A theoretical modeling framework for motile and colonial harmful algae.

Climate change is leading to an increase in severity, frequency, and distribution of harmful algal blooms across the globe. For many harmful algae species in eutrophic lakes, the formation of such blooms is controlled by three factors: the lake hydrodynamics, the vertical motility of the algae organisms, and the ability of the organisms to form colonies. Here, using the common cyanobacterium Microcystis aeruginosa as an example, we develop a model that accounts for both vertical transport and colony dynamics. At the core of this treatment is a model for aggregation. For this, we used Smoluchowski dynamics containing parameters related to Brownian motion, turbulent shear, differential setting, and cell-to-cell adhesion. To arrive at a complete description of bloom formation, we place the Smoluchowski treatment as a reaction term in a set of one-dimensional advection-diffusion equations, which account for the vertical motion of the algal cells through molecular and turbulent diffusion and self-regulating buoyant motion. Results indicate that Smoluchowski aggregation qualitatively describes the colony dynamics of M. aeruginosa. Further, the model demonstrates wind-induced mixing is the dominant aggregation process, and the rate of aggregation is inversely proportional to algal concentration. Because blooms of Microcystis typically consist of large colonies, both of these findings have direct consequences to harmful algal bloom formation. While the theoretical framework outlined in this manuscript was derived for M. aeruginosa, both motility and colony formation are common among bloom-forming algae. As such, this coupling of vertical transport and colony dynamics is a useful step for improving forecasts of surface harmful algal blooms.

Guidance for Health Care Leaders During the Recovery Stage of the COVID-19 Pandemic: A Consensus Statement.

Importance: The COVID-19 pandemic is the greatest global test of health leadership of our generation. There is an urgent need to provide guidance for leaders at all levels during the unprecedented preresolution recovery stage. Objective: To create an evidence- and expertise-informed framework of leadership imperatives to serve as a resource to guide health and public health leaders during the postemergency stage of the pandemic. Evidence Review: A literature search in PubMed, MEDLINE, and Embase revealed 10 910 articles published between 2000 and 2021 that included the terms leadership and variations of emergency, crisis, disaster, pandemic, COVID-19, or public health. Using the Standards for Quality Improvement Reporting Excellence reporting guideline for consensus statement development, this assessment adopted a 6-round modified Delphi approach involving 32 expert coauthors from 17 countries who participated in creating and validating a framework outlining essential leadership imperatives. Findings: The 10 imperatives in the framework are: (1) acknowledge staff and celebrate successes; (2) provide support for staff well-being; (3) develop a clear understanding of the current local and global context, along with informed projections; (4) prepare for future emergencies (personnel, resources, protocols, contingency plans, coalitions, and training); (5) reassess priorities explicitly and regularly and provide purpose, meaning, and direction; (6) maximize team, organizational, and system performance and discuss enhancements; (7) manage the backlog of paused services and consider improvements while avoiding burnout and moral distress; (8) sustain learning, innovations, and collaborations, and imagine future possibilities; (9) provide regular communication and engender trust; and (10) in consultation with public health and fellow leaders, provide safety information and recommendations to government, other organizations, staff, and the community to improve equitable and integrated care and emergency preparedness systemwide. Conclusions and Relevance: Leaders who most effectively implement these imperatives are ideally positioned to address urgent needs and inequalities in health systems and to cocreate with their organizations a future that best serves stakeholders and communities.

The "What Now?" Workbook: Its potential utility following life-changing events.

BACKGROUND.: Following a life-changing event, such as a serious illness, people can experience a disruption of meaning and identity, making it difficult to move forward. The "What Now?" Workbook was developed to enable exploration of the personal meanings of specific occupations to facilitate future planning. PURPOSE.: The aim of this study was to investigate the utility-usability and usefulness-of the workbook in practice. METHOD.: Five occupational therapists trialled the workbook at a specialist cancer centre in England. Qualitative data were gathered via a focus group, an interview, and questionnaires. The data were subject to a realist thematic analysis. FINDINGS.: The findings showed the workbook to have actual and potential utility for service users in this setting, as perceived by their occupational therapists, by helping them to explore occupations, their loss, meanings, and future possibilities as part of an occupational therapy intervention. IMPLICATIONS.: The workbook appears to offer a structured yet flexible way to explore personal meanings of occupations, enabling service users to gain insights and move forward following a life-changing illness.

Screening, diagnosis and treatment of iron deficiency in chronic heart failure: putting the 2016 European Society of Cardiology heart failure guidelines into clinical practice.

Iron deficiency is common in patients with chronic heart failure (CHF) and is associated with reduced exercise performance, impaired health-related quality of life and an increased risk of mortality, irrespective of whether or not anaemia is present. Iron deficiency is a serious but treatable condition. Several randomized controlled clinical trials have demonstrated the ability of intravenous (IV) iron, primarily IV ferric carboxymaltose (FCM), to correct iron deficiency in patients with heart failure with reduced ejection fraction (HFrEF), resulting in improvements in exercise performance, CHF symptoms and health-related quality of life. The importance of addressing the issue of iron deficiency in patients with CHF is reflected in the 2016 European Society of Cardiology (ESC) heart failure guidelines, which recognize iron deficiency as an important co-morbidity, independent of anaemia. These guidelines recommend that all newly diagnosed heart failure patients are routinely tested for iron deficiency and that IV FCM should be considered as a treatment option in symptomatic patients with HFrEF and iron deficiency (serum ferritin < 100 µg/L, or ferritin 100-299 µg/L and transferrin saturation < 20%). Despite these specific recommendations, there is still a lack of practical, easy-to-follow advice on how to diagnose and treat iron deficiency in clinical practice. This article is intended to complement the current 2016 ESC heart failure guidelines by providing practical guidance to all health care professionals relating to the procedures for screening, diagnosis and treatment of iron deficiency in patients with CHF.

