Leveraging natural capital accounting to support businesses with nature-related risk assessments and disclosures.

Nature loss threatens businesses, the global economy and financial stability. Understanding and addressing these risks for business will require credible measurement approaches and data. This paper explores how natural capital accounting (NCA) can support business data and information needs related to nature, including disclosures aligned with the Taskforce on Nature-related Financial Disclosures recommendations. As businesses seek to measure, manage and disclose their nature-related risks and opportunities, they will need well-organized, consistent and high-quality information regarding their dependencies and impacts on nature, which few businesses currently collect or track in-house. NCA may be useful for these purposes but has not been widely used or applied by businesses. National NCA guided by the U.N. System of Environmental-Economic Accounting may provide: (i) a useful framework for businesses in conceptualizing, organizing and managing nature-related data and statistics; and (ii) data and information that can directly support business disclosures, corporate NCA and other business applications. This paper explores these opportunities as well as synergies between national and corporate natural capital accounts. In addition, the paper discusses key barriers to advancing the wider use and benefits of NCA for business, including: awareness of NCA, data access, business capabilities related to NCA, spatial and temporal scales of data, audit and assurance considerations, potential risks, and costs and incentives. This article is part of the theme issue 'Bringing nature into decision-making'.

Effective strategies for Fecal Immunochemical Tests (FIT) programs to improve colorectal cancer screening uptake among populations with limited access to the healthcare system: a rapid review.

BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of cancer death globally. CRC screening can reduce the incidence and mortality of CRC. However, socially disadvantaged groups may disproportionately benefit less from screening programs due to their limited access to healthcare. This poor access to healthcare services is further aggravated by intersecting, cumulative social factors associated with their sociocultural background and living conditions. This rapid review systematically reviewed and synthesized evidence on the effectiveness of Fecal Immunochemical Test (FIT) programs in increasing CRC screening in populations who do not have a regular healthcare provider or who have limited healthcare system access. METHODS: We used three databases: Ovid MEDLINE, Embase, and EBSCOhost CINAHL. We searched for systematic reviews, meta-analysis, and quantitative and mixed-methods studies focusing on effectiveness of FIT programs (request or receipt of FIT kit, completion rates of FIT screening, and participation rates in follow-up colonoscopy after FIT positive results). For evidence synthesis, deductive and inductive thematic analysis was conducted. The findings were also classified using the Cochrane Methods Equity PROGRESS-PLUS framework. The quality of the included studies was assessed. RESULTS: Findings from the 25 included primary studies were organized into three intervention design-focused themes. Delivery of culturally-tailored programs (e.g., use of language and interpretive services) were effective in increasing CRC screening. Regarding the method of delivery for FIT, specific strategies combined with mail-out programs (e.g., motivational screening letter) or in-person delivery (e.g., demonstration of FIT specimen collection procedure) enhanced the success of FIT programs. The follow-up reminder theme (e.g., spaced out and live reminders) were generally effective. Additionally, we found evidence of the social determinants of health affecting FIT uptake (e.g., place of residence, race/ethnicity/culture/language, gender and/or sex). CONCLUSIONS: Findings from this rapid review suggest multicomponent interventions combined with tailored strategies addressing the diverse, unique needs and priorities of the population with no regular healthcare provider or limited access to the healthcare system may be more effective in increasing FIT screening. Decision-makers and practitioners should consider equity and social factors when developing resources and coordinating efforts in the delivery and implementation of FIT screening strategies.

Expression of Interleukin-1ß protein in vitro,exvivo and in vivo salmonid models.

Interleukin-1ß (IL-1ß) is one of the first cytokines expressed during immune responses, and its levels are affected by many factors, including stress. To date, it has only been possible to measure IL-1ß transcript (mRNA) expression quantitatively in fish using qPCR. This is because previous studies that measured IL-1ß protein concentrations in these taxa used western blotting, which only provides qualitative data. To advance our knowledge of fish IL-1ß biology, and because post-translational processing plays a critical role in the activation of this molecule, we developed a quantitative enzyme-linked immunosorbent assay (ELISA) to accurately measure the concentration of IL-1ß protein in several cell cultures and in vivo in salmonids. We compared changes in IL-1ß protein levels to the expression of its mRNA. The developed ELISA was quite sensitive and has a detection limit of 12.5 pg/mL. The tools developed, and information generated through this research, will allow for a more accurate and complete understanding of IL-1ß's role in the immune response of salmonids.The assay described here has the potential to significantly advance our ability to assess fish health and immune status.

