Use of an expert elicitation methodology to compare welfare impacts of two approaches for blood sampling European badgers (Meles meles) in the field.

In the UK and Republic of Ireland, the European badger (Meles meles) is considered the most significant wildlife reservoir of the bacterium Mycobacterium bovis, the cause of bovine tuberculosis (bTB). To expand options for bTB surveillance and disease control, the Animal and Plant Health Agency developed a bespoke physical restraint cage to facilitate collection of a small blood sample from a restrained, conscious badger in the field. A key step, prior to pursuing operational deployment of the novel restraint cage, was an assessment of the relative welfare impacts of the approach. We used an established welfare assessment model to elicit expert opinion during two workshops to compare the impacts of the restraint cage approach with the only current alternative for obtaining blood samples from badgers in the field, which involves administration of a general anaesthetic. Eleven panellists participated in the workshops, comprising experts in the fields of wildlife biology, animal welfare science, badger capture and sampling, and veterinary science. Both approaches were assessed to have negative welfare impacts, although in neither case were overall welfare scores higher than intermediate, never exceeding 5-6 out of a possible 8. Based on our assessments, the restraint cage approach is no worse for welfare compared to using general anaesthesia and possibly has a lower overall negative impact on badger welfare. Our results can be used to integrate consideration of badger welfare alongside other factors, including financial cost and efficiency, when selecting a field method for blood sampling free-living badgers.

Patient and multidisciplinary health professional perceptions of an Australian geriatric evaluation and management and rehabilitation hospital in the home service.

OBJECTIVES: Hospital in the Home models are rapidly expanding in response to increasing bed pressures. This study examined patient and multidisciplinary health professional perceptions of a new geriatric evaluation and management and rehabilitation hospital in the home service in Australia. The service was unique, as adults of all ages with a variety of rehabilitation or geriatric evaluation and management needs were within scope. METHODS: A qualitative descriptive approach was used with a consumer co-researcher and a consumer advisor being integral to decision-making. Patient feedback was collected via a paper-based patient satisfaction survey between August 2020 and February 2022. Additionally, interviews with current and past staff were conducted from July to November 2021. Reflexive thematic analysis was conducted for qualitative data and descriptive statistics used for quantitative data. RESULTS: Patient surveys were analysed (n = 199, 42.2% response rate) with 60.8% of participants aged 75 years or over and 26.6% speaking a language other than English. High satisfaction was expressed. Feelings of comfort, familiarity, convenience, and reassurance were voiced. A person-centred approach enhanced involvement in care. Challenges included carer burden and clear communication. Sixteen staff (33% response rate) were interviewed. In general, staff said the service was inclusive and responsive, and the home environment beneficial, particularly for patients from culturally diverse backgrounds. A strong hospital partnership and comprehensive multidisciplinary approach were vital. Challenges included fragmentation due to part-time roles and combining with a pre-existing acute hospital in the home service. CONCLUSIONS: This qualitative exploration of staff and patients' perceptions of a geriatrician-led, multidisciplinary geriatric evaluation and management and rehabilitation hospital in the home service demonstrated that it was person-centred and optimised patients' control and ownership of care. The inclusive service parameters ensured responsiveness to diverse needs whilst allowing earlier return home from hospital, both of which are vital for quality patient care.

Learning and development needs for successful staff and consumer partnerships on healthcare quality improvement committees: a co-produced cross-sectional online survey.

Objectives This study aimed to conduct a learning and development needs analysis of quality improvement partnership capabilities of staff and consumers on partnership committees at an Australian metropolitan hospital and health service. Objectives were to compare consumer and staff self-rated capability importance, performance, and learning needs; to investigate if years of partnership experience influenced ratings; and to ascertain staff and consumer preferred learning strategies. Methods An online cross-sectional survey was adapted from the Hennessy-Hicks Training Needs Analysis questionnaire. Participants self-rated the importance of, and their performance on, 10 capabilities, across four domains, of an internationally validated co-produced capability development framework. They also rated preferences regarding learning approaches and media. Results A total of 199 members from 41 committees (174 staff; 25 consumers; response rate 35.38%) participated. There was a statistically significant learning and development need across all capabilities (P < 0.01). The highest learning need was for influencing organisational systems and policy (mean = -0.96; s.d. = 1.23), followed by equalising power and leadership (mean = -0.91; s.d. = 1.22), and then implementing partnership best practices (mean = -0.89; s.d. = 1.22). There were no statistically significant differences between consumers and staff on ratings, or correlations between years of partnership experience and ratings (P < 0.01). A combination of learning approaches was preferred, followed by learning through experience. Self-reflection was least preferred, which is concerning given it may promote equalising power and leadership. Face-to-face then videoconferencing were the preferred learning media. Conclusions Continuous co-learning for staff and consumers about QI partnerships is essential. Committee members needed more feedback regarding their influence and to be engaged in innovative co-design practices.