Chronic Heart Failure Care Planning: Considerations in Older Patients.

In developed countries, it is estimated that more than 10 % of adults aged over 70 years have heart failure (HF). Despite therapeutic advances, it remains a condition associated with significant morbidity and mortality. It is one of the commonest causes of unscheduled hospital admissions in older adults and data consistently show a lower uptake of evidence-based investigations and therapies as well as higher rates of HF hospitalisations and mortality than in younger adults. These rates are highest amongst patients discharged to 'skilled nursing facilities', where comorbidities, frailty and cognitive impairment are common and have a significant impact on outcomes. In this review, we examine current guidance and its limitations and offer a pragmatic approach to management of HF in this elderly population.

Exploring the concept of leadership from the perspective of physical therapists in Canada.

PURPOSE: To explore the concept of leadership from the perspective of physical therapists in Canada. METHODS: A quantitative, cross-sectional nationwide study was performed using a Web-based survey distributed to all members of the Canadian Physiotherapy Association (CPA) with a registered e-mail address (n=6,156). Frequency distributions and percentages were obtained for all leadership characteristics, and chi-square tests were performed, with significance set at p<0.05. RESULTS: A total of 1,875 members responded, for a 30% response rate. Communication, professionalism, and credibility were rated as extremely important leadership characteristics by the majority of respondents across all three settings (workplace, health care system, and society); practising in the private sector contributed significantly to the perceived importance of business acumen (p<0.001). Overall, 79.6% of respondents self-declared as leaders; male gender, primary work facility in private practice or educational institution, and supervision of students were factors associated with self-declaration as a leader. CONCLUSIONS: The top three characteristics that physical therapists perceive as important differ from those reported among other health care professions. Further research is required to understand whether the presence of multiple health care professionals in an acute-care setting facilitates leadership opportunities or whether physical therapists feel overshadowed. Future studies should also investigate whether individuals practising outside the private sector recognize the business aspects of their workplace.

Objectif : Explorer le concept de leadership du point de vue des physiothérapeutes au Canada. Méthode : Une étude quantitative transversale nationale a été réalisée à l'aide d'un sondage par Internet distribué à tous les membres de l'Association canadienne de physiothérapie (ACP) qui possèdent une adresse de courriel inscrite à l'Association (n=6156). La répartition de la fréquence et les pourcentages ont été obtenus pour toutes les caractéristiques de leadership de l'étude, et des tests du Khi-carré ont été réalisés avec un seuil de signification fixé à <0,5. Résultats : Au total, 1875 membres ont répondu, soit un taux de réponse de 30 %. La communication, le professionnalisme et la crédibilité ont été classés comme des caractéristiques de leadership extrêmement importantes dans tous les milieux (lieu de travail, système de santé et société en général); la pratique dans le secteur privé a grandement contribué à l'importance perçue du concept de « sens des affaires ¼ (p<0,001). Dans l'ensemble, 79,6 % des répondants ont dit se considérer comme des dirigeants (leaders). Les facteurs suivants ont été associés à cette déclaration : le fait d'être de sexe masculin, de travailler principalement en pratique privée ou dans un établissement d'enseignement et d'exercer un travail de supervision auprès d'étudiants. Conclusions : Les trois premières caractéristiques perçues par les physiothérapeutes comme étant importantes diffèrent de celles dont on fait état dans d'autres professions du milieu de la santé. D'autres recherches seront nécessaires pour comprendre si la présence de plusieurs professionnels de la santé dans des établissements de soins de courte durée facilite les possibilités de leadership ou si les physiothérapeutes sentent que les autres professionnels leur portent ombrage. D'autres études devraient aussi tenter de déterminer si les physiothérapeutes qui pratiquent ailleurs que dans le secteur privé sont conscients du côté plus entrepreneurial de leur milieu de travail.

Eudaimonic well-being: its importance and relevance to occupational therapy for humanity.

Contemporary critique of the philosophy and theory of occupational therapy has asserted that the mainstream of the profession holds a westernized view of the world and that occupational therapy has been shackled to notions of health/illness and the medical establishment for too long, hampering movement into social and political spheres. Strategies and developments have been proposed to combat these biases, which have included increased cultural relativism and a re-focus on the subjective experience of occupation. The value placed on "being" in occupational therapy philosophy is described alongside the related terms of occupational integrity and spirituality. Drawing on theory and research from psychology, this paper proposes the construct of eudaimonic well-being as both relevant and valuable to occupational therapy in re-conceptualizing the profession, countering some of the central tensions in the identity of the profession and re-asserting that well-being through occupation is for all and for humanity. Finally, the paper proposes that well-being, in a eudaimonic sense, should be advertised and evidenced as a routine outcome of occupational therapy and consolidated into occupational therapy models as a relevant and meaningful concept.