Developing an International Standard Set of Patient-Reported Outcome Measures for Psychotic Disorders.

OBJECTIVE: The objective of this project was to develop a set of patient-reported outcome measures for adolescents and adults who meet criteria for a psychotic disorder. METHODS: A research team and an international consensus working group, including service users, clinicians, and researchers, worked together in an iterative process by using a modified Delphi consensus technique that included videoconferencing calls, online surveys, and focus groups. The research team conducted systematic literature searches to identify outcomes, outcome measures, and risk adjustment factors. After identifying outcomes important to service users, the consensus working group selected outcome measures, risk adjustment factors, and the final set of outcome measures. International stakeholder groups consisting of >100 professionals and service users reviewed and commented on the final set. RESULTS: The consensus working group identified four outcome domains: symptoms, recovery, functioning, and treatment. The domains encompassed 14 outcomes of importance to service users. The research team identified 131 measures from the literature. The consensus working group selected nine measures in an outcome set that takes approximately 35 minutes to complete. CONCLUSIONS: A set of patient-reported outcome measures for use in routine clinical practice was identified. The set is free to service users, is available in at least two languages, and reflects outcomes important to users. Clinicians can use the set to improve clinical decision making, and administrators and researchers can use it to learn from comparing program outcomes.

Support for My Video is Support for Me: A YouTube Scoping Review of Videos Including Adolescents With Chronic Pain.

OBJECTIVES: Adolescents are heavy users of social media as a venue to share experience and obtain information. Adolescents with chronic pain may be no different. Given that adolescents with chronic pain report feelings of social isolation, of being different, and lack peer understanding, social media may help them obtain social support. We conducted a scoping review of YouTube to identify how adolescents with chronic pain use this platform to connect with other adolescents. MATERIALS AND METHODS: The terms "youth with chronic pain" and "teens with chronic pain" were entered into the YouTube search bar to locate videos. Videos in English, targeted at and including an adolescent with chronic pain were included. Videos were screened for eligibility until 20 consecutive videos listed on the main page were excluded. For each included video the first 5 related videos suggested by YouTube in the sidebar were also screened for eligibility. RESULTS: This selection process resulted in 18 included videos, with a total of 936 viewer comments. Recurring comment themes were identified using qualitative content analysis. Video content mainly covered multidisciplinary treatment options, alternative treatments, and impact of pain on daily life. Although a variety of treatment options were discussed, details of treatment were lacking. Comments reflected the overarching message "you are not alone!" and mainly focused on providing and receiving support, sharing suffering, and revealing the impact of pain on relationships and daily life. DISCUSSION: Despite potential challenges associated with social media, YouTube may be a promising platform for provision of social support for adolescents with chronic pain.

Four priorities for new links between conservation science and accounting research.

Article impact statement: New collaborations with accounting research can improve conservation impact of ecosystem-based information systems.

The use of cyclosporine for Stevens-Johnson syndrome-toxic epidermal necrolysis spectrum at the University of Louisville: A case series and literature review.

INTRODUCTION: Cyclosporine therapy for Stevens-Johnson syndrome-toxic epidermal necrolysis (SJSTEN) was first reported in the literature by Renfro et al. in 1989. Herein we report an additional 4 cases of SJS-TEN treated with cyclosporine. METHODS: Case information was collected retroactively at the University of Louisville Hospital in Louisville, KY. All cases had a diagnosis of SJS or TEN by a dermatologist. All patients were ≥18 years of age and treated with cyclosporine during their admission. RESULTS: Three of four patients re-epithelialized within an average of 3.67 days of starting 3-4 mg/kg/day of cyclosporine. One patient passed away, likely due to advanced endometrial cancer. DISCUSSION: We provide a review of the literature on cyclosporine use for SJS/TEN, including various outcome measures - stabilization (cessation of new lesions), time to re-epithelialization, mortality rate, and hospital length of stay and, where available, comparison to other systemic agents. CONCLUSION: The outcomes appear to be consistent with rapid re-epithelialization and low mortality as seen in many previous reports. Treating SJS-TEN with systemic agents including cyclosporine will remaincontroversial because the vast majority of data comes from case reports, case series, or small open prospective trials.

Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making.

BACKGROUND: Providers have traditionally established priorities for quality improvement; however, patients and their family members have recently become involved in priority setting. Little is known about how to reconcile priorities of different stakeholder groups into a single prioritized list that is actionable for organizations. OBJECTIVE: To describe the decision-making process for establishing consensus used by a diverse panel of stakeholders to reconcile two sets of quality improvement priorities (provider/decision maker priorities n=9; patient/family priorities n=19) into a single prioritized list. DESIGN: We employed a modified Delphi process with a diverse group of panellists to reconcile priorities for improving care of critically ill patients in the intensive care unit (ICU). Proceedings were audio-recorded, transcribed and analysed using qualitative content analysis to explore the decision-making process for establishing consensus. SETTING AND PARTICIPANTS: Nine panellists including three providers, three decision makers and three family members of previously critically ill patients. RESULTS: Panellists rated and revised 28 priorities over three rounds of review and reached consensus on the "Top 5" priorities for quality improvement: transition of patient care from ICU to hospital ward; family presence and effective communication; delirium screening and management; early mobilization; and transition of patient care between ICU providers. Four themes were identified as important for establishing consensus: storytelling (sharing personal experiences), amalgamating priorities (negotiating priority scope), considering evaluation criteria and having a priority champion. CONCLUSIONS: Our study demonstrates the feasibility of incorporating families of patients into a multistakeholder prioritization exercise. The approach described can be used to guide consensus building and reconcile priorities of diverse stakeholder groups.

Research priorities for managing the impacts and dependencies of business upon food, energy, water and the environment.

Delivering access to sufficient food, energy and water resources to ensure human wellbeing is a major concern for governments worldwide. However, it is crucial to account for the 'nexus' of interactions between these natural resources and the consequent implications for human wellbeing. The private sector has a critical role in driving positive change towards more sustainable nexus management and could reap considerable benefits from collaboration with researchers to devise solutions to some of the foremost sustainability challenges of today. Yet opportunities are missed because the private sector is rarely involved in the formulation of deliverable research priorities. We convened senior research scientists and influential business leaders to collaboratively identify the top forty questions that, if answered, would best help companies understand and manage their food-energy-water-environment nexus dependencies and impacts. Codification of the top order nexus themes highlighted research priorities around development of pragmatic yet credible tools that allow businesses to incorporate nexus interactions into their decision-making; demonstration of the business case for more sustainable nexus management; identification of the most effective levers for behaviour change; and understanding incentives or circumstances that allow individuals and businesses to take a leadership stance. Greater investment in the complex but productive relations between the private sector and research community will create deeper and more meaningful collaboration and cooperation.

Patient and Family Member-Led Research in the Intensive Care Unit: A Novel Approach to Patient-Centered Research.

INTRODUCTION: Engaging patients and family members as partners in research increases the relevance of study results and enhances patient-centered care; how to best engage patients and families in research is unknown. METHODS: We tested a novel research approach that engages and trains patients and family members as researchers to see if we could understand and describe the experiences of patients admitted to the intensive care unit (ICU) and their families. Former patients and family members conducted focus groups and interviews with patients (n = 11) and families of surviving (n = 14) and deceased (n = 7) patients from 13 ICUs in Alberta Canada, and analyzed data using conventional content analysis. Separate blinded qualitative researchers conducted an independent analysis. RESULTS: Participants described three phases in the patient/family "ICU journey"; admission to ICU, daily care in ICU, and post-ICU experience. Admission to ICU was characterized by family shock and disorientation with families needing the presence and support of a provider. Participants described five important elements of daily care: honoring the patient's voice, the need to know, decision-making, medical care, and culture in ICU. The post-ICU experience was characterized by the challenges of the transition from ICU to a hospital ward and long-term effects of critical illness. These "ICU journey" experiences were described as integral to appropriate interactions with the care team and comfort and trust in the ICU, which were perceived as essential for a community of caring. Participants provided suggestions for improvement: 1) provide a dedicated family navigator, 2) increase provider awareness of the fragility of family trust, 3) improve provider communication skills, 4) improve the transition from ICU to hospital ward, and 5) inform patients about the long-term effects of critical illness. Analyses by independent qualitative researchers identified similar themes. CONCLUSIONS: Patient and family member-led research is feasible and can identify opportunities for improving care.