'Learning and growing together': exploring consumer partnerships in a PhD, an ethnographic study.

BACKGROUND: Consumer and community involvement (CCI) in health research is increasingly recognised as best practice and is closely linked with calls for epistemic justice and more transparent university collaborations with consumers. Given doctoral candidates play a key role in the future of co-production, examination of consumer partnerships in PhDs is important. This study aimed to describe and evaluate consumer partnerships in a PhD from the perspective of the consumer co-researchers, the PhD candidate, and the academic supervisors including optimal approaches, impacts, and benefits and challenges. METHODS: This prospective, co-produced ethnographic study was conducted over 33 months. Data collection included field notes, a monthly online log of partnership experiences and time spent, interviews or a focus group every six months, and a PhD student reflexive diary. Qualitative data were analysed using reflexive thematic analysis. RESULTS: The student, two academics, and four consumer co-researchers were involved. A mean of 11.10 h per month were spent on CCI. The student spent the most time (mean 15.86 h per month). Preparation for dissemination of findings was the most frequent partnership activity. The two overarching themes emphasised that a PhD promotes a rich partnership ethos with the student at the centre and that the partnership was a worthwhile but challenging process. The four sub-themes highlighted that developing a collegial and supportive environment with regular meetings combined with a multi-faceted and responsive co-learning approach were core to success. Additionally, there were benefits for individuals, research processes and outcomes, and for driving change in consumer-academic research partnerships. Recruiting to and forming the partnership, maintaining the collaboration through inevitable changes and challenges, and an ethical and supportive closure of the research team were critical. CONCLUSIONS: This longitudinal ethnographic study demonstrated that doctoral research can create a rich ethos for research and knowledge co-production which evolved over time. Equalising power dynamics through relationship building and co-learning was critical. Additionally, a focus on supportively ending the partnership was essential, and CCI may reduce PhD student isolation and procrastination. Enhanced university incentivisation of co-production in health research is recommended to address gaps in consumer remuneration and student support.

Partnering with people who use health services, their families, and the community (consumers) to do research is ethically the right thing to do and leads to better research. Unfortunately, it often does not happen, and researchers are not sure how to do it. To change this, we want researchers to partner with consumers early in their research career, when they are doing a PhD. However, there is limited evidence about this topic. This study described and evaluated a partnership from the viewpoints of the PhD student, the university supervisors (academics), and the consumer co-researchers over 33 months. We found that the whole team learned and grew together, and that the longer-term learning environment of a PhD helped foster a more equal partnership. The partnership was enjoyable and provided many benefits to those involved and to the studies. Much time was spent sharing research in ways that were better for consumers such as social media, newsletters, and presentations. At the start of the partnership, it was important to set up the team for success and there were many challenges along the way which needed flexibility. It was important to prepare for the ending of the PhD so that everyone felt supported to move on. Two big challenges were that the university did not have resources such as templates or courses to help the student learn about partnerships and did not have dedicated funding to pay the consumers for their time.

Tissue distribution of angiotensin-converting enzyme 2 (ACE2) receptor in wild animals with a focus on artiodactyls, mustelids and phocids.

