Older peoples' lived experiences of personalised care in care homes: A meta-ethnography.

BACKGROUND: Guidance and policy on personalised (or person-centred) care of older people living in care homes advocates that all residents must have their preferences considered, and that all care provided must be reasonably adjusted to meet the person's specific needs. Despite this, research that considers what matters to residents in terms of the care they receive is limited. OBJECTIVES: Our review aims to explore care home residents' lived experiences of personalised care and understand what really matters to them. METHODS: Six electronic databases (CINHAL, Medline (Ovid), Embase, PubMed, Web of Science & PsychInfo) and Google Scholar (grey literature) were searched to identify qualitative studies relating to personalised care in care home settings, which also included resident (voices) quotes. The literature review and synthesis are reported using eMERGe guidance. RESULTS: Fifteen studies met the inclusion criteria for our meta-ethnography. Four conceptual categories (the challenge of fitting into institutional care, the passing of time, holding onto a sense of self and a desire to feel at home) and two key concepts (creating a culture of purposeful living and caring and forming and maintaining meaningful & empowering relationships) were identified. Finally, a conceptual framework of understanding represents what personally matters to residents in terms of their care. CONCLUSION: Our meta-ethnography, guided by residents' lived experiences of personalised care, offers a new perspective of what personally matters to residents in terms of the care they receive. The conceptual framework of understanding highlights the importance of moving from an institutional position of doing for residents to a person-centred position of doing with residents. IMPLICATIONS FOR PRACTICE: Our findings highlight the importance of understanding the differences between personalised and person-centred care for policy and practice. Further considerations are required on how this might be applied through nurse and care home professionals' education and work practices.

Collaborative leadership to support sustainability in practice for dietitians as allied health professionals.

BACKGROUND: Allied health professionals (AHPs) have an important role to support the Greener National Health Service (NHS) agenda. Dietitians are AHPs who are already demonstrating strong influence on food sustainability advocacy. There is call for more collaboration across the health professions to optimise "green" leadership in the pursuit of planetary health. The present study aimed to investigate the perceived role of AHP leaders and future leaders around more sustainable healthcare practices. METHODS: A mixed methods approach using audio-recorded semi-structured interviews with strategic AHP leaders (n = 11) and focus groups with student AHPs (n = 2). Standardised open-ended questions considered concepts of (i) leadership, (ii) green agenda, (iii) collaboration and (iv) sustainability. Purposive sampling used already established AHP networks. Thematic analysis systematically generated codes and themes with dietetic narratives drawn out specifically as exemplars. RESULTS: The findings represent diverse AHP voices, with six of 14 AHPs analysed, including dietetic (future) leaders. Three key themes emerged: (1) collective vision of sustainable practice; (2) empowering, enabling and embedding; and (3) embracing collaborative change. Dietetic specific narratives included food waste, NHS food supply chain issues, and tensions between health and sustainability advice. CONCLUSIONS: The present study shows that collaborative leadership is a core aspiration across AHP leaders and future leaders to inform the green agenda. Despite inherent challenges, participant perceptions illustrate how "change leadership" might be realised to support the net zero agenda within health and social care. Dietitians possess the relevant skills and competencies, and therefore have a fundamental role in evolving collaborative leadership and directing transformational change towards greener healthcare practices. Recommendations are made for future leaders to embrace this agenda to meet the ambitious net zero targets.

A genome-wide SNP genotyping resource for tropical pine tree species.

We performed gene and genome targeted SNP discovery towards the development of a genome-wide, multispecies genotyping array for tropical pines. Pooled RNA-seq data from shoots of seedlings from five tropical pine species was used to identify transcript-based SNPs resulting in 1.3 million candidate Affymetrix SNP probe sets. In addition, we used a custom 40 K probe set to perform capture-seq in pooled DNA from 81 provenances representing the natural ranges of six tropical pine species in Mexico and Central America resulting in 563 K candidate SNP probe sets. Altogether, 300 K RNA-seq (72%) and 120 K capture-seq (28%) derived SNP probe sets were tiled on a 420 K screening array that was used to genotype 576 trees representing the 81 provenances and commercial breeding material. Based on the screening array results, 50 K SNPs were selected for commercial SNP array production including 20 K polymorphic SNPs for P. patula, P. tecunumanii, P. oocarpa and P. caribaea, 15 K for P. greggii and P. maximinoi, 13 K for P. elliottii and 8K for P. pseudostrobus. We included 9.7 K ancestry informative SNPs that will be valuable for species and hybrid discrimination. Of the 50 K SNP markers, 25% are polymorphic in only one species, while 75% are shared by two or more species. The Pitro50K SNP chip will be useful for population genomics and molecular breeding in this group of pine species that, together with their hybrids, represent the majority of fast-growing tropical and subtropical pine plantations globally.

Exploring the barriers and gateways to intersubjectivity in dementia care: A meta-ethnography.

