A conceptual model of the nurse's role as primary palliative care provider in goals of care communication

Objective

Nurses have opportunities to engage in goals of care conversations that can promote palliative care communication. The purpose of this study was to describe nurses' experiences in goals of care communication as summarized in the literature and to present a conceptual model of communication pathways for nurses.

Methods

An integrative review of the literature (2016-2022) addressing nurses' experiences in goals of care communication was conducted using PubMed, CINAHL, and PsychInfo databases. A total of 92 articles were retrieved. A total of 12 articles were included for this review after applying the inclusion and exclusion criteria.

Results

Of the 12 articles, the majority were qualitative studies (n = 8). Qualitative analysis of findings from all articles revealed three dominant themes: nurses' ambiguous role responsibilities, goals of care as end-of-life communication, and the need for nurse communication training.

Conclusion

This article suggests an innovative conceptual model for advancing nurse communication about goals of care to facilitate primary palliative care.

Innovation

The framework characterizes two communication pathways for Advanced Practice Nurses who direct goals of care discussions and Registered Nurses who support goals of care communication. The model informs future communication training aimed at supporting primary palliative care.

Improving the simulations of the hydrological model in the karst catchment by integrating the conceptual model with machine learning models

Hydrological modelling can be complex in nonhomogeneous catchments with diverse geological, climatic, and topographic conditions. In this study, an integrated conceptual model including the snow module with machine learning modelling approaches was implemented for daily rainfall-runoff modelling in mostly karst Ljubljanica catchment, Slovenia, which has heterogeneous characteristics and is potentially exposed to extreme events that make the modelling process more challenging and crucial. In this regard, the conceptual model CemaNeige Génie Rural à 6 paramètres Journalier (CemaNeige GR6J) was combined with machine learning models, namely wavelet-based support vector regression (WSVR) and wavelet-based multivariate adaptive regression spline (WMARS) to enhance modelling performance. In this study, the performance of the models was comprehensively investigated, considering their ability to forecast daily extreme runoff. Although CemaNeige GR6J yielded a very good performance, it overestimated low flows. The WSVR and WMARS models yielded poorer performance than the conceptual and hybrid models. The hybrid model approach improved the performance of the machine learning models and the conceptual model by revealing the linkage between variables and runoff in the conceptual model, which provided more accurate results for extreme flows. Accordingly, the hybrid models improved the forecasting performance of the maximum flows up to 40 % and 61 %, and minimum flows up to 73 % and 72 % compared to the CemaNeige GR6J and stand-alone machine learning models. In this regard, the hybrid model approach can enhance the daily rainfall-runoff modelling performance in nonhomogeneous and karst catchments where the hydrological process can be more complicated.

Patient experiences in ulcerative colitis: conceptual model and review of patient-reported outcome measures

PURPOSE

To identify symptoms and their impacts on daily functioning and health-related quality of life (HRQoL) experienced by adult patients with ulcerative colitis (UC) and evaluate patient-reported outcome (PRO) measures for UC clinical studies.

METHODS

A conceptual model of symptoms and impacts of UC were developed from a literature review. PRO measures were identified from the literature, clinical trials databases, health technology assessment submissions, and regulatory label claims, and were selected for conceptual analysis based on disease specificity and use across information sources. PRO measures covering the most concepts when mapped against the conceptual model were assessed for gaps in psychometric properties using Food and Drug Administration (FDA) guidance and consensus-based standards for the selection of health measurement instruments (COSMIN) criteria.

RESULTS

The conceptual model grouped the 52 symptom concepts and 72 proximal and distal impacts into eight, two, and five dimensions, respectively. Of 65 PRO measures identified, eight underwent conceptual analysis. Measures covering the most concepts and assessed for psychometric properties were the Inflammatory Bowel Disease Questionnaire, Symptoms and Impacts Questionnaire for UC, UC-PRO symptoms modules, UC-PRO impact modules, and Crohn's and UC Questionnaire; all had good or excellent support for content validity. The UC-PRO Signs and Symptoms fully met FDA guidance and COSMIN criteria for content validity and most psychometric properties.

CONCLUSION

Existing PRO measures assess concepts relevant to patients with UC, but all PRO measures reviewed require further psychometric evaluation to demonstrate they are fit for purpose.

Disparities in the treatment of primary hyperparathyroidism: A scoping review and conceptual model

BACKGROUND

Primary hyperparathyroidism is underdiagnosed and surgical treatment is underutilized and inequitably distributed. We present a review of the current literature on disparities in the treatment of hyperparathyroidism, with a focus on gaps in knowledge and paths forward.

