Realized distribution patterns of crowned lemurs (Eulemur coronatus) within a human-dominated forest fragment in northern Madagascar.

Due to the impact of anthropogenic activities on forest extent and integrity across Madagascar, it is increasingly necessary to assess how endangered lemur populations inhabiting human-dominated forest fragments can effectively sustain themselves ecologically. Our research addresses this concern by exploring how the distribution patterns of a small population of crowned lemurs (Eulemur coronatus), occupying a degraded forest fragment at Oronjia Forest New Protected Area in northern Madagascar, are impacted by the availability of key ecological and anthropogenic factors. We hypothesize that the distribution of E. coronatus within the fragment is limited by the availability of critical ecological resources and conditions and the intensity of anthropogenic features and activities. To examine this, we used MaxEnt to develop a species distribution model using presence-only occurrence records and 10 independent background covariates detailing the site's ecological and anthropogenic aspects. The results indicate that the realized distribution patterns of E. coronatus within human-dominated forest fragments are strongly associated with sections of forest that contain sparsely and sporadically distributed resources, such as freshwater and continuous hardwood vegetation. We conclude that the distribution of E. coronatus at Oronjia is shaped by their need to maximize foraging opportunities in a degraded forest landscape where they are subject to both environmental and anthropogenic stressors.

Clostridium difficile multidisciplinary team root cause analysis: impact on clinical care and circumvention of financial penalties posed by clinical commissioning groups, but at what cost?

BACKGROUND: In Hampshire Hospitals NHS Foundation Trust, in addition to an on-the-spot investigation into hospital-onset Clostridium difficile infection (CDI) by the infection prevention team, a multidisciplinary team root cause analysis (MDT-RCA) forum has been developed. The MDT-RCA aims to deliver a more thorough investigation into individual cases and the recommendation of cases to the clinical commissioning groups (CCG) appeals panel against potential financial penalties (£10,000 per breached case). We mainly aimed to investigate the financial impact of MDT-RCAs to the Trust. METHODOLOGY: Over two years, 84 cases of hospital-onset CDI cases were reviewed by the MDT-RCA forum. RESULTS: Among this cohort, no additional learning outcomes were identified by the MDT-RCAs over those that were found by on-the-spot investigations. In total, 543 staff members attended the MDT-RCAs at a potential cost to the Trust of £23,795.74-£51,670.10. The Trust appealed against financial penalties for 27 cases and 14 were successful, i.e. £140,000 would have been avoided had targets been breached by 14 cases. However, targets were only breached by two cases, meaning only £20,000 in fines was avoided. Deducting this from the total costs of the MDT-RCA meant the Trust lost £3,795.74-£31,670.10. CONCLUSION: Over the two years reviewed, the MDT-RCA proved to be costly to the Trust, with no additional learning or quality improvement measures identified.

The effectiveness of portfolios for post-graduate assessment and education: BEME Guide No 12.

BACKGROUND: Portfolios in post-graduate healthcare education are used to support reflective practice, deliver summative assessment, aid knowledge management processes and are seen as a key connection between learning at organisational and individual levels. This systematic review draws together the evidence on the effectiveness of portfolios across postgraduate healthcare and examines the implications of portfolios migrating from paper to an electronic medium across all professional settings. METHODS: A literature search was conducted for articles describing the use of a portfolio for learning in a work or professional study environment. It was designed for high sensitivity and conducted across a wide range of published and unpublished sources relevant to professional education. No limits for study design or outcomes, country of origin or language were set. Blinded, paired quality rating was carried out, and detailed appraisal of and data extraction from included articles was managed using an online tool developed specifically for the review. Findings were discussed in-depth by the team, to identify and group pertinent themes when answering the research questions. RESULTS: Fifty six articles from 10 countries involving seven healthcare professions met our inclusion criteria and minimum quality threshold; mostly uncontrolled observational studies. Portfolios encouraged reflection in some groups, and facilitated engagement with learning. There was limited evidence of the influence of a number of factors on portfolio use, including ongoing support from mentors or peers, implementation method, user attitude and level of initial training. Confounding variables underlying these issues, however have not been fully investigated. A number of authors explored the reliability and validity of portfolios for summative assessment but reports of accuracy across the disparate evidence base varied. Links to competency and Quality Assurance frameworks have been demonstrated. There were conflicting reports about whether the different purposes of portfolios can be combined without compromising the meaningfulness of the contents. There was good evidence that the flexibility of the electronic format brought additional benefits to users, assessors and organisations, and encouraged more enthusiastic use. Security of data remained a high priority issue at all levels, and there was emerging evidence of successful transfer between electronic portfolio systems. CONCLUSION: The evidence base is extensive, but contains few high quality studies with generalisable messages about the effectiveness of portfolios. There is, however, good evidence that if well implemented, portfolios are effective and practical in a number of ways including increasing personal responsibility for learning and supporting professional development. Electronic versions are better at encouraging reflection and users voluntarily spend longer on them. Regular feedback from a mentor enhances this success, despite competing demands on users' time and occasional scepticism about the purpose of a portfolio. Reports of inter-rater reliability for summative assessments of portfolio data are varied and there is benefit to be gained from triangulating with other assessment methods. There was insufficient evidence to draw conclusions on how portfolios work in interdisciplinary settings.

GP experiences of partner and external peer appraisal: a qualitative study.

BACKGROUND: Appraisal is being adopted both in the UK and internationally as a means of aiding personal development for family doctors. However, it is not clear by whom they should be appraised. AIM: To explore attitudes of GPs towards being appraised by externally appointed GP colleagues and by their own partners. DESIGN OF STUDY: Semi-structured interviews of GPs who had experienced both forms of appraisal. SETTING: Lothian, Scotland. METHOD: Sixty-six GPs agreed to take part in a study of partner (n = 46) and external (n = 20) peer-based appraisal. Six months later this group was followed up by questionnaire to determine views of the process, in order to obtain a purposeful sample of 13 GPs who were interviewed in depth. RESULTS: We uncovered concern and a need for clarity about the linkage of appraisal to revalidation. Interviewees felt that the potentially charged nature of appraisal could lead to collusion between appraiser and appraisee, which may lead to a superficial engagement. Similarly, lack of local knowledge of an appraisee potentially enabled a strategy of avoidance. GPs opting for partner appraisal were less likely to undergo appraisal due to lack of protected time. CONCLUSION: There are reported advantages and disadvantages to having an external peer or partner appraisal. The relationship between revalidation and appraisal needs to be clarified as this leads to collusion and avoidance strategies by both appraisers and appraisees. Good training is required to both recognise and address these strategies. Protected time is essential for effective appraisal.