well as procedural (e.g. lack of stakeholder engagement) and relationship dimensions (e.g. lack of trust). The polarisation of views in this conflict testifies to how entrenched stakeholders can become through lack of communication and trust. The policy instruments that stakeholders identified as having potential to address the conflict include the introduction of incentives/compensation scheme; changes to restrictions; more data and research on Hen Harrier bird surveys; implementation of landscape management models; and better communication and stakeholder engagement. The study highlights that conservation conflicts persist due to the multi-functional nature of forests and also due to repeated mistakes in terms of the lack of engagement with local stakeholders. Increasing the involvement of local actors has important substantive and instrumental benefits including improving the quality of decisions, as well as creating a greater chance of policies being better socially and politically acceptable. The need for more and better capacity-building across EU Member States for statutory and government agencies to learn from one another in terms of how to avoid repeating the same mistakes from one site to another is highlighted.

Barriers to Effective use of Palliative Care Services in the Acute Care Setting with Emphasis on Terminal Noncancer Diseases.

INTRODUCTION: This study assessed the views of nurses, resident doctors, and attending physicians of the use of a readily available pain and palliative care specialty at their institution while assessing their ability to recognize terminal noncancer illnesses. METHODOLOGY: In community hospital consisting of an in-patient pain and palliative specialty, attending physicians, residents, and nurses participate in a survey highlighting the following: parameters for referral/consultation, definition of noncancer-related terminal illnesses, role of pain and palliative care in acute care, consult/referral delay, barriers to effective referral, recognition and withdrawal of futile care, and opioid prescription. Patterns of responses by each professional group were compared and contrasted. RESULTS: The most common accepted reasons for referral were that of hospice care, terminal cancer, and uncontrolled pain, while reasons related to terminal noncancer illnesses were less accepted. A majority of approved physical and social parameters to define terminal noncancer illnesses were not universally accepted among the groups-especially among attendings and residents. While most participants agreed that the best time to refer to palliative care specialty was at the point of diagnosis of a terminal illness, >25% of participants from each group felt that referrals should be done later in the course of the illness. The most highlighted reasons expressed by attendings and residents for the delay in consult were either that of excessive withdrawal of modalities of care or interference with ongoing management that may benefit the patient. Most residents and nurses agreed that attendings' reluctance to consult is a major barrier to its utilization. CONCLUSION: Barriers to effective utilization are multifactorial, mostly relating to perceptions of the specialty as well as ineffective communication within specialties.

A Systematic Review of Prognostic Factors for Sensory Recovery After Digital Nerve Reconstruction.

BACKGROUND: Successful digital nerve repair is crucial in preventing painful neuroma formation and restoring sensory function after traumatic hand injury. The purpose of this study is to identify prognostic factors affecting sensory recovery following digital nerve reconstruction. METHODS: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines including studies reporting patients 18 years and older, greater than 10 reconstructed digital nerves, and greater than or equal to 3 months follow-up. Studies with proximal nerve injuries in the same distribution or inadequate sensory data were excluded. Included studies were evaluated by methodological index for nonrandomized studies score. Possible predictors were examined using the t test and 1-way analysis of variance with α ≤ 0.05. RESULTS: Twenty-five studies met the inclusion criteria, consisting of 818 surgically reconstructed digital nerves (mean age, 38 years; 78% male) with a mean ± SD defect length of 1.5 ± 0.5 cm. Mean follow-up time was 22 months. Fifty-six percent of patients presented with concomitant injuries to tendons (31%) and the digital artery (13%). Mean ± SD time to surgical repair was 36 ± 73.8 days. Reconstructive techniques included 35% end-to-end primary neurorrhaphy, 31% nerve grafts, and 11% synthetic conduits. Postoperatively, 81% of the patients demonstrated sensory recovery of S3+/S4, with 45% complaining of hyperesthesia. Nerve reconstructions performed within 15 days of injury had significantly better static 2-point discrimination than delayed procedures (P = 0.02). Static 2-point discrimination measurements were also significantly better for shorter defect lengths (<1.3 cm, P = 0.05). No significant functional differences were found across age, follow-up time, injured digit or side, nor reconstructive technique. CONCLUSIONS: Digital nerve reconstruction has good to excellent sensory recovery in up to 81% of patients with improved results in nerve gaps less than 1.3 cm. Performing the reconstruction within 15 days of injury is also correlated with improved sensory recovery.