BACKGROUND: Behaviours that challenge in dementia, often described and diagnosed as behavioural psychological symptoms of dementia, are experienced by 75% of people living with dementia in care homes or hospital environments, with 43% of nurses and care providers reporting these behaviours as moderately or severely distressing to them. During behaviours that challenge moments in dementia, there is the potential for an intersubjective relationship to take place between the people living with dementia and the nurse. AIMS: This review explores and synthesises literature to consider the presence of intersubjectivity in people living with dementia. If the ability to be intersubjective remains present for people living with dementia, it will consider how its presence can be nurtured to offer a positive intersubjective communication between the person living with dementia and their carer/nurse. METHODS: The review used meta-ethnography methodology to develop concepts that help us to understand the implications of existing research on the presence of intersubjectivity in people living with dementia, and its relationship to those providing their care. Sixteen electronic databases (including MEDLINE/PubMed, Wiley Online Library and Sage publications) and grey literature such as Alzheimer's Society and Department of Health across journals dating from 2000-2020 were searched. Eight studies were selected and reviewed for quality and relevance for a meta-ethnographic literature synthesis of intersubjectivity in dementia. CONCLUSION: The meta-ethnography concluded that people living with dementia continue to have the capacity to be intersubjective on an emotional level. Nurses and other care providers need to acknowledge the presence of "personhood" and "personness" in people living with dementia to nurture positive intersubjective care relationships. The meta-ethnography has also been reviewed for reporting clarity against the EQUATOR checklist in the form of the eMERGe guideline (France et al., 2019).

Where are the children? An autoethnography of deception in dementia in an acute hospital.

An acute hospital environment is a confusing place for many patients requiring admission, especially when they are presenting as acutely unwell. This can be particularly difficult for people living with dementia. As cognition changes it is not uncommon for people living with dementia to have difficulties with their ability to orientate to time, place and person. These disorientating moments can lead to personal distress, and at times behavioural changes. As well as being distressing for the person living with dementia, it can also be emotionally and ethically challenging for acute hospital staff, including nurses. One area found to be particularly challenging is the concept of whether actively engaging with a person living with dementia's living truth is deceitful. This raises further questions of what forms of nurse responses to temporal disorientation might be constituted as lying, colluding, or alternatively validating. This article uses autoethnography as a research methodology with which to explore a mental health nurse's lived experience of the challenges of responding truthfully to disorientation and distress in an acute hospital. This article is not attempting to offer conclusive answers to these challenging ethical questions. It is instead re-opening and re-visiting the discourse of what is truth in dementia from a personal and professional nurse perspective through a lived narrative. The conclusion to the concept of truth in dementia is complex, nuanced and individualized. However, it is essential that a nurse's response to disorientation and distress is always person and living present focused, and not lie focused.

Genomic Breeding for Diameter Growth and Tolerance to Leptocybe Gall Wasp and Botryosphaeria/Teratosphaeria Fungal Disease Complex in Eucalyptus grandis.

Eucalyptus grandis is one of the most important species for hardwood plantation forestry around the world. At present, its commercial deployment is in decline because of pests and pathogens such as Leptocybe invasa gall wasp (Lepto), and often co-occurring fungal stem diseases such as Botryosphaeria dothidea and Teratosphaeria zuluensis (BotryoTera). This study analyzed Lepto, BotryoTera, and stem diameter growth in an E. grandis multi-environmental, genetic trial. The study was established in three subtropical environments. Diameter growth and BotryoTera incidence scores were assessed on 3,334 trees, and Lepto incidence was assessed on 4,463 trees from 95 half-sib families. Using the Eucalyptus EUChip60K SNP chip, a subset of 964 trees from 93 half-sib families were genotyped with 14,347 informative SNP markers. We employed single-step genomic BLUP (ssGBLUP) to estimate genetic parameters in the genetic trial. Diameter and Lepto tolerance showed a positive genetic correlation (0.78), while BotryoTera tolerance had a negative genetic correlation with diameter growth (-0.38). The expected genetic gains for diameter growth and Lepto and BotryoTera tolerance were 12.4, 10, and -3.4%, respectively. We propose a genomic selection breeding strategy for E. grandis that addresses some of the present population structure problems.

In Situ Genetic Evaluation of European Larch Across Climatic Regions Using Marker-Based Pedigree Reconstruction.