Natural cases of zooanthroponotic transmission of SARS-CoV-2 to animals have been reported during the COVID-19 pandemic, including to free-ranging white-tailed deer (Odocoileus virginianus) in North America and farmed American mink (Neovison vison) on multiple continents. To understand the potential for angiotensin-converting enzyme 2 (ACE2)-mediated viral tropism we characterised the distribution of ACE2 receptors in the respiratory and intestinal tissues of a selection of wild and semi-domesticated mammals including artiodactyls (cervids, bovids, camelids, suids and hippopotamus), mustelid and phocid species using immunohistochemistry. Expression of the ACE2 receptor was detected in the bronchial or bronchiolar epithelium of several European and Asiatic deer species, Bactrian camel (Camelus bactrianus), European badger (Meles meles), stoat (Mustela erminea), hippopotamus (Hippopotamus amphibious), harbor seal (Phoca vitulina), and hooded seal (Cystophora cristata). Further receptor mapping in the nasal turbinates and trachea revealed sparse ACE2 receptor expression in the mucosal epithelial cells and occasional occurrence in the submucosal glandular epithelium of Western roe deer (Capreolus capreolus), moose (Alces alces alces), and alpaca (Vicunga pacos). Only the European badger and stoat expressed high levels of ACE2 receptor in the nasal mucosal epithelium, which could suggest high susceptibility to ACE2-mediated respiratory infection. Expression of ACE2 receptor in the intestinal cells was ubiquitous across multiple taxa examined. Our results demonstrate the potential for ACE2-mediated viral infection in a selection of wild mammals and highlight the intra-taxon variability of ACE2 receptor expression, which might influence host susceptibility and infection.

Different in so many ways: Exploring consumer, health service staff, and academic partnerships in a research advisory group through rapid ethnography.

INTRODUCTION: Consumer and community involvement (CCI) encompasses the range of consumer engagement activities across the research cycle. Research advisory groups (RAGs) are a common method of CCI that may empower the consumer voice in research. However, there is limited evaluation of RAGs to guide occupational therapists considering this as a CCI strategy in research. The aim of this study was to explore the processes and outcomes of a RAG partnership for an eDelphi study. METHODS: Rapid ethnography enabled a rich, thick description of the RAG through triangulation of field notes, a monthly research team log, focus groups, and an individual interview. Data were analysed using reflexive thematic analysis. Recruitment targeted consumers, health service staff, and academics with experience in CCI to enhance the diversity of perspectives guiding the eDelphi study. The RAG met four times over 4 months. FINDINGS: Seven diverse RAG members were recruited resulting in a RAG of 12 members, including the research team that included two consumers. Reflexive thematic analysis resulted in an overarching theme: Different in so many ways, which reinforced that authentic CCI in research continues to be rare even for stakeholders with experience in CCI. There were four subthemes: Set up for success, Authentic and capable facilitation, Structures and strategies for genuine partnerships, and A ripple effect of benefits. Findings added to the limited research regarding RAGs and highlighted that a short-term RAG with 12 diverse stakeholders was an effective strategy to foster mutually beneficial and meaningful collaboration. Partnering with two consumer co-researchers in RAG planning, implementation, and evaluation was central to success. CONCLUSION: Findings demonstrated that with careful co-planning and recruitment, capable facilitation with support of a committed research team (inclusive of consumers), and empowering meeting processes and structures, a short-term RAG resulted in many benefits to participants and enhanced research outcomes.

A Rapid Literature Review of Multi-Criteria Decision Support Methods in the Context of One Health for All-Hazards Threat Prioritization.

Background: Multi-Criteria Decision Analysis (MCDA) is a decision support tool that can be used in public health emergency management. The use of a One Health lens in MCDA can support the prioritization of threats and interventions which cut across the human, animal, and environmental domains. Previous literature reviews have focused on creating a snapshot of MCDA methodological trends. Our study provides an update to the MCDA methods literature with key considerations from a One Health perspective and addresses the application of MCDA in an all-hazards decision-making context. Methods: We conducted a literature search on MEDLINE, EMBASE, SCOPUS, the CAB database, and a limited online gray literature search in partnership with a librarian from Health Canada. Articles were limited to those published in the year 2010 or later in a high-income setting (OECD member countries). Results: Sixty-two articles were included for synthesis. Of these articles, most were Canadian studies (20%); and prioritized health risks, threats, and interventions in the human domain (69%). Six commonly used prioritization criteria were identified: threat, health, intervention, strategic, social, and economic impact. Stakeholders were engaged in 85% of studies and commonly consisted of government groups, non-governmental groups, subject matter experts, and the public. While most articles (65%) included elements of One Health based on our definition, only 5 studies (9%) explicitly acknowledged One Health as a guiding principle for the study. Forty seven percentage of studies noted that MCDA was beneficial in supporting the decision-making process. Conclusion: Current literature on health prioritization presents some variability in the depth of integration of the One Health framework and on the use of various MCDA methodologies given prioritization objectives. Studies which applied a comprehensive One Health approach, prioritized disparate threats, or conducted cyclical prioritizations for governing bodies were broad in scope, but sparse. The results of our review indicate the need for better guidance on the integration of a One Health approach and the use of various MCDA methods given the main prioritization objectives.