Development, Implementation, and Evaluation of Three Outreach Events to Improve COVID-19 Vaccine Uptake Among Racial and Ethnic Minority Communities in Houston, Texas, 2022.

OBJECTIVES: Lack of access to timely, accurate, and linguistically appropriate COVID-19 information has complicated the dissemination of evidence-based information and contributed to vaccine hesitancy among racial and ethnic minority groups in the United States. We developed community events that provided outreach, education, and access to COVID-19 vaccination to overcome vaccine hesitancy in these communities. METHODS: Using spatial analysis techniques, we identified 3 communities with low vaccine uptake in Houston, Texas, in fall 2021; engaged 20 stakeholders from these communities via 4 focus groups to understand barriers to vaccination; and developed and implemented 3 COVID-19 vaccine education and outreach events tailored to the needs of these communities in January-March 2022. We used program evaluation surveys to assess attendee characteristics and satisfaction with the events. Vaccinated attendees also completed surveys on what motivated them to get vaccinated. RESULTS: Two communities were predominantly Hispanic, and the third had an equal number of Black and Hispanic residents. Based on community stakeholder input, the study team organized 2 health fairs and 1 community festival featuring dialogue-based COVID-19 vaccine engagement in January and March 2022. Across the 3 events, a total of 865 attendees received COVID-19 education and 205 (24.0%) attendees received a COVID-19 vaccine or booster. Of 90 attendees who completed program evaluation surveys, 81 (90%) rated the outreach event as good or excellent. Of 145 attendees who completed postvaccination surveys, 132 (91%) endorsed ≥1 key program feature as motivating them to either get vaccinated or vaccinate their child that day. CONCLUSION: Community outreach events are important strategies for disseminating information, building trust, and facilitating COVID-19 vaccine uptake.

Electroconvulsive therapy for the acute management of severe agitation in dementia (ECT-AD): A modified study protocol.

OBJECTIVE: This study began as a single-blind randomized controlled trial (RCT) to investigate the efficacy and safety of electroconvulsive therapy (ECT) for severe treatment-refractory agitation in advanced dementia. The aims are to assess agitation reduction using the Cohen-Mansfield Agitation Inventory (CMAI), evaluate tolerability and safety outcomes, and explore the long-term stability of agitation reduction and global functioning. Due to challenges encountered during implementation, including recruitment obstacles and operational difficulties, the study design was modified to an open-label format and other protocol amendments were implemented. METHODS: Initially, the RCT randomized participants 1:1 to either ECT plus usual care or simulated ECT plus usual care (S-ECT) groups. As patients were enrolled, data were collected from both ECT and simulated ECT (S-ECT) patients. The study now continues in an open-label study design where all patients receive actual ECT, reducing the targeted sample size from 200 to 50 participants. RESULTS: Study is ongoing and open to enrollment. CONCLUSION: The transition of the ECT-AD study design from an RCT to open-label design exemplifies adaptive research methodologies in response to real-world challenges. Data from both the RCT and open-label phases of the study will provide a unique perspective on the role of ECT in managing severe treatment-refractory agitation in dementia, potentially influencing future clinical practices and research approaches.

Modelling the role of learner presence within the community of inquiry framework to determine online course satisfaction in distance education.

