Search

The value of no-take marine protected areas (MPAs) in providing fisheries-independent information to evaluate the status of adjacent fish stocks is increasingly being recognised. However, to ensure robust assessments of fisheries using this approach, MPAs need to be representative of the wider fished area and sampling should include multiple MPA and fished locations spanning the area of interest. The spiny lobster Jasus edwardsii fishery in Aotearoa New Zealand’s Hauraki Gulf has been in decline since the late 1990s, but latest stock estimates suggest a dramatic recovery following catch reductions in 2018. We compared J. edwardsii populations on shallow reefs (

The value of no-take marine protected areas (MPAs) in providing fisheriesindependent information to evaluate the status of adjacent fish stocks is increasingly being recognised. However, to ensure robust assessments of fisheries using this approach, MPAs need to be representative of the wider fished area and sampling should include multiple MPA and fished locations spanning the area of interest. The spiny lobster Jasus edwardsii fishery in Aotearoa New Zealand's Hauraki Gulf has been in decline since the late 1990s, but latest stock estimates suggest a dramatic recovery following catch reductions in 2018. We compared J. edwardsii populations on shallow reefs (<20 m depth) in three marine reserves with six fished locations across the Hauraki Gulf to provide a fisheries-independent assessment of this important fishery and the degree of recovery following catch reductions. Region-wide surveys found that J. edwardsii populations within protected areas were dominated by large, legal-size individuals, whereas lobster in fished locations were mostly below or around legal-size. Total, vulnerable, and spawning stock biomass was 12-43 times higher within MPAs compared to fished locations. Overall, biomass at fished locations was <10% of that in reserves and there was little evidence of recovery following catch reductions. Our fisheries-independent data suggest that recent stock assessments have severely overestimated the recovery and state of lobster populations in the Hauraki Gulf and that populations on shallow reefs remain depleted. These findings highlight the critical need for fisheries-independent data and the value of MPA monitoring data in evaluating population status and recovery following fisheries management actions. [ABSTRACT FROM AUTHOR]

Sea urchin overgrazing is a leading cause of kelp forest loss and in such cases their removal is increasingly advocated for kelp forest restoration. However, refining removal approaches is needed to improve the efficiency and success of restoration, as most previous removal studies have been small scale and require ongoing removals to maintain low densities and allow kelp recovery. We investigated the effectiveness of one‐off urchin removal from large, semi‐discrete areas of urchin barrens as a tool to promote kelp recovery. We removed sea urchins (Evechinus chloroticus) from four areas (1.6–2 ha) of urchin barrens in northeastern New Zealand. Exposed urchins were reduced to approximately 7% of initial densities and remained low, yet cryptic urchin densities increased after 2 years. Kelp (Ecklonia radiata) and fucoid (Sargassum sinclairii, Carpophyllum spp.) densities increased rapidly in removal areas, but remained constant or declined in adjacent control urchin barren areas. Macroalgal canopy recovery varied among and within removal areas, but increased on average from approximately 5 to 43% in 2 years. Densities of large sea urchin predators did not increase with kelp recovery, likely due to ongoing fishing within removal areas. Our results demonstrate that a single urchin removal from large, semi‐discrete areas of urchin barrens can effectively and efficiently promote rapid multi‐species macroalgal recovery without additional actions (e.g. repeated urchin removals or macroalgae enhancement) for at least 2 years. However, this approach does not restore whole ecosystems and consequently restoration benefits through kelp recovery will be temporary without longer‐term urchin management and/or rebuilding of predator populations. [ABSTRACT FROM AUTHOR]