Development and Testing of the First-Episode Psychosis Services Fidelity Scale.

OBJECTIVE: The purpose of this study was to test the reliability and validity of the First-Episode Psychosis Services Fidelity Scale (FEPS-FS) and compare it with similar scales. METHODS: A fidelity scale was developed from previously identified essential components of first-episode psychosis services. The scale was tested in six programs in two countries and compared with three existing scales. RESULTS: Program data collection from multiple sources indicated the feasibility and reliability of the FEPS-FS (intraclass correlation coefficient for interrater reliability=.842; 95% confidence interval=.795-.882). Satisfactory programs scored an average of 86% of the maximum total score; the single unsatisfactory program scored 70%. Compared with the other scales, the FEPS-FS has fewer items, but it has the highest proportion of items common to all scales. CONCLUSIONS: The FEPS-FS is a feasible, compact, reliable, and valid measure of adherence to evidence-based practices for first-episode psychosis services that can be applied to any first-episode psychosis service.

Policy impacts of ecosystem services knowledge.

Research about ecosystem services (ES) often aims to generate knowledge that influences policies and institutions for conservation and human development. However, we have limited understanding of how decision-makers use ES knowledge or what factors facilitate use. Here we address this gap and report on, to our knowledge, the first quantitative analysis of the factors and conditions that explain the policy impact of ES knowledge. We analyze a global sample of cases where similar ES knowledge was generated and applied to decision-making. We first test whether attributes of ES knowledge themselves predict different measures of impact on decisions. We find that legitimacy of knowledge is more often associated with impact than either the credibility or salience of the knowledge. We also examine whether predictor variables related to the science-to-policy process and the contextual conditions of a case are significant in predicting impact. Our findings indicate that, although many factors are important, attributes of the knowledge and aspects of the science-to-policy process that enhance legitimacy best explain the impact of ES science on decision-making. Our results are consistent with both theory and previous qualitative assessments in suggesting that the attributes and perceptions of scientific knowledge and process within which knowledge is coproduced are important determinants of whether that knowledge leads to action.

From the conventional to the alternative: exploring patients' pathways of cancer treatment and care.

BACKGROUND: Complementary and alternative medicine (CAM) use is widespread and on the increase among cancer patients. Most research to date has involved a cross-sectional snapshot of CAM use rather than an exploration into the longitudinal, nonlinear treatment trajectories that cancer patients develop. Our aim is to explore and describe different treatment and decision-making pathways that individuals develop after receipt of a diagnosis of either breast, colorectal, or prostate cancer. METHODS: The study was part of a larger mixed-methods pilot project to explore the feasibility of conducting a five-year international study to assess cancer patients' treatment pathways, including health care use and the perceived impact of different patterns of use on health outcomes over the course of one year. The results presented in this paper are based on the analysis of personal interviews that were conducted over the course of 12 months with 30 participants. RESULTS: Five pathways emerged from the data: passive conventional, self-directed conventional, cautious integrative, aggressive integrative, and aggressive alternative. Factors that shaped each pathway included health beliefs, decision-making role, illness characteristics, and the patient-practitioner relationship. CONCLUSIONS: The results of this examination of the longitudinal treatment and decision-making trajectory provide important information to support health care professionals in their quest for individualized, targeted support at each stage of the patient pathway.

Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care.