This study sought to investigate the nuances in predictive relationships existing among teaching presence, cognitive presence and social presence as well as learner presence in the Community of Inquiry (CoI) framework towards online course satisfaction. The study is necessitated by the deficiency of current literature in providing information on the nuances in interaction among the three original presences and learner presence, prior to the final determination of online course satisfaction. Thus, the study adopted a survey design and collected data via a questionnaire from 347 postgraduate students on an online database course. Partial Least Squares Structural Equation Modelling was used to validate a definite model on the predictive relationships existing among teaching presence, cognitive presence, social presence, learner presence and online course satisfaction. Results from the structural model analysis proved a statistically significant predictive relationship between learner presence and the three other presences (i.e. cognitive presence, social presence and teaching presence). Other relationships established include social presence and cognitive presence; social presence and teaching presence. Finally, online course satisfaction was predicted by social presence and teaching presence. Based on the findings it was recommended that institutions that offer online courses should device concrete strategies that promote social presence and teaching presence since these variables are precursors to online course satisfaction. Finally, the design of online courses should be effective and learner-centred to attract the learner since learner presence determines all the other three 'presences' in online learning environment.

Developmental ablation of mature oligodendrocytes exacerbates adult CNS demyelination.

Multiple sclerosis (MS) is a CNS neurodegenerative autoimmune disease characterized by loss of oligodendrocytes and myelin in the brain and the spinal cord that results in localized functional deficits. Several risk factors have been associated with MS, however none fully explain the enhanced susceptibility seen in older individuals. Epidemiological data, based on geographical prevalence studies suggest that susceptibility is established early in life and frequently long before the diagnosis of disease raising the possibility that developmental events influence adult disease onset and progression. Here we test the hypothesis that selective loss of mature oligodendrocytes during postnatal development results in enhanced susceptibility to a demyelinating insult to the mature CNS. A transgenic mouse model was utilized to specifically induce apoptotic cell death in a subset of mature oligodendrocytes (MBP-iCP9) during the first 2 postnatal weeks followed by either a local LPC spinal cord injection or the induction of EAE in the adult animal. Immunostaining, immunoblotting, behavioral testing, and electron microscopy were utilized to examine the differences in the response between animals with developmental loss of oligodendrocytes and controls. We show that during development, oligodendrocyte apoptosis results in transient reductions in myelination and functional deficits that recover after 10-14 days. Compared to animals in which oligodendrocyte development was unperturbed, animals subjected to postnatal oligodendrocyte loss showed delayed recovery from an LPC lesion to the mature spinal cord. Unexpectedly, the induction and severity of MOG induced EAE was not significantly altered in animals following oligodendrocyte developmental loss even though there was a substantial increase in spinal cord tissue damage and CNS inflammation. It is unclear why the elevated glial responses seen in developmentally compromised animals were not reflected in enhanced functional deficits. These observations suggest that developmental loss of oligodendrocytes results in long lasting tissue changes that alter its response to subsequent insults and the capacity for repair in the adult.

Can dietary fructans lower serum glucose?

BACKGROUND: Convincing evidence indicates that the consumption of inulin-type fructans, inulin, and oligofructose has beneficial effects on blood glucose changes in animal models, although data in humans have been considered equivocal. As such, a systematic review of available literature on humans was conducted to evaluate the effectiveness of dietary inulin-type fructans on serum glucose. METHODS: Thirteen eligible randomized controlled trials (RCT), published from 1984 to 2009, were identified using a comprehensive search strategy involving the PubMed, Medline, and Cochrane Library databases. Exclusion criteria, such as the absence of a control group, lack of information on the quantity of inulin-type fructans used, and lack of glucose values at outcome, were established. RESULTS: Upon review, only four of the 13 trials (31%) showed a decrease in serum glucose concentration and only one of these was statistically significant. The remaining nine trials showed no significant changes in serum glucose concentration. CONCLUSION: Based on the present systematic review, it does not appear that inulin-type fructans have a significant lowering effect on serum glucose in humans. More RCT are needed to determine whether inulin-type fructans, inulin, and oligofructose have beneficial effects on blood glucose in humans.