Resilience in nursing medication administration practice: a systematic review with narrative synthesis., Objective: Little is known about how nurses adapt medication administration practices to preserve safety. The capacity to adapt and respond before harm occurs has been labelled 'resilience'. Current evidence examining medication safety largely focuses on errors and what goes wrong. This review aimed to synthesise evidence for the application of resilience principles and practices in nursing medication administration., Design: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the review, which was registered with PROSPERO., Data Sources: MEDLINE, EMBASE, PsychINFO and CINAHL databases were searched from 14 August 2020 to 1 January 2021 for English-language studies., Methods: A systematic review of empirical studies of any design relating to resilience and safety in nursing medication administration in the inpatient setting was conducted. Methodological quality was appraised using the Mixed Methods Appraisal Tool. Data were synthesised thematically., Results: Thirty-two studies with a range of methodologies of mostly good quality met the inclusion criteria. Eleven interventional studies included two that evaluated the effectiveness of education interventions and nine exploratory studies with outcomes showing the impact of an intervention designed or examined to build resilience. Twenty-one non-interventional studies showed how resilience principles are put into practice. Only three studies explicitly named the concept of resilience. Resilient medication administration strategies result from five triggers., Conclusions: Nurses' resilience practices were found to be responses to identified trigers that threaten safety and productivity. These were often short term, real-time proactive adaptations to preserve safety, compensating for and responding to complexities in the modern healthcare setting., Prospero Registration Number: CRD42018087928., Competing Interests: Competing interests: The authors declare no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Protein aggregation causes a wide range of neurodegenerative diseases. Targeting and removing aggregates, but not the functional protein, is a considerable therapeutic challenge. Here, we describe a therapeutic strategy called "RING-Bait," which employs an aggregating protein sequence combined with an E3 ubiquitin ligase. RING-Bait is recruited into aggregates, whereupon clustering dimerizes the RING domain and activates its E3 function, resulting in the degradation of the aggregate complex. We exemplify this concept by demonstrating the specific degradation of tau aggregates while sparing soluble tau. Unlike immunotherapy, RING-Bait is effective against both seeded and cell-autonomous aggregation. RING-Bait removed tau aggregates seeded from Alzheimer's disease (AD) and progressive supranuclear palsy (PSP) brain extracts and was also effective in primary neurons. We used a brain-penetrant adeno-associated virus (AAV) to treat P301S tau transgenic mice, reducing tau pathology and improving motor function. A RING-Bait strategy could be applied to other neurodegenerative proteinopathies by replacing the Bait sequence to match the target aggregate., Competing Interests: Declaration of interests L.V.C.M., G.P., W.A.M., and L.C.J. are listed as inventors on a patent containing data published in this paper., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Background: Hospital 'command centres' use digital technologies to collect, analyse and present real-time information that may improve patient flow and patient safety. Bradford Royal Infirmary has trialled this approach and presents an opportunity to evaluate effectiveness to inform future adoption in the United Kingdom., Objective: To evaluate the impact of the Bradford Command Centre on patient care and organisational processes., Design: A comparative mixed-methods study. Operational data from a study and control site were collected and analysed. The intervention was observed, and staff at both sites were interviewed. Analysis was grounded in a literature review and the results were synthesised to form conclusions about the intervention., Setting: The study site was Bradford Royal Infirmary, a large teaching hospital in the city of Bradford, United Kingdom. The control site was Huddersfield Royal Infirmary in the nearby city of Huddersfield., Participants: Thirty-six staff members were interviewed and/or observed., Intervention: The implementation of a digitally enabled hospital command centre., Main Outcome Measures: Qualitative perspectives on hospital management. Quantitative metrics on patient flow, patient safety, data quality., Data Sources: Anonymised electronic health record data. Ethnographic observations including interviews with hospital staff. Cross-industry review including relevant literature and expert panel interviews., Results: The Command Centre was implemented successfully and has improved staff confidence of better operational control. Unintended consequences included tensions between localised and centralised decision-making and variable confidence in the quality of data available. The Command Centre supported the hospital through the COVID-19 pandemic, but the direct impact of the Command Centre was difficult to measure as the pandemic forced all hospitals, including the study and control sites, to innovate rapidly. Late in the study we learnt that the control site had visited the study site and replicated some aspects of the command centre themselves; we were unable to explore this in detail. There was no significant difference between pre- and post-intervention periods for the quantitative outcome measures and no conclusive impact on patient flow and data quality. Staff and patients supported the command-centre approaches but patients expressed concern that individual needs might get lost to 'the system'., Conclusions: Qualitative evidence suggests the Command Centre implementation was successful, but it proved challenging to link quantitative evidence to specific technology interventions. Staff were positive about the benefits and emphasised that these came from the way they adapted to and used the new technology rather than the technology per se., Limitations: The COVID-19 pandemic disrupted care patterns and forced rapid innovation which reduced our ability to compare study and control sites and data before, during and after the intervention., Future Work: We plan to follow developments at Bradford and in command centres in the National Health Service in order to share learning. Our mixed-methods approach should be of interest to future studies attempting similar evaluation of complex digitally enabled whole-system changes., Study Registration: The study is registered as IRAS No.: 285933., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129483) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 41. See the NIHR Funding and Awards website for further award information.

Background: Providing feedback to healthcare professionals and organisations on performance or patient outcomes may improve care quality and professional development, particularly in Emergency Medical Services (EMS) where professionals make autonomous, complex decisions and current feedback provision is limited. This study aimed to determine the content and outcomes of feedback in EMS by measuring feedback prevalence, identifying predictors of receiving feedback, categorising feedback outcomes and determining predictors of feedback efficacy., Methods: An observational mixed-methods study was used. EMS professionals delivering face-to-face patient care in the United Kingdom's National Health Service completed a baseline survey and diary entries between March-August 2022. Diary entries were event-contingent and collected when a participant identified they had received feedback. Self-reported data were collected on feedback frequency, environment, characteristics and outcomes. Feedback environment was measured using the Feedback Environment Scale. Feedback outcomes were categorised using hierarchical cluster analysis. Multilevel logistic regression was used to assess which variables predicted feedback receipt and efficacy. Qualitative data were analysed using content analysis., Results: 299 participants completed baseline surveys and 105 submitted 538 diary entries. 215 (71.9%) participants had received feedback in the last 30 days, with patient outcome feedback the most frequent (n = 149, 42.8%). Feedback format was predominantly verbal (n = 157, 73.0%) and informal (n = 189, 80.4%). Significant predictors for receiving feedback were a paramedic role (aOR 3.04 [1.14, 8.00]), a workplace with a positive feedback-seeking culture (aOR 1.07 [1.04, 1.10]) and white ethnicity (aOR 5.68 [1.01, 29.73]). Feedback outcomes included: personal wellbeing (closure, confidence and job satisfaction), professional development (clinical practice and knowledge) and service outcomes (patient care and patient safety). Feedback-seeking behaviour and higher scores on the Feedback Environment Scale were statistically significant predictors of feedback efficacy. Solicited feedback improved wellbeing (aOR 3.35 [1.68, 6.60]) and professional development (aOR 2.58 [1.10, 5.56]) more than unsolicited feedback., Conclusion: Feedback for EMS professionals was perceived to improve personal wellbeing, professional development and service outcomes. EMS workplaces need to develop a culture that encourages feedback-seeking to strengthen the impact of feedback for EMS professionals on clinical decision-making and staff wellbeing., (© 2024. The Author(s).)

Selective degradation of pathological protein aggregates while sparing monomeric forms is of major therapeutic interest. The E3 ligase tripartite motif-containing protein 21 (TRIM21) degrades antibody-bound proteins in an assembly state-specific manner due to the requirement of TRIM21 RING domain clustering for activation, yet effective targeting of intracellular assemblies remains challenging. Here, we fused the RING domain of TRIM21 to a target-specific nanobody to create intracellularly expressed constructs capable of selectively degrading assembled proteins. We evaluated this approach against green fluorescent protein-tagged histone 2B (H2B-GFP) and tau, a protein that undergoes pathological aggregation in Alzheimer's and other neurodegenerative diseases. RING-nanobody degraders prevented or reversed tau aggregation in culture and in vivo, with minimal impact on monomeric tau. This approach may have therapeutic potential for the many disorders driven by intracellular protein aggregation.

Electronic hospital pharmacy (EHP) systems are ubiquitous in today's hospitals, with many also implementing electronic prescribing (EP) systems; both contain a potential wealth of medication-related data to support quality improvement. The reasons for reuse and users of this data are generally unknown. Our objectives were to survey secondary use of data (SUD) from EHP and EP systems in UK hospitals, to identify users of and factors influencing SUD.A national postal survey was sent out to all hospital chief pharmacists with pre-notifications and follow-up reminders. Descriptive statistical analysis was performed.Of 187 hospital organisations, 65 (35%) responded. All had EHP systems (for ≥20 years) and all reused data; 50 (77%) had EP systems (established 1-10 years) but only 40 (80%) reused data. Reported facilitators for SUD included medication safety, providing feedback, benchmarking, saving time and patient experience. The purposes of SUD included audits, quality improvement, risk management and general medication-related reporting. Earlier introduction of SUD could provide an opportunity to heighten local improvement initiatives.Data from EHP systems is reused for multiple purposes. Evaluating SUD and sharing experiences could provide richer insight into potential SUD and barriers/factors to consider when implementing or upgrading EP/EHP systems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)