Valuing All Voices: refining a trauma-informed, intersectional and critical reflexive framework for patient engagement in health research using a qualitative descriptive approach.

BACKGROUND: Critical stakeholder-identified gaps in current health research engagement strategies include the exclusion of voices traditionally less heard and a lack of consideration for the role of trauma in lived experience. Previous work has advocated for a trauma-informed, intersectional, and critical reflexive approach to patient and public involvement in health research. The Valuing All Voices Framework embodies these theoretical concepts through four key components: trust, self-awareness, empathy, and relationship building. The goal of this framework is to provide the context for research teams to conduct patient engagement through the use of a social justice and health equity lens, to improve safety and inclusivity in health research. The aim of this study was to revise the proposed Valuing All Voices Framework with members of groups whose voices are traditionally less heard in health research. METHODS: A qualitative descriptive approach was used to conduct a thematic analysis of participant input on the proposed framework. Methods were co-developed with a patient co-researcher and community organizations. RESULTS: Group and individual interviews were held with 18 participants identifying as Inuit; refugee, immigrant, and/or newcomer; and/or as a person with lived experience of a mental health condition. Participants supported the proposed framework and underlying theory. Participant definitions of framework components included characterizations, behaviours, feelings, motivations, and ways to put components into action during engagement. Emphasis was placed on the need for a holistic approach to engagement; focusing on open and honest communication; building trusting relationships that extend beyond the research process; and capacity development for both researchers and patient partners. Participants suggested changes that incorporated some of their definitions; simplified and contextualized proposed component definitions; added a component of "education and communication"; and added a 'how to' section for each component. The framework was revised according to participant suggestions and validated through member checking. CONCLUSIONS: The revised Valuing All Voices Framework provides guidance for teams looking to employ trauma-informed approaches, intersectional analysis, and critical reflexive practice in the co-development of meaningful, inclusive, and safe engagement strategies. PLAIN ENGLISH SUMMARY: Patient engagement in health research continues to exclude many people who face challenges in accessing healthcare, including (but not limited to) First Nations, Inuit, and Metis people; immigrants, refugees, and newcomers; and people with lived experience of a mental health condition. We proposed a new guide to help researchers engage with patients and members of the public in research decision-making in a meaningful, inclusive, and safe way. We called this the Valuing All Voices Framework, and met with people who identify as members of some of these groups to help define the key parts of the framework (trust; self-awareness; empathy; and relationship building), to tell us what they liked and disliked about the proposed framework, and what needed to be changed. Input from participants was used to change the framework, including clarifying definitions of the key parts, adding another key part called "education and communication", and providing action items so teams can put these key parts into practice.

Fukushima remediation: status and overview of future plans.

The 2011 accident at the Fukushima Dai-ichi Nuclear Power Plant, Japan, released large quantities of volatile radionuclides, requiring evacuation of a 20 km zone around the reactor site plus additional areas where fallout was particularly high. After decay of shorter-lived isotopes, off-site contamination is now dominated by (134/137)Cs, with ∼1800 km(2) having external gamma doses above 5 mSv y(-1). Although the significance for health of such radiation levels is low, there has been a Government decision that these areas will be cleaned up to reduce exposure and allow displaced residents to return home. After initial tests at 2 sites, a further 11 demonstration remediation projects have been carried out. This work is coordinated by the Japan Atomic Energy Agency (JAEA), with MCM providing support in quality assessment of radioactivity measurements, evaluating the success of different clean-up methods and developing guidelines for the next multi-year phase of large-scale remediation. This work provides a unique perspective on the progress of remediation, experience gained and issues that still need to be resolved - particularly associated with management of the huge quantities of waste generated. This knowledge base will also be important for the bigger challenge of on-site remediation, which will require decades to complete. Additionally, experience and tools may be transferable to cleaning nuclear legacy sites around the world, a problem that is often forgotten in the debate on national nuclear waste management.

Analytical and sampling constraints in ²¹°Pb dating.

²¹°Pb dating provides a valuable, widely used means of establishing recent chronologies for sediments and other accumulating natural deposits. The Constant Rate of Supply (CRS) model is the most versatile and widely used method for establishing ²¹°Pb chronologies but, when using this model, care must be taken to account for limitations imposed by sampling and analytical factors. In particular, incompatibility of finite values for empirical data, which are constrained by detection limit and core length, with terms in the age calculation, which represent integrations to infinity, can generate erroneously old ages for deeper sections of cores. The bias in calculated ages increases with poorer limit of detection and the magnitude of the disparity increases with age. The origin and magnitude of this effect are considered below, firstly for an idealized, theoretical ²¹°Pb profile and secondly for a freshwater lake sediment core. A brief consideration is presented of the implications of this potential artefact for sampling and analysis.

Testing the use of septum-capped vials for 13C-isotope abundance analysis of carbon dioxide.

Studying ecosystem processes in the context of carbon cycling and climate change has never been more important. Stable carbon isotope studies of gas exchange within terrestrial ecosystems are commonly undertaken to determine sources and rates of carbon cycling. To this end, septum-capped vials ('Exetainers') are often used to store samples of CO(2) prior to mass spectrometric analysis. To evaluate the performance of such vials for preserving the isotopic integrity (delta(13)C) and concentration of stored CO(2) we performed a rigorous suite of tests. Septum-capped vials were filled with standard gases of varying CO(2) concentrations (approximately 700 to 4000 ppm), delta(13)C values (approx. -26.5 to +1.8 per thousand(V-PDB)) and pressures (33 and 67% above ambient), and analysed after a storage period of between 7 and 28 days. The vials performed well, with the vast majority of both isotope and CO(2) concentration results falling within the analytical uncertainty of chamber standard gas values. Although the study supports the use of septum-capped vials for storing samples prior to mass spectrometric analysis, it does highlight the need to ensure that sampling chamber construction is robust (air-tight).