METHODS

We searched PubMed and Scopus for abstracts related to disparities in hyperparathyroidism.

RESULTS

16 articles (of 1541) met inclusion criteria. The most commonly examined disparity was race. Notably, Black, Hispanic, and Asian patients were less likely to undergo surgery after diagnosis, face delays in obtaining treatment, and less likely to see a high-volume surgeon. Similar disparities in care were noted among those without insurance, older patients, and patients with limited English proficiency.

CONCLUSION

There are clear inequities in the treatment of hyperparathyroidism. Current research is in an early "identification" phase of disparities research; a new conceptual model based on established socioecological frameworks is provided to help move the field forward to "understanding" and "intervening" in surgical disparities.

Design and validation of a conceptual model regarding impact of open science on healthcare research processes

INTRODUCTION

The development and use of digital tools in various stages of research highlight the importance of novel open science methods for an integrated and accessible research system. The objective of this study was to design and validate a conceptual model of open science on healthcare research processes.

METHODS

This research was conducted in three phases using a mixed-methods approach. The first phase employed a qualitative method, namely purposive sampling and semi-structured interview guides to collect data from healthcare researchers and managers. Influential factors of open science on research processes were extracted for refining the components and developing the proposed model; the second phase utilized a panel of experts and collective agreement through purposive sampling. The final phase involved purposive sampling and Delphi technique to validate the components of the proposed model according to researchers' perspectives.

FINDINGS

From the thematic analysis of 20 interview on the study topic, 385 codes, 38 sub-themes, and 14 main themes were extracted for the initial proposed model. These components were reviewed by expert panel members, resulting in 31 sub-themes, 13 main themes, and 4 approved themes. Ultimately, the agreed-upon model was assessed in four layers for validation by the expert panel, and all the components achieved a score of > 75% in two Delphi rounds. The validated model was presented based on the infrastructure and culture layers, as well as supervision, assessment, publication, and sharing.

CONCLUSION

To effectively implement these methods in the research process, it is essential to create cultural and infrastructural backgrounds and predefined requirements for preventing potential abuses and privacy concerns in the healthcare system. Applying these principles will lead to greater access to outputs, increasing the credibility of research results and the utilization of collective intelligence in solving healthcare system issues.

Considering pollinators' ecosystem services in the remediation and restoration of contaminated lands: Overview of research and its gaps

The concept of ecosystem services provides a useful framework for understanding how people are affected by changes to the natural environment, such as when a contaminant is introduced (e.g., oil spills, hazardous substance releases) or, conversely, when contaminated lands are remediated and restored. Pollination is one example of an important ecosystem service; pollinators play a critical role in any functioning terrestrial ecosystem. Other studies have suggested that consideration of pollinators' ecosystem services could lead to better remediation and restoration outcomes. However, the associated relationships can be complex, and evaluation requires synthesis from numerous disciplines. In this article, we discuss the possibilities for considering pollinators and their ecosystem services when planning remediation and restoration of contaminated lands. To inform the discussion, we introduce a general conceptual model of how pollinators and the ecosystem services associated with them could be affected by contamination in the environment. We review the literature on the conceptual model components, including contaminant effects on pollinators and the direct and indirect ecosystem services provided by pollinators, and identify information gaps. Though increased public interest in pollinators likely reflects increasing recognition of their role in providing many important ecosystem services, our review indicates that many gaps in understanding-about relevant natural and social systems-currently impede the rigorous quantification and evaluation of pollinators' ecosystem services required for many applications, such as in the context of natural resource damage assessment. Notable gaps include information on non-honeybee pollinators and on ecosystem services beyond those benefitting the agricultural sector. We then discuss potential research priorities and implications for practitioners. Focused research attention on the areas highlighted in this review holds promise for increasing the possibilities for considering pollinators' ecosystem services in the remediation and restoration of contaminated lands. Integr Environ Assess Manag 2024;20:322-336. © 2023 SETAC.

Evaluating the effects of climate change and chemical, physical, and biological stressors on nearshore coral reefs: A case study in the Great Barrier Reef, Australia

An understanding of the combined effects of climate change (CC) and other anthropogenic stressors, such as chemical exposures, is essential for improving ecological risk assessments of vulnerable ecosystems. In the Great Barrier Reef, coral reefs are under increasingly severe duress from increasing ocean temperatures, acidification, and cyclone intensities associated with CC. In addition to these stressors, inshore reef systems, such as the Mackay-Whitsunday coastal zone, are being impacted by other anthropogenic stressors, including chemical, nutrient, and sediment exposures related to more intense rainfall events that increase the catchment runoff of contaminated waters. To illustrate an approach for incorporating CC into ecological risk assessment frameworks, we developed an adverse outcome pathway network to conceptually delineate the effects of climate variables and photosystem II herbicide (diuron) exposures on scleractinian corals. This informed the development of a Bayesian network (BN) to quantitatively compare the effects of historical (1975-2005) and future projected climate on inshore hard coral bleaching, mortality, and cover. This BN demonstrated how risk may be predicted for multiple physical and biological stressors, including temperature, ocean acidification, cyclones, sediments, macroalgae competition, and crown of thorns starfish predation, as well as chemical stressors such as nitrogen and herbicides. Climate scenarios included an ensemble of 16 downscaled models encompassing current and future conditions based on multiple emission scenarios for two 30-year periods. It was found that both climate-related and catchment-related stressors pose a risk to these inshore reef systems, with projected increases in coral bleaching and coral mortality under all future climate scenarios. This modeling exercise can support the identification of risk drivers for the prioritization of management interventions to build future resilient reefs. Integr Environ Assess Manag 2024;20:401-418. © 2023 Norwegian Institute for Water Research and The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC). This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Salinization of shallow groundwater in the Jiaokou Irrigation District and associated secondary environmental challenges

Understanding groundwater salinization of irrigation areas and related secondary environmental challenges is important for ensuring sustainable development. However, the mechanism under which groundwater salinization forms under the influence of long-term anthropogenic activities remains unclear. Therefore, this study analyzed the spatiotemporal variation in groundwater salinization and the underlying mechanism, and discussed the secondary environmental challenges in an irrigation area. The Jiaokou Irrigation District, North China, was adopted as a case study. The results showed a slight downward trend in groundwater salinity over the past two decades at a rate of 0.0229 g/L/y. Higher groundwater salinity was observed in areas with shallow groundwater depth. This correlation was mainly attributed to evaporative concentration, with secondary processes including natural weathering, depth of water-table, and fertilizer leaching. Drainage ditches may reduce groundwater salinity. Groundwater was transformed from freshwater to salt water and then to brackish water during the runoff process. The former transformation is mainly related to evaporation and fertilization. The latter transformation could be related to the inverse relationship between the distance to the Wei River and sediment permeability, with sediment permeability positively related to groundwater flow and leading to the discharge of salt into the Wei River. The secondary environmental challenges related to groundwater salinization in irrigation areas, mainly manifested in deterioration of irrigation water quality, soil salinization, and increased fluorine concentration. This study can act as a theoretical and practical reference for the development and utilization of water resources, ecological protection, and soil salinization in typical irrigation districts.

The underlying role of food guilt in adolescent food choice: A potential conceptual model for adolescent food choice negotiations under circumstances of conscious internal conflict

Food choice decisions are challenging to conceptualise, and literature is lacking specific to adolescent food choice decisions. Understanding adolescent nutrition and food choice is becoming increasingly important. This research aims to understand what influences the food choices of Irish adolescents, and the mental negotiations occurring in food-based decisions. Additionally, it aims to develop a holistic conceptual model of food choice, specific to adolescents. A qualitative study was conducted in N = 47 Irish adolescents, via focus group discussions using vignettes to introduce discussion topics around food and eating habits. Data were analysed using reflexive thematic analysis, involving both semantic and latent analysis. Thirteen distinct factors related to adolescent food choices were discussed, forming one main theme and three inter-linking subthemes. The main theme relates to food choice being multi-factorial in nature, needing a balance of priorities through internal negotiations for food choice with the aim of reducing food guilt. This can change depending on the social setting. Social concerns and food guilt appear to play a strong role in adolescent food choice, with adolescents feeling guilty for eating unhealthy food, wasting food, or spending/wasting money on food. A conceptual model for food choice in adolescents was developed, named a "Food Choice Funnel", incorporating a specific "Food Guilt Matrix". While we should encourage healthy eating and a healthy lifestyle, it is important to understand the value placed on the social component to eating among adolescents, since they have increasing social interactions and occasions where choosing health-promoting foods may be more challenging. Healthy eating messages should be designed in a balanced manner to support healthy growth and development, while limiting the potential to induce feelings of guilt among adolescents.

Facilitating access to primary care for people living in socio-economically vulnerable circumstances in Belgium through community health workers: towards a conceptual model

INTRODUCTION

Inspired by examples in low- and middle-income countries, 50 community health workers (CHWs) were introduced in Belgium to improve access to primary care for people living in socio-economically vulnerable circumstances. This article aims to explore the ways in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care.

METHODS

The qualitative research focuses on the first year of implementation of this pioneer nationwide CHW programme in Belgium. To respond to the research aim, thirteen semi-structured in-depth interviews were held with people living in socio-economically vulnerable circumstances. In addition, a photovoice study was conducted with fifteen CHWs comprising four phases: (1) photovoice training; (2) participatory observation with each CHW individually; (3) an individual semi-structured in-depth interview; and (4) three focus group discussions. The transcripts and the observation notes were analysed in accordance with the abductive analysis procedures described by Timmermans and Tavory.

RESULTS

The qualitative results show that the CHWs' outreaching way of working allows them to reach people living at the crossroads of different vulnerabilities that are intertwined and reinforce each other. They experience complex care needs, while at the same time they face several barriers that interrupt the continuum of access to primary care - as conceptualised in the theoretical access-to-care framework of (Levesque et al. Int J Equity Health. 12:18, 2013). Building on the theoretical access-to-care framework described by (Levesque et al. Int J Equity Health. 12:18, 2013), the conceptual model outlines first the underlying mechanisms of CHW-facilitated access to primary care: (I) outreaching and pro-active way of working; (II) building trust; (III) providing unbiased support and guidance in a culturally sensitive manner; and (IV) tailoring the CHWs' approach to the unique interplay of barriers at the individual and health system level along the access-to-care continuum as experienced by the individual. Further disentangling how CHWs provide support to the barriers in access to care across the continuum and at each step is outlined further in the process characteristics of this conceptual model. Furthermore, the qualitative results show that the way in which CHWs support people is also impacted by the broader health system, such as long waiting times and unwelcoming healthcare professionals after referral from a CHW.

DISCUSSION

The conceptual model of CHW-facilitated access to primary care developed in this article explores the way in which CHWs support people living in socio-economically vulnerable circumstances in their access to primary care in Belgium. Through their outreaching method, they play a valuable bridging role between the Belgian healthcare system and people living in socio-economically vulnerable circumstances.

Hysteresis response of groundwater depth on the influencing factors using an explainable learning model framework with Shapley values

Machine learning has been widely used for groundwater prediction. However, the hysteresis response of groundwater depth (GD) to input features has not been fully investigated. This study uses an interpretation method to reveal the interplay between climate, human activity, and GD while considering the response of groundwater to multiple factors. Six factors [precipitation (P), wind speed (WS), temperature (T), population (POP), gross domestic product (GDP), and effective irrigated area (EIA)] were selected to analyze the hysteresis response of GD in terms of the lag correlation coefficient and lag time. The correlation between climatic variables and GD was weaker than that of anthropogenic variables. The lag time between variables and different types of GD was less than four months at most sites, except for EIA and WS in deep groundwater. The SVM model achieved satisfactory performance in 89 % of the sites. If there were sharp changes in GD during the testing period or significant variations in its seasonal patterns at different times, the SVM model performed poorly. The model was interpreted using the Shapley additive explanation method. The impact of POP and GDP on deep groundwater in irrigated areas was higher than that of shallow groundwater. In urban areas with intensive human activities, anthropogenic variables were the main factors affecting shallow groundwater while the impact of climate was gradually increasing in the suburbs. The influence of precipitation on shallow groundwater was decreased after water transfer from the South-to-North Water Diversion project. Furthermore, this study proposed a multifactor-driven conceptual model that can provide recommendations for analyzing groundwater dynamics in similar areas.

Natural and anthropogenic factors regulating fluoride enrichment in groundwater of the Nansi Lake Basin, Northern China

Excess fluoride (F-) in groundwater can be hazardous to human health of local residents who rely upon it. Beside natural sources, anthropogenic input may be an additional source to be considered. Twenty surface water and 396 groundwater samples were collected from the Nansi Lake Basin, with hydrogeochemical and isotope techniques employed to clarify the spatial variability, source, and the natural and anthropogenic factors regulating the occurrence of high F- groundwater. The factors responsible for elevated F- levels in surface water and deep confined aquifers are discussed based on their hydraulic relationship. Also a conceptual model of F- enrichment with different aquifer systems is put forward based on the geomorphic units of the basin. The results show that F- concentration is between 0.1 and 6.9 mg/L in the west of Lake, while ranged from 0.03 to 1.74 mg/L in the east of Lake. The hydrogeological setting and lithