Protecting peatlands requires understanding stakeholder perceptions and relational values: A case study of peatlands in the Yorkshire Dales.

Sustainable peatland management is a global environmental governance challenge given peat's carbon storage. Peatlands worldwide are sites of contested demands between stakeholders with distinct management priorities. In the United Kingdom, peatland management is a focus of political interest for nature-based solutions (NBS), causing tensions with land managers who feel their traditional knowledge is undervalued. Using Q-method (a semi-quantitative method for clarifying distinct viewpoints) with estate managers, gamekeepers, farmers, and employees of land-owning organisations, we explored perceptions around changing upland management in the Yorkshire Dales. Land managers hold strong values of ownership, aesthetics, and stewardship. The prospect of changing management causes fears of losing these relational values alongside instrumental values. Yorkshire Dales stakeholders agreed on NBS aims (reducing flooding, limiting wildfires, protecting wild birds), but disagreed on methods to achieve these. Our research supports engaging local stakeholders at all stages of peatland protection schemes to minimise resentment towards top-down management.

NHS librarians collaborate to develop a search bank peer reviewing and sharing COVID-19 searches: an evaluation.

BACKGROUND: Responding to the COVID-19 pandemic, Health Education England (HEE) mobilised a group of expert searchers from NHS libraries in England to develop a platform for librarians to share peer reviewed search strategies and results on the Knowledge for Healthcare website. OBJECTIVES: (1) To document the origins of the COVID-19 search bank, (2) evaluate attitudes of NHS librarians in England towards the search bank and (3) identify lessons learned and consider whether the initiative might be developed further. METHODS: Structured interviews with the peer reviewers (n = 10) were conducted, and a questionnaire survey of the NHS library community using the search bank was undertaken. RESULTS: The interviews confirmed the value of collaboration. Expert searchers worked in pairs to peer review submitted search strategies. The survey (85 responses) indicated that a majority had used the search bank, and approved of the project, with some differences of opinion on functionality and future developments. DISCUSSION: Collaborative working for the search bank probably saved time for individual NHS librarians. The quality of the searches submitted was variable as were librarians' approaches to presentation and development of search strategies. Peer review benefits from a buddy approach among expert searchers and agreement about feedback provided to contributors. CONCLUSION: Search strategies are the most useful element of a search bank. Peer review can be challenging and would benefit from a formal structure, but it is professionally rewarding.

Side by Side: Reflections on Two Lifetimes of Dance.

Telling stories about our experiences in dance brings to light unconscious knowledge and memories of the past and helps us understand our own decisions and practices. Reflexivity and story telling is central in the process of remembering and embodies some of the key aspects of autoethnography as a research tool. We are directed to examine and reflect on our experiences, analyzing goals and intentions, making connections between happenings and recounting each single experience. Dance has the potential for positive impact on both physical and mental health among professional dancers as well as among dance students and has the power to connect them to culture and community in unique and important ways. Research has provided evidence that arts engagement provides positive forms of social inclusion, opportunities to share arts, culture, language, and values and points to the value of the arts in the prevention and amelioration of health problems. Together with those benefits of a dance experience there is clear evidence of what can be learned in, through and about dance. In this time of the Covid-19 pandemic it seemed more relevant and poignant to examine our own experiences in dance as well as those experiences of others that have influenced our lives.

Traumatic Dislocation of the Pisiform Bone.

Pisiform dislocation is a rare wrist injury. The limited literature available describes this pathology in the form of case reports. An immediate closed reduction and immobilization is indicated for acute injury while there is a debate in the management of cases with delayed diagnosis or failed closed reduction. In this case, a 32-year-old, right-handed man visited the emergency department with pain at the ulnar side of his left wrist after a fall. The initial management involved immobilization, and the patient was referred to the authors' specialized clinic 10 days later because of persistence of important ulnar wrist pain. The choice of treatment was pisiform excision without ligament reconstruction with excellent functional results.

Midterm Outcome of Bone-Ligament-Bone Graft and Dorsal Capsulodesis for Chronic Scapholunate Instability.

PURPOSE: To assess midterm outcomes of our bone-ligament-bone (BLB) grafts for chronic scapholunate (SL) instability and better define criteria for their use. METHODS: We conducted a retrospective review of 26 patients treated with BLB grafts and dorsal capsulodesis between 1997 and 2009. Twenty-four patients were reviewed. Mean follow-up was 8.2 years. Two patients had dynamic lesions, 7 had SL dissociation, 14 had a dorsal intercalated segment instability lesion, and 1 had SL advanced collapse stage 1. Mean age at surgery was 46 years. All patients presented with pain and 14 had lack of strength. Results were reviewed clinically and radiologically. Images were assessed by 4 surgeons and 1 radiologist for radial styloid, radioscaphoid, radiolunate, midcarpal, and scaphotrapeziotrapezoid degenerative changes. RESULTS: Five patients needed subsequent 4-corner arthrodesis. Of the remaining 19 patients at follow-up, both extension and flexion decreased to 73% of the contralateral side. Postoperative grip strength improved from 78% to 90% of the nonsurgical wrist. Quick Disabilities of the Arm, Shoulder, and Hand score was 10 of 100 and the Patient-Rated Wrist Evaluation score was 10 of 100. Radiologically, the SL gap was improved and maintained at follow-up. The SL angle (mean before surgery, 79°) was initially corrected to 69° but returned to preoperative values at follow-up. Eleven of the 19 cases had signs of midcarpal arthritis. CONCLUSIONS: Bone-ligament-bone grafts with SL dorsal capsulodesis were able to restore and maintain an improved SL interval in all patients. The technique achieved good clinical results and high patient satisfaction, but it did not stop the progression of arthritis, particularly at the midcarpal level. This technique is an option for isolated unrepairable lesion of the dorsal SL ligament with an easily correctable lunate and especially when restoration of grip strength is important. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Optimal 3-T MRI for depiction of the finger A2 pulley: comparison between T1-weighted, fat-saturated T2-weighted and gadolinium-enhanced fat-saturated T1-weighted sequences.

OBJECTIVE: To compare three spin-echo sequences, transverse T1-weighted (T1WI), transverse fat-saturated (FS) T2-weighted (T2WI), and transverse gadolinium-enhanced (Gd) FS T1WI, for the visualisation of normal and abnormal finger A2 pulley with magnetic resonance (MR) imaging at 3 tesla (T). MATERIALS AND METHODS: Sixty-three fingers from 21 patients were consecutively investigated. Two musculoskeletal radiologists retrospectively compared all sequences to assess the visibility of normal and abnormal A2 pulleys and the presence of motion or ghost artefacts. RESULTS: Normal and abnormal A2 pulleys were visible in 94% (59/63) and 95% (60/63) on T1WI sequences, in 63% (40/63) and 60% (38/63) on FS T2WI sequences, and in 87% (55/63) and 73% (46/63) on Gd FS T1WI sequences when read by the first and second observer, respectively. Motion and ghost artefacts were higher on FS T2WI sequences. Seven among eight abnormal A2 pulleys were detected, and were best depicted with Gd FS T1WI sequences in 71% (5/7) and 86% (6/7) by the first and the second observer, respectively. CONCLUSION: In 3-T MRI, the comparison between transverse T1WI, FS T2WI, and Gd FS T1WI sequences shows that transverse T1WI allows excellent depiction of the A2 pulley, that FS T2WI suffers from a higher rate of motion and ghost artefacts, and transverse Gd FS T1WI is the best sequence for the depiction of abnormal A2 pulley.

Finger A2 pulley lesions in rock climbers: detection and characterization with magnetic resonance imaging at 3 Tesla--initial results.

OBJECTIVES: To evaluate magnetic resonance imaging (MRI) at 3 T in the diagnosis and characterization of lesions of the finger flexor A2 pulley in patients with clinically suspected A2 pulley lesions. MATERIALS AND METHODS: Eight consecutive patients with clinically suspected lesions of the A2 pulley were included in this retrospective study. 3 T MRI was performed with T1-weighted, T2-weighted fat suppressed, and T1-weighted fat suppressed contrast enhanced sequences. The A2 pulley of all the fingers visible on the images were analyzed and pulley lesions characterized. RESULTS: All asymptomatic pulleys were normal at MRI. In the 8 symptomatic fingers 7 pulleys were abnormal at MRI. With the clinical examination as gold standard, sensitivity, specificity, positive predictive value, and negative predictive value of MRI were 87.5%, 100%, 100%, and 95.2% respectively. Characterization of the different pulley lesion was possible. CONCLUSION: MRI at 3 T allows reliable direct visualization and characterization of traumatic A2 pulley lesions.

Evaluating the impact of library user training programmes across Thames Valley Strategic Health Authority in the UK.

BACKGROUND: This study was undertaken to provide evidence that library outreach projects in the NHS in the Thames Valley Strategic Health Authority area were effective and could justify continued funding. OBJECTIVES: The object was to assess whether information literacy skills training taken up by health professionals impacts on their confidence and skills in using electronic sources of health information. METHOD: A total of 487 health professionals taking up training on a voluntary basis were assessed by completing a self-assessment questionnaire prior to and after training to establish their information literacy skills and confidence levels. Of these, 223 trainees (46%) also returned 6-week follow-up questionnaires. RESULTS: Results showed that 464 trainees (95%) intended to apply what they had learnt in a variety of ways; use of specific resources greatly increased after training and confidence in using them increased substantially. Use of search techniques increased considerably overall, whereas use of Google decreased. CONCLUSIONS: The major findings of this research are that training health-care personnel in the use of electronic resources impacts positively on their information literacy skills and confidence, and that the information available to them is considered to have potential value across health-care practice.

Demonstrating the positive impact of information support on patient care in primary care: a rapid literature review.

AIM: To review the literature on the positive impact of information services, or information resources, on patient care in primary care. OBJECTIVES: To identify and summarize key papers on which librarians might draw in making the case for investment, and to highlight gaps in the research evidence Methodology: A rapid literature review was conducted in the summer of 2005. RESULTS: There is a small body of evidence to demonstrate the positive impact of library and information services on the direct care of patients as well as a beneficial impact on the care of future patients through the application of evidence to multiple patients. CONCLUSIONS: There is relatively limited research evidence of the impact of information, and library services, in primary care, in comparison with hospital settings and the research available is generally reliant on small samples. There is a lack of impact studies conducted with non-clinical staff. The review highlights the value of critical incident technique (CIT). It is possible to gather evidence of the potential for information services to deliver cost savings.

Impact of a chest-pain guideline on clinical decision-making.

OBJECTIVE: To evaluate the impact of a chest-pain guideline on clinical decision-making and medium-term outcomes of patients presenting to a hospital emergency department (ED) with non-traumatic chest pain. DESIGN: Before-and-after guideline implementation study. SETTING: Bankstown-Lidcombe Hospital, Sydney, NSW (454-bed metropolitan teaching hospital), in the six-month periods before and after guideline implementation in February 2001. PARTICIPANTS: Patients presenting to the ED with non-traumatic chest pain who had chest-pain assessment forms completed by ED doctors, comprising 422/768 (54.9%) of those presenting before and 461/691 (66.7%) after guideline implementation. MAIN OUTCOME MEASURES: Appropriateness of admission/discharge decisions compared with decision of senior cardiologist based on guideline; death, recurrent chest pain, ED re-presentation and hospital readmission in the ensuing three months. RESULTS: After guideline implementation, appropriate admission/discharge decisions increased significantly from 180/265 (68%) to 261/324 (81%) (difference, 13%; 95% CI, 6%-20%). The largest increase was for patients at moderate risk of death or acute myocardial infarction within six months, from 39/96 (38%) to 57/103 (55%) (difference, 18%; 95% CI, 4%-31%). Increases were seen for both junior doctors (interns and resident medical officers) (18%; 95% CI, 7%-30%) and senior doctors (11%; 95% CI, 2%-19%). Logistic regression showed that implementation of the guideline, seniority of assessing doctor and patient history of coronary disease were independent predictors of appropriate decisions. There was a significant decline in re-presentations to ED with recurrent chest pain in patients previously presenting with cardiac or possibly cardiac pain, from 46/201 (23%) before implementation to 32/247 (13%) after (difference, 210%; 95% CI, 217% to 23%). CONCLUSIONS: The chest-pain guideline resulted in a significant improvement in clinical decision-making in the ED and reduced re-presentations with cardiac/possibly cardiac chest pain.