Approaches to co-production of research in care homes: a scoping review.

BACKGROUND: Using the technique of co-production to develop research is considered good practice. Co-production involves the public, practitioners and academics working together as equals throughout a research project. Co-production may help develop alternative ways of delivering care for older adults that are acceptable to those who live and work in care homes. However, guidance about applying co-production approaches in this context is lacking. This scoping review aims to map co-production approaches used in care homes for older adults in previous research to support the inclusion of residents and care staff as equal collaborators in future studies. METHODS: A scoping review was conducted using the Joanna Briggs Institute scoping review methodology. Seven electronic databases were searched for peer-reviewed primary studies using co-production approaches in care home settings for older adults. Studies were independently screened against eligibility criteria by two reviewers. Citation searching was completed. Data relating to study characteristics, co-production approaches used, including any barriers and facilitators, was charted by one reviewer and checked by another. Data was summarised using tables and diagrams with an accompanying narrative description. A collaborator group of care home and health service representatives were involved in the interpretation of the findings from their perspectives. RESULTS: 19 studies were selected for inclusion. A diverse range of approaches to co-production and engaging key stakeholders in care home settings were identified. 11 studies reported barriers and 13 reported facilitators affecting the co-production process. Barriers and facilitators to building relationships and achieving inclusive, equitable and reciprocal co-production were identified in alignment with the five NIHR principles. Practical considerations were also identified as potential barriers and facilitators. CONCLUSION: The components of co-production approaches, barriers and facilitators identified should inform the design of future research using co-production approaches in care homes. Future studies should be explicit in reporting what is meant by co-production, the methods used to support co-production, and steps taken to enact the principles of co-production. Sharing of key learning is required to support this field to develop. Evaluation of co-production approaches, including participants' experiences of taking part in co-production processes, are areas for future research in care home settings.

Co-production involves people from different backgrounds working together as equals throughout a research project. Co-production may be a useful approach to help ensure that research in care homes focuses on approaches that are important and agreeable to older people and staff. A wide range of research and guidance about co-production has been published but there is limited guidance about how to do co-production in care homes. We carried out a review that involved pulling together previous research that used co-production in care homes for older adults. We looked at published research studies to learn about: Key components of the strategies used to achieve co-production, How care home residents and care home staff were involved, What helped or made co-production difficult to achieve. A collaborator group including representatives from care homes and healthcare services were involved in this research. They helped decide what was most important about the results.We found 19 published research articles that used co-production in care homes. The strategies used in the articles differed. There were also differences in how care home residents and staff were involved in co-production. Factors that helped people involved to work together in an inclusive and equal way were identified. At the same time, there were also many challenges.These results should be used to design future research using co-production in care homes. Future studies should clearly report what is meant by co-production, the strategies used and key learning points. Evaluation of co-production and the experiences of people involved is needed.

Long-term pattern and magnitude of soil carbon feedback to the climate system in a warming world.

In a 26-year soil warming experiment in a mid-latitude hardwood forest, we documented changes in soil carbon cycling to investigate the potential consequences for the climate system. We found that soil warming results in a four-phase pattern of soil organic matter decay and carbon dioxide fluxes to the atmosphere, with phases of substantial soil carbon loss alternating with phases of no detectable loss. Several factors combine to affect the timing, magnitude, and thermal acclimation of soil carbon loss. These include depletion of microbially accessible carbon pools, reductions in microbial biomass, a shift in microbial carbon use efficiency, and changes in microbial community composition. Our results support projections of a long-term, self-reinforcing carbon feedback from mid-latitude forests to the climate system as the world warms.

Soil warming alters nitrogen cycling in a New England forest: implications for ecosystem function and structure.

Global climate change is expected to affect terrestrial ecosystems in a variety of ways. Some of the more well-studied effects include the biogeochemical feedbacks to the climate system that can either increase or decrease the atmospheric load of greenhouse gases such as carbon dioxide and nitrous oxide. Less well-studied are the effects of climate change on the linkages between soil and plant processes. Here, we report the effects of soil warming on these linkages observed in a large field manipulation of a deciduous forest in southern New England, USA, where soil was continuously warmed 5°C above ambient for 7 years. Over this period, we have observed significant changes to the nitrogen cycle that have the potential to affect tree species composition in the long term. Since the start of the experiment, we have documented a 45% average annual increase in net nitrogen mineralization and a three-fold increase in nitrification such that in years 5 through 7, 25% of the nitrogen mineralized is then nitrified. The warming-induced increase of available nitrogen resulted in increases in the foliar nitrogen content and the relative growth rate of trees in the warmed area. Acer rubrum (red maple) trees have responded the most after 7 years of warming, with the greatest increases in both foliar nitrogen content and relative growth rates. Our study suggests that considering species-specific responses to increases in nitrogen availability and changes in nitrogen form is important in predicting future forest composition and feedbacks to the climate system.

Soil warming and carbon-cycle feedbacks to the climate system.

In a decade-long soil warming experiment in a mid-latitude hardwood forest, we documented changes in soil carbon and nitrogen cycling in order to investigate the consequences of these changes for the climate system. Here we show that whereas soil warming accelerates soil organic matter decay and carbon dioxide fluxes to the atmosphere, this response is small and short-lived for a mid-latitude forest, because of the limited size of the labile soil carbon pool. We also show that warming increases the availability of mineral nitrogen to plants. Because plant growth in many mid-latitude forests is nitrogen-limited, warming has the potential to indirectly stimulate enough carbon storage in plants to at least compensate for the carbon losses from soils. Our results challenge assumptions made in some climate models that lead to projections of large long-term releases of soil carbon in response to warming of forest ecosystems.

Studies on the physiopathology of chronic obstructive pulmonary disease in the horse. VIII. Mean modal vectors of the P wave and the QRS complex.

Mean modal vectors of P1, P2 and QRS were determined in the 3 planes of a semi-orthogonal EKG lead system in 17 horses and ponies with chronic obstructive pulmonary disease (COPD) and in 17 clinically normal horses and ponies. Subjects were paired so that the heart rates of each pair were not dissimilar by more than 2 cycles per minute. Probably significant differences were observed between the mean angles of P1 vectors in the transverse and sagittal planes (T plane, normal = 324 degrees +/- 24,6 degrees, COPD = 342 degrees +/- 21,0 degrees, t = 2,0, P less than 0,05; S plane, normal = 331 degrees +/- 22,6 degrees, COPD = 348 degrees +/- 16,2 degrees, t = 2,52, P less than 0,02). There were no significant differences between the mean angles of planar modal QRS vectors of normal subjects and those of COPD subjects.

Studies on the physiopathology of chronic obstructive pulmonary disease in the horse. VII. Percentage venous admixture.

The percentage venous admixture was calculated in 21 clinically normal horses and ponies and in 13 horses and ponies with chronic obstructure pulmonary disease (COPD). The oxygen contents of pulmonary end-capillary blood, arterial and mixed venous blood were calculated from blood and respiratory gas values and substituted in the shunt equation. The mean percentage venous admixture of the COPD subjects was significantly greater than that of the normal subjects. It was concluded that a larger proportion of alveoli in the lungs of COPD subjects were hypoventilated than that of alveoli of the normal lungs.

Studies on the physiopathology of chronic obstructive pulmonary disease in the horse. V. Blood gas and acid-base values during exercise.

The haemoglobin concentration, the partial pressures of oxygen and carbon dioxide, the oxygen content and the pH were determined in the arterial and mixed venous blood of 5 normal and 3 horses with chronic obstructive pulmonary disease (COPD) at 3 stages of an exercise distance of 1200 m. Arterial and mixed venous samples were collected simultaneously by means of an automatic technique during the walk, trot and gallop at 0-100 m, at 500-600 m and at 1100-1200 m. The standard bicarbonate and the lactic and pyruvic acid concentrations were also determined in arterial and mixed venous blood. Highly significant changes in the mean values of PvO2. O2 content and delta a-vO2 content occurred during exercise in COPD subjects, and significant changes in PvO2 and delta a-vO2 content occurred during exercise in normal subjects. We concluded that COPD subjects compensated for respiratory dysfunction during exercise by extracting more oxygen from the blood than did normal horses. There was a highly significant correlation between the changes in standard bicarbonate and the changes in lactic acid concentration during exercise in both normal and COPD subjects. This led to the conclusion that lactic acid production was primarily, but not completely, responsible for the metabolic acidosis of exercise in horses.

Studies on the physiopathology of chronic obstructive pulmonary disease in the horse. IV. Blood gas and acid-base values at rest.