Sustainable and efficient forestry in a rapidly changing climate is a daunting task. The sessile nature of trees makes adaptation to climate change challenging; thereby, ecological services and economic potential are under risk. Current long-term and costly gene resources management practices have been primarily directed at a few economically important species and are confined to defined ecological boundaries. Here, we present a novel in situ gene-resource management approach that conserves forest biodiversity and improves productivity and adaptation through utilizing basic forest regeneration installations located across a wide range of environments without reliance on structured tree breeding/conservation methods. We utilized 4,267 25- to 35-year-old European larch trees growing in 21 reforestation installations across four distinct climatic regions in Austria. With the aid of marker-based pedigree reconstruction, we applied multi-trait, multi-site quantitative genetic analyses that enabled the identification of broadly adapted and productive individuals. Height and wood density, proxies to fitness and productivity, yielded in situ heritability estimates of 0.23 ± 0.07 and 0.30 ± 0.07, values similar to those from traditional "structured" pedigrees methods. In addition, individual trees selected with this approach are expected to yield genetic response of 1.1 and 0.7 standard deviations for fitness and productivity attributes, respectively, and be broadly adapted to a range of climatic conditions. Genetic evaluation across broad climatic gradients permitted the delineation of suitable reforestation areas under current and future climates. This simple and resource-efficient management of gene resources is applicable to most tree species.

Dementia and its relationship with suicidality: A critical interpretive synthesis.

OBJECTIVES: The objective of this literature review and synthesis of data was to consider the presence, drivers, and protectors of suicidality in people diagnosed with dementia. The review also considered what factors represented an increased risk of suicidality. Finally, it reflected on the morality and ethics of choice when discussing dying in dementia. METHOD: This article used a critical interpretive synthesis model which interpreted data associated with the subject of suicidality in dementia. A sample frame was used to determine the quality and relevance of extracted data, and finally to construct a critical interpretive synthesis. Data were extracted from eight key papers. RESULTS: The review and synthesis concluded with eight synthetic constructs, and two concluding synthesised arguments. Argument one was the substantial increased risk of suicidality in people diagnosed with dementia and clinical depression. The second argument was that end-of-life discussions are common place in people with a dementia diagnosis and their families. CONCLUSION: Death remains a difficult subject for some to discuss, especially when talking about suicidality. Nevertheless, having these conversations is possible, even when there are added complexities that a dementia diagnosis can bring. These conversations do, however, need to be individualized and measured. And, whilst respecting the person's pre-morbid wishes, advance decisions and ethics of choice, we also need to consider the ongoing arguments of the 'right to life' versus the 'right to die'. However, before these conversations can take place, additional suicidality risk factors such as a new and early dementia diagnosis and mental health comorbidities such as depression need to be acknowledged and addressed.

Estimating Realized Heritability in Panmictic Populations.

Narrow sense heritability [Formula: see text] is a key concept in quantitative genetics, as it expresses the proportion of the observed phenotypic variation that is transmissible from parents to offspring. [Formula: see text] determines the resemblance among relatives, and the rate of response to artificial and natural selection. Classical methods for estimating [Formula: see text] use random samples of individuals with known relatedness, as well as response to artificial selection, when it is called realized heritability. Here, we present a method for estimating realized [Formula: see text] based on a simple assessment of a random-mating population with no artificial manipulation of the population structure, and derive SE of the estimates. This method can be applied to arbitrary phenotypic segments of the population (for example, the top-ranking p parents and offspring), rather than random samples. It can thus be applied to nonpedigreed random mating populations, where relatedness is determined from molecular markers in the p selected parents and offspring, thus substantially saving on genotyping costs. Further, we assessed the method by stochastic simulations, and, as expected from the mathematical derivation, it provides unbiased estimates of [Formula: see text] We compared our approach to the regression and maximum-likelihood approaches utilizing Galton's dataset on human heights, and all three methods provided identical results.

Dynamic Gene-Resource Landscape Management of Norway Spruce: Combining Utilization and Conservation.

Traditional gene-resource management programs for forest trees are long-term endeavors requiring sustained organizational commitment covering extensive landscapes. While successful in maintaining adaptation, genetic diversity and capturing traditional growth attributes gains, these programs are dependent on rigid methods requiring elaborate mating schemes, thus making them slow in coping with climate change challenges. Here, we review the significance of Norway spruce in the boreal region and its current management practices. Next, we discuss opportunities offered by novel technologies and, with the use of computer simulations, we propose and evaluate a dynamic landscape gene-resource management in Norway. Our suggested long-term management approach capitalizes on: (1) existing afforestation activities, natural crosses, and DNA-based pedigree assembly to create structured pedigree for evaluation, thus traditional laborious control crosses are avoided and (2) landscape level genetic evaluation, rather than localized traditional progeny trials, allowing for screening of adapted individuals across multiple environmental gradients under changing climate. These advantages lead to greater genetic response to selection in adaptive traits without the traditional breeding and testing scheme, facilitating conservation of genetic resources within the breeding population of the most important forest tree species in Norway. The use of in situ selection from proven material exposed to realistic conditions over vast territories has not been conducted in forestry before. Our proposed approach is in contrast to worldwide current programs, where genetic evaluation is constrained by the range of environments where testing is conducted, which may be insufficient to capture the broad environmental variation necessary to tackle adaptation under changing climate.