BACKGROUND: Large amounts of scientific evidence are generated, but not implemented into patient care (the 'knowledge-to-care' gap). We identified and prioritized knowledge-to-care gaps in critical care as opportunities to improve the quality and value of healthcare. METHODS: We used a multi-method community-based participatory research approach to engage a Network of all adult (n = 14) and pediatric (n = 2) medical-surgical intensive care units (ICUs) in a fully integrated geographically defined healthcare system serving 4 million residents. Participants included Network oversight committee members (n = 38) and frontline providers (n = 1,790). Network committee members used a modified RAND/University of California Appropriateness Methodology, to serially propose, rate (validated 9 point scale) and revise potential knowledge-to-care gaps as priorities for improvement. The priorities were sent to frontline providers for evaluation. Results were relayed back to all frontline providers for feedback. RESULTS: Initially, 68 knowledge-to-care gaps were proposed, rated and revised by the committee (n = 32 participants) over 3 rounds of review and resulted in 13 proposed priorities for improvement. Then, 1,103 providers (62% response rate) evaluated the priorities, and rated 9 as 'necessary' (median score 7-9). Several factors were associated with rating priorities as necessary in multivariable logistic regression, related to the provider (experience, teaching status of ICU) and topic (strength of supporting evidence, potential to benefit the patient, potential to improve patient/family experience, potential to decrease costs). CONCLUSIONS: A community-based participatory research approach engaged a diverse group of stakeholders to identify 9 priorities for improving the quality and value of critical care. The approach was time and cost efficient and could serve as a model to prioritize areas for research quality improvement across other settings.

Natural capital and ecosystem services informing decisions: From promise to practice.

The central challenge of the 21st century is to develop economic, social, and governance systems capable of ending poverty and achieving sustainable levels of population and consumption while securing the life-support systems underpinning current and future human well-being. Essential to meeting this challenge is the incorporation of natural capital and the ecosystem services it provides into decision-making. We explore progress and crucial gaps at this frontier, reflecting upon the 10 y since the Millennium Ecosystem Assessment. We focus on three key dimensions of progress and ongoing challenges: raising awareness of the interdependence of ecosystems and human well-being, advancing the fundamental interdisciplinary science of ecosystem services, and implementing this science in decisions to restore natural capital and use it sustainably. Awareness of human dependence on nature is at an all-time high, the science of ecosystem services is rapidly advancing, and talk of natural capital is now common from governments to corporate boardrooms. However, successful implementation is still in early stages. We explore why ecosystem service information has yet to fundamentally change decision-making and suggest a path forward that emphasizes: (i) developing solid evidence linking decisions to impacts on natural capital and ecosystem services, and then to human well-being; (ii) working closely with leaders in government, business, and civil society to develop the knowledge, tools, and practices necessary to integrate natural capital and ecosystem services into everyday decision-making; and (iii) reforming institutions to change policy and practices to better align private short-term goals with societal long-term goals.

Relationship between relapse and hospitalization in first-episode psychosis.

OBJECTIVE: Relapse is a frequently used outcome measure in schizophrenia research. However, difficulties in reliably measuring relapse diminish its usefulness. Hospitalization is a potential alternative, but its relationship to relapse has not been assessed. METHODS: This study used data from a two-year, prospective study to examine associations between relapse and hospitalization in a cohort of 200 Canadian patients with first-episode psychosis. First, the relationship between relapse and hospitalization was assessed by cross-tabulating relapse and hospitalization. Next, survival curves of time to first relapse or hospitalization were compared. Finally, to examine the convergent validity of relapse and hospitalization, the predictive capacity of three predictors were examined: a substance use disorder diagnosis, prior hospitalization, and medication adherence. RESULTS: Rates of both relapse and hospitalization were similar. During the two-year follow-up, 37% of the patients experienced a relapse, and 26% were hospitalized. As an indicator of relapse, hospitalization had a low sensitivity (47%) and high specificity (87%). A higher risk of hospitalization and relapse was associated with prior hospitalization, a substance use disorder diagnosis, and medication nonadherence. CONCLUSIONS: Results indicated that relapse and hospitalization are separate but related outcome measures. They had similar frequencies and were found to have similar relationships with some predictors. Relapse is a more useful outcome measure in smaller clinical studies in which routine standardized clinical measures can be used. Hospitalization is more relevant in larger studies or as a quality indicator for studies using administrative databases, and it serves as a good measure for quality management in health systems.