Refining a capability development framework for building successful consumer and staff partnerships in healthcare quality improvement: A coproduced eDelphi study.

BACKGROUND: The capability of consumers and staff may be critical for authentic and effective partnerships in healthcare quality improvement (QI). Capability frameworks describe core knowledge, skills, values, attitudes, and behaviours and guide learning and development at individual and organizational levels. OBJECTIVE: To refine a capability framework for successful partnerships in healthcare QI which was coproduced from a scoping review. DESIGN: A two-round eDelphi design was used. The International Expert Panel rated the importance of framework items in supporting successful QI partnerships, and suggested improvements. They also rated implementation options and commented on the influence of context. PARTICIPANTS: Seven Research Advisory Group members were recruited to support the research team. The eDelphi panel included 53 people, with 44 (83%) and 42 (77. 8%) participating in rounds 1 and 2, respectively. They were from eight countries and had diverse backgrounds. RESULTS: The Research Advisory Group and panel endorsed the framework and summary diagram as valuable resources to support the growth of authentic and meaningful partnerships in QI across healthcare contexts, conditions, and countries. A consensus was established on content and structure. Substantial rewording included a stronger emphasis on growth, trust, respect, inclusivity, diversity, and challenging the status quo. The final capability development framework included three domains: Personal Attributes, Relationships and Communication, and Principles and Practices. The Equalizing Decision Making, Power, and Leadership capability was foundational and positioned across all domains. Ten capabilities with twenty-seven capability descriptions were also included. The Principles and Practices domain, Equalizing Decision Making, Power, and Leadership capability, and almost half (44.4%) of the capability descriptions were rated as more important for staff than consumers (p < .01). However, only the QI processes and practices capability description did not meet the inclusion threshold for consumers. Thus, the framework was applicable to staff and consumers. CONCLUSION: The refined capability development framework provides direction for planning and provision of learning and development regarding QI partnerships. PATIENT OR PUBLIC CONTRIBUTION: Two consumers were full members of the research team and are coauthors. A Research Advisory Group, inclusive of consumers, guided study execution and translation planning. More than half of the panel were consumers.

"Extremely Painful, but Worth It": The Lived Experience of Receiving Collagenase as Treatment for Dupuytren Disease.

BACKGROUND: Collagenase injection is a relatively new, minimally invasive treatment option for Dupuytren disease. Most literature focusses on quantitative outcome measures, such as degree of residual contracture and recurrence. The patient experience of the treatment has rarely been explored. This study sought to explore patients' experiences of the treatment process, including their reasons for seeking and choosing the treatment. METHODS: A qualitative descriptive design was used to explore patients' experiences. Seven patients (aged 57 to 81 years) who had received collagenase treatment for Dupuytren disease engaged in individual, semistructured interviews. Interviews were audio recorded, transcribed verbatim, and analyzed thematically. RESULTS: Thematic analysis revealed that Dupuytren disease was an obstacle to doing things, but not a barrier. Patients "went with the flow" of treatment, often taking a passive approach to their health care decisions. Patients found the collagenase injections to be extremely painful, but worth it. They had a varied knowledge of the disease and treatment. CONCLUSIONS: Patients were pleased with the results of the collagenase treatment, even if the finger was not completely straight or there was recurrence. The quick recovery and minimal complications were positive factors; however, the injections were extremely painful and could deter patients from future treatment. This research highlighted that a number of patients had low health literacy regarding their condition, and this affected their expectations of treatment outcomes and future treatment seeking. There are opportunities for health professionals to improve health literacy for people with Dupuytren disease, possibly in a group setting.