Radiometer Blood Micro-system 2 was used in studies designed to, (a) compare the mean blood gas and acid-base values of 38 normal horses and 20 horses with chronic obstructive pulmonary disease (COPD), (b) determine the means and standard deviations of blood gas and acid-base values of Thoroughbred horses in training, and (c) investigate the relationships between clinical data, blood gas values, intracardiac and pulmonary arterial pressures in subjects with COPD. There were significant differences between the mean values for partial pressure of arterial oxygen (PaO2), arterial carbon dioxide (PaCO2) and mixed venous carbon dioxide (PvCO2) in normal and COPD subjects. The mean values and standard deviations for determinations of blood gases and acid-base status in Thoroughbred horses in training were as follows: PaO2 = 77,4 +/- 4,3 mm Hg; PvO2 (mixed venous oxygen partial pressure) = 36,2 +/- 4,1 mm Hg; PaCO2 = 40,9 +/- 5,8 mm Hg; PvCO2 = 49,4 +/- 5,0 mm Hg; pHa (arterial) = 7,358 +/- 0,051; pHv (venous) = 7,343 +/- 0,027; standard bicarbonate = 22,7 mM/l. The PaO2, the PaCO2 and the arterial pH were significantly correlated to the respiratory frequency in COPD subjects. The correlations of pulmonary diastolic pressure to both PaO2 and pHa were of probable significance (P less than 0,05) in COPD subjects. PaCO2 was highly significantly correlated to PaO2 and pHa in COPD subjects.

Studies on the physiopathology of chronic obstructive pulmonary disease in the horse. III. The intrathoracic pressure.

The intrathoracic pressure was determined by direct intrapleural cannulation in 17 clinically normal horses and 14 horses with chronic obstructive pulmonary disease (COPD). There were significant differences between the normal and COPD horses with regard to max. Ppl and max. delta Ppl. The mean values for minimum Ppl of the 2 groups of subjects were not significantly different. The results were discussed in relation to those of other workers.

Studies on the physiopathology of chronic obstructive pulmonary disease in the horse. II. Right heart haemodynamics.

Pressure curves obtained by cardiac catheterization of the pulmonary artery, right ventricle and right atrium of 9 horses and ponies with chronic obstructive pulmonary disease (COPD) were compared with those similarly recorded from 6 clinically normal control subjects. The mean pulmonary peak systolic, pulmonary minimum diastolic and ventricular peak systolic pressures of the COPD subjects were significantly higher (P less than 0,01) than the corresponding mean pressures of the clinically normal control subjects. The mean pressure calculated from pressure curves obtained from 8 Thoroughbreds in training did not differ significantly from those of the clinically normal subjects not in training.

Exercise studies in horses: 1. A simple telemetry system for recording excercise ECGs in horses.

A robust low cost portable radiotelemetry system is described for the horse and its method of operation and advantages briefly discussed. The equipment consisted of 2 electrodes forming a bipolar lead, a transmitter, a receiver and a writing device. The sitting, application and immobilising of the electrodes was a most important factor in obtaining good quality recordings. ECGs were recorded at all paces and also while jumping and the results proved satisfactory.

Exercise studies in horses: 2. The cardiac response to exercise in normal horses and in horses with chronic obstructive pulmonary disease.

The relationship of velocity (v) to heart rate (HR)and of kinetic energy (KE) to heart rate, were investigated in 6 normal horses and in 6 horses with chronic obstructive pulmonary, disease (COPD). Radiotelemetry was used to determine the heart rate while subjects were ridden on a 400m track. Velocity was measured by stop-watch between 2 markers 50 m apart at the end of the track. Kinetic energy was calculated from the formula KE =1/2 Mv2, where M = mass of horse, rider, saddle and bridle (KG) and V = velocity (metres per second). In all subjects, the relationship of velocity to heart rate was a linear one at each individual pace (i.e. walk, trot and gallop). There were however significant differences between the v/HR regression curves of each pace. These differences indicated that the increase in velocity per unit increase in heart rate was greater at the trot than at the walk, and greater at the gallop than at the trot. When data for all paces were combined, the relationship log v/log HR was a linear one. The above findings were also true of the relationship of kinetic energy to the heart rate. In horses, which reached maximal heart rate at a relatively low velocity, the v/HR curve became asymptotic. At comparable submaximal velocities, the heart rate of COPD subjects was approximately 20 beats per minute higher than that of normal subjects. This was also true when the term "kinetic energy per units mass" was substituted for velocity.

Microstructure of sediments: investigation with ultrathin sections.

Exaimnination of ultrathin sections of "undisturbed" marin1e sediments from the Gulf of Mexico indicates that they are chlaracterized by a loose, open, random arrangement of particles. The microstructures do not appear to conform entirely to either cardhouse or honeycomb structures.