Essential evidence-based components of first-episode psychosis services.

OBJECTIVE The purpose of this study was to identify essential evidence-based components of first-episode psychosis services. METHODS The study was conducted in two stages. In the first stage a systematic review of both peer-reviewed and gray literature (January 1980 to April 2010) was conducted. Databases searched included MEDLINE, PsycINFO, and EMBASE. In the second stage, a consensus-building technique, the Delphi, was used with an international panel of experts. The panelists were presented the evidence-based components identified in the review, together with the level of supporting evidence for each component. They rated the importance of each component on a 5-point scale. A score of 5 was required to determine that a component was essential. RESULTS The review identified 1,020 citations; abstracts were reviewed for relevance. A total of 280 peer-reviewed articles met criteria for relevance. Two researchers independently reviewed these articles and identified 75 unique service components. Each component was assigned a level of supporting evidence. Twenty-seven experts completed the first Delphi round, of whom 23 participated in the second. Consensus was achieved in two rounds, with 32 components rated as essential. CONCLUSIONS The two-step process yielded a manageable list of 32 evidence-based components of first-episode psychosis services. Given the proliferation of such services and the absence of an evidence-based fidelity scale, this list can form a foundation for developing a fidelity scale for such services. It may also be helpful to funders and providers as a summary of essential services.

Conformance to evidence-based treatment recommendations in schizophrenia treatment services.

OBJECTIVE: To assess quality of health care provided in a representative Canadian mental health service using conformance to evidence-based treatment recommendations, and to examine differences from published US results. METHOD: We used a cross-sectional cohort design involving a randomly selected sample of patients diagnosed with schizophrenia attending 1 of 3 mental health clinics in 1 Canadian regional health system. The sample size was calculated to detect differences with the US sample. Conformance criteria were based on a published protocol. Data were collected using patient interviews and a structured review of health records. Conformance to 9 key Schizophrenia Patient Outcomes Research Team recommendations was assessed. RESULTS: Conformance ranged between 58% and 90% for pharmacological recommendations, and 0% to 81% for psychosocial recommendations. No patients who met criteria for assertive case management had been referred to an assertive case management team. Significant differences in conformance rates to some treatment recommendations were found between Canadian and published US results. CONCLUSIONS: It proved possible to assess health care quality using process measures of conformance to treatment recommendations. Conformance to clinical recommendations for pharmacotherapy is higher than for psychosocial therapies. The absence of barriers to access for pharmacological therapies likely enhances the higher conformance to these recommendations. Limited or variable access to psychosocial services, specifically assertive community treatment, likely negatively affects conformance to psychosocial treatment recommendations. Methodological limitations preclude drawing conclusions on comparisons between Canadian and US services.

Development of a core set of performance measures for evaluating schizophrenia treatment services.

OBJECTIVE: The purpose of study was to identify a list of performance measures for schizophrenia treatment services and to assemble a multistakeholder group to reach consensus on a core list. METHODS: The study was conducted in two stages: first, a systematic review of the literature was conducted to identify a comprehensive list of measures; second, a consensus-building technique, the Delphi process, was used with participants from six groups of stakeholders: schizophrenia experts, mental health clinicians, mental health administrators, the payer (the Alberta Ministry of Health and Wellness), patients, and family members. Thirty stakeholders participated in three rounds of self-completed questionnaires. The degree of consensus achieved in the Delphi process was defined as the semi-interquartile range for each measure. RESULTS: Ninety-seven measures were identified in the literature review. The Delphi method reduced the list to 36 measures rated as essential. The measures address eight domains of service-level evaluation: acceptability, accessibility, appropriateness, competence, continuity, effectiveness, efficiency, and safety. Despite the diversity in backgrounds of the stakeholder groups, the Delphi technique was effective in moving participants' ratings toward consensus through successive questionnaire rounds. The resulting measures reflected the interests of all stakeholders. CONCLUSIONS: Several further steps are required before these measures are implemented and include working toward reliability and validity of specific measures, assessing the feasibility and cost-effectiveness of collecting the data, and finally, undertaking risk adjustment for outcome measures.