Multi-site evaluation of advanced practice hand therapy clinics for the management of patients with trigger digit.

STUDY DESIGN: Prospective cohort design. BACKGROUND: Patient time on Australian public hospital surgical outpatient department (SOPD) waitlists often exceeds clinical recommendations for chronic hand conditions. Diversion to allied health is an alternative option, however evidence regarding patient and organizational outcomes in hand therapy is lacking. PURPOSE OF THE STUDY: To evaluate clinical and organizational efficacy, patient outcomes and satisfaction of diversion of referrals for patients with trigger digit (TD) from SOPD waitlists to Advanced Practice Hand Therapy (APHT) at 3 Australian hospitals. METHODS: Data was collected from eligible patients with TD through chart reviews and telephone satisfaction surveys. Data included number of patients requiring SOPD review, repeat referral to SOPD in the 12 months following APHT discharge, patient-rated outcomes, satisfaction scores, wait times to SOPD review and conversion to surgery-rates. Mann Whitney-U, t-test, Pearson's chi-squared test and a Binary Logistic Regression analysis were performed. RESULTS: 104 patients completed APHT treatment. Seventy patients (67%) did not require return to the SOPD waitlist. Repeat referral to SOPD within 12 months of APHT discharge occurred for only 1 patient. Patients requiring SOPD review after APHT treatment were seen within target time frames and demonstrated 88% conversion to surgery-rates. Michigan Hand Outcome Questionnaire scores showed greater improvement in those not requiring SOPD review (P< .001~25.9 vs 4.2). Regression analysis identified a negative association between initial total Michigan Hand Outcome Questionnaire scores and unfavorable discharge outcomes (OR 0.96, P= .007). Most (81%-93%) patients indicated satisfaction with the APHT service. CONCLUSION: Diversion of referrals for TD from SOPD to APHT is an effective waitlist management strategy, with the propensity to reduce waiting times, improve patient flow, whilst resulting in favorable clinical and patient-rated outcomes and satisfaction.

Co-produced capability framework for successful patient and staff partnerships in healthcare quality improvement: results of a scoping review.

BACKGROUND: Internationally, patient and public involvement (PPI) is core policy for health service quality improvement (QI). However, authentic QI partnerships are not commonplace. A lack of patient and staff capability to deliver successful partnerships may be a barrier to meaningful QI collaboration. OBJECTIVES: The research questions for this scoping review were: What is known regarding the capabilities required for healthcare staff and patients to effectively partner in QI at the service level?; and What is known regarding the best practice learning and development strategies required to build and support those capabilities? METHODS: A six-stage scoping review was completed. Five electronic databases were searched for publications from January 2010 to February 2020. The database searches incorporated relevant terms for the following concepts: capabilities for PPI in healthcare QI; and best practice learning and development strategies to support those capabilities. Data were analysed using descriptive statistics and qualitative content analysis. RESULTS: Forty-nine papers were included. Very little peer-reviewed literature focused explicitly on capabilities for QI partnerships and thus implicit paper content was analysed. A Capability framework for successful partnerships in healthcare quality improvement was developed. It includes knowledge, skills and attitudes across three capability domains: Personal Attributes; Relationships and Communication; and Philosophies, Models and Practices, and incorporates 10 capabilities. Sharing power and leadership was discussed in many papers as fundamental and was positioned across all of the domains. Most papers discussed staff and patients' co-learning (n=28, 57.14%). Workshops or shorter structured training sessions (n=36, 73.47%), and face-to-face learning (n=34, 69.38%) were frequently reported. CONCLUSION: The framework developed here could guide individualised development or learning plans for patient partners and staff, or could assist organisations to review learning topics and approaches such as training content, mentoring guidelines or community of practice agendas. Future directions include refining and evaluating the framework. Development approaches such as self-reflection, communities of practice, and remote learning need to be expanded and evaluated.

Consumer engagement in occupational therapy health-related research: A scoping review of the Australian Occupational Therapy Journal and a call to action.

INTRODUCTION: Consumer engagement in research is becoming an ethical, political, and moral imperative. The aim of this scoping review was to provide a snapshot of the current status of the emerging area of consumer engagement in occupational therapy health-related research, as published in the Australian Occupational Therapy Journal. METHODS: A scoping review was conducted of all health-related original research published in the Australian Occupational Therapy Journal for 5½ years, plus Early View, as at June 2019. Eligible papers were examined for consumer engagement content which included any active choice or control by consumers, beyond being a research participant. A recognised six stage methodology was used with quantitative and qualitative data analysed. Two consumers collaborated in interpreting the data including finalising themes, leading theme naming, developing key discussion points, and producing recommendations. RESULTS: Of the 123 eligible papers, 48 (39.02%) included consumer engagement. However, only two incorporated consumer engagement across all research phases-preparation, execution and translation. A total of 103 consumer engagement activities were charted and categorised across all papers. There were limited instances of consumer collaboration (14/103, 13.59%) or consumer-led research processes (15/103, 14.56%) reported. Four themes emerged: Parity in research partnerships; It's important to know the Who, What, When, How and So What of consumer involvement; Consumer engagement must be a two-way process-not a dead end street; and Meeting the challenge-being diverse and inclusive. CONCLUSION: Comprehensive consumer-researcher partnerships may not be common-place in health-related occupational therapy research in the Australian Occupational Therapy Journal. This paper is a call to action. Occupational therapists must embrace consumer research partnerships as a demonstration of the key philosophies of enabling and empowering consumers and communities. Collaboration with two consumers in finalising data analysis, results interpretation and reporting added a diverse and valuable perspective.

Community disruption in small biogenic habitats: A coastal invader overcomes habitat complexity to alter community structure.

Non-indigenous species are often identified as threats to native species and communities. Yet, the mechanisms that enable many of these invaders to thrive and alter their newly invaded habitats are still not fully understood. This applies to habitats such as widespread sedimentary shorelines characterized by the presence of scattered biogenic clumps of blue mussels (Mytilus edulis) structurally more complex than bare sediments. In Atlantic Canada, some of these shorelines are numerically dominated by native mud crabs (Dyspanopeus sayi) but have been gradually invaded by the European green crab (Carcinus maenas). This study describes between-habitat (mussel clump vs. bare sediment) differences in density and diversity of invertebrates. It also tests the impact of juvenile green crabs in comparison to native mud crabs using two approaches: First, measuring habitat-related differences in these crabs' feeding rates on a common prey (soft-shell clams, Mya arenaria). Second, measuring their influence on invertebrate communities associated with mussel clumps. The results show that mussel clumps hold higher invertebrate density and diversity than surrounding sedimentary bottoms. In the laboratory, the feeding rates of native mud crabs were dependent on the type of habitat (sand flat > mussel clump), whereas those of green crabs were significantly higher and unrelated to the habitat in which predation occurred. In field experiments, juvenile green crabs were also the only predators that changed community structure in the mussel clump habitat. These results indicate that green crabs can cause a significant impact on native species and communities. Moreover, they suggest that the ability of this species to overcome the refuge provided by complex biogenic habitats for prey may represent an unexplored mechanism to explain this invader's expansion here and elsewhere.

A cohort investigation of patient-reported function and satisfaction after the implementation of advanced practice occupational therapy-led care for patients with chronic hand conditions at eight Australian public hospitals.

STUDY DESIGN: Prospective cohort. INTRODUCTION: Patients referred to medical specialist outpatient clinics in Australian public hospitals often wait longer than the recommended timeframe for their first appointment. This study examines the use of advanced hand therapy practitioners to facilitate access to care for long-waitlisted patients with chronic hand conditions. PURPOSE OF STUDY: To examine patient-reported function and satisfaction outcomes with advanced practice hand therapy. METHODS: Data was collected from eight public hospital outpatient departments in Queensland, Australia. Patients with chronic hand conditions were screened from waitlists at each site and invited to participate in the hand therapy program while waiting to see a medical practitioner. RESULTS: A total of 1947 patients were screened from the waitlists, and 1116 patients completed advanced practice therapy. Patients completing hand therapy were older (P ≤ .001) and more likely to have more than one diagnosis (P ≤ .001). They reported a significant improvement in function using the Michigan Hand Questionnaire (P ≤ .001) and demonstrated increased grip strength (left injuries P = .016, right injuries P = .001). Ninety-three percent were satisfied or highly satisfied with hand therapy care. Some variation in Michigan Hand Questionnaire scores was observed across different diagnoses, with those with carpal tunnel syndrome and trigger finger reporting the best outcomes. CONCLUSIONS: Advanced practice hand therapy for long-waitlisted patients with chronic hand conditions was associated with improvements in patient function and satisfaction. Further research is warranted to study the specific response of different diagnostic groups to intervention using this model of care.

Quantifying the relative predation pressure on bumblebee nests by the European badger (Meles meles) using artificial nests.

Bumblebee populations are declining. Factors that impact the size and success of colonies act by either limiting resource availability (bottom-up regulation) or causing mortality, for example, pesticides, disease, and possibly predation (top-down regulation). The impact of predation has not been quantified, and so, the current study used novel artificial nests as a proxy for wild bumblebee nests to quantify the relative predation pressure from badgers in two habitats: woodland and grassland, and at two nesting depths: surface and underground. Badgers occur across most parts of the UK and are known to predate on bumblebee nests. We found that significantly more artificial nests (pots containing bumblebee nest material) were dug up compared with control pots (pots without bumblebee nest material). This shows that artificial nests have the potential to be used as a method to study the predation of bumblebee nests by badgers. In a location of high badger density, predation pressure was greater in woodland than grassland, whereas no difference was observed in relation to nest depth. Woodland and grassland are shared habitats between bumblebees and badgers, and we suggest that higher predation may relate to activity and foraging behavior of badgers in woodland compared with grassland. We discuss how badger predation in different habitats could impact different bumblebee species according to their nesting behaviors. Understanding the relative impact of badger predation on bumblebee colonies provides key information on how such top-down regulation affects bumblebee populations.

Evaluation of occupational therapy-led advanced practice hand therapy clinics for patients on surgical outpatient waiting lists at eight Australian public hospitals.

STUDY DESIGN: This is a prospective cohort study. INTRODUCTION: Evidence is emerging that advanced practice hand therapy clinics improve patient outcomes. PURPOSE OF THE STUDY: The aim of this study was to evaluate an advanced practice hand therapy model of care for patients with chronic hand conditions on surgical outpatient waiting lists at eight Australian public hospitals. METHODS: Nonurgent and semiurgent patients were screened and treated, as required, by an advanced practice hand therapist and then discharged from the surgical outpatient waiting list as appropriate. Outcomes included patient safety, impact on the waiting list, patient satisfaction, and patients' perception of change as measured by Global Rating of Change (GROC). The GROC score was also compared across diagnoses. The relationship between the waiting time and need for surgical review during hand therapy treatment was also assessed. As appropriate, T-tests and analysis of variance were used for statistical analyses. RESULTS: A total of 37.2% of patients who commenced hand therapy were removed or discharged from the surgical outpatient waiting lists. Of the subset of patients who completed hand therapy (n = 1116), 28.4% were discharged without requiring surgical follow-up. A further 7.53% requested return to the waiting list despite discharge being recommended. The model of care was safe, and patient satisfaction was above 90%. The mean GROC score was +2.09 (±3.58) but varied across diagnoses with trigger finger or trigger thumb showing the greatest improvement (+4.21 ± 2.92, P < .01). Patients who did not require surgical consultation during hand therapy had a shorter wait time for their initial hand therapy appointment (P < .001). CONCLUSIONS: The advanced practice hand therapy model of care was safe and effective in reducing hospital surgical outpatient waiting lists. Patients reported high satisfaction.

Wildlife surveillance using deep learning methods.

Wildlife conservation and the management of human-wildlife conflicts require cost-effective methods of monitoring wild animal behavior. Still and video camera surveillance can generate enormous quantities of data, which is laborious and expensive to screen for the species of interest. In the present study, we describe a state-of-the-art, deep learning approach for automatically identifying and isolating species-specific activity from still images and video data.We used a dataset consisting of 8,368 images of wild and domestic animals in farm buildings, and we developed an approach firstly to distinguish badgers from other species (binary classification) and secondly to distinguish each of six animal species (multiclassification). We focused on binary classification of badgers first because such a tool would be relevant to efforts to manage Mycobacterium bovis (the cause of bovine tuberculosis) transmission between badgers and cattle.We used two deep learning frameworks for automatic image recognition. They achieved high accuracies, in the order of 98.05% for binary classification and 90.32% for multiclassification. Based on the deep learning framework, a detection process was also developed for identifying animals of interest in video footage, which to our knowledge is the first application for this purpose.The algorithms developed here have wide applications in wildlife monitoring where large quantities of visual data require screening for certain species.

Primary Contact Occupational Therapy Hand Clinics: The pull of an occupational perspective.

BACKGROUND/AIM: Primary contact models of care are an emerging area of occupational therapy practice that aim to respond to the changing health-care landscape. There is a dearth of literature exploring an occupational perspective in primary contact roles, and literature in the broader scope of hand therapy has recognised that occupational therapists' practice often aligns with the biomedical worldview. Therefore, this study aimed to explore the practice of occupational therapists within Primary Contact Occupational Therapy Hand (PCOTH) Clinics from an occupational perspective. METHOD: This ethnographic study gathered in-depth data through observations of primary contact hand therapy sessions, review of progress notes and interviews with occupational therapists. Qualitative data analysis was conducted using a three-stage process first at the item level, then pattern level and finally at the structural level. The research team collaboratively discussed all codes and then themes. RESULTS: The push of the biomedical culture and the pull of an occupational perspective was conceptualised as an overarching theme shaping occupational therapists' practice in the primary contact clinics. Five themes emerged: bottom-up approach to an occupational perspective, an occupational perspective via informal discussion, occupational therapists' expectations of patients, occupational perspective on autopilot and blurred professional identity. CONCLUSION: Occupational therapists working in primary contact roles were pushed by the biomedical culture of the setting. Despite this, there was still a pull towards an occupational perspective. This research provides an initial exploration of primary contact clinics, and highlighted the added bonus of an occupational perspective. The findings present a timely opportunity for occupational therapists to critically reflect on practice in PCOTH clinics.

Oysters and eelgrass: potential partners in a high pCO2 ocean.

Climate change is affecting the health and physiology of marine organisms and altering species interactions. Ocean acidification (OA) threatens calcifying organisms such as the Pacific oyster, Crassostrea gigas. In contrast, seagrasses, such as the eelgrass Zostera marina, can benefit from the increase in available carbon for photosynthesis found at a lower seawater pH. Seagrasses can remove dissolved inorganic carbon from OA environments, creating local daytime pH refugia. Pacific oysters may improve the health of eelgrass by filtering out pathogens such as Labyrinthula zosterae (LZ), which causes eelgrass wasting disease (EWD). We examined how co-culture of eelgrass ramets and juvenile oysters affected the health and growth of eelgrass and the mass of oysters under different pCO2 exposures. In Phase I, each species was cultured alone or in co-culture at 12°C across ambient, medium, and high pCO2 conditions, (656, 1,158 and 1,606 µatm pCO2 , respectively). Under high pCO2 , eelgrass grew faster and had less severe EWD (contracted in the field prior to the experiment). Co-culture with oysters also reduced the severity of EWD. While the presence of eelgrass decreased daytime pCO2 , this reduction was not substantial enough to ameliorate the negative impact of high pCO2 on oyster mass. In Phase II, eelgrass alone or oysters and eelgrass in co-culture were held at 15°C under ambient and high pCO2 conditions, (488 and 2,013 µatm pCO2 , respectively). Half of the replicates were challenged with cultured LZ. Concentrations of defensive compounds in eelgrass (total phenolics and tannins), were altered by LZ exposure and pCO2 treatments. Greater pathogen loads and increased EWD severity were detected in LZ exposed eelgrass ramets; EWD severity was reduced at high relative to low pCO2 . Oyster presence did not influence pathogen load or EWD severity; high LZ concentrations in experimental treatments may have masked the effect of this treatment. Collectively, these results indicate that, when exposed to natural concentrations of LZ under high pCO2 conditions, eelgrass can benefit from co-culture with oysters. Further experimentation is necessary to quantify how oysters may benefit from co-culture with eelgrass, examine these interactions in the field and quantify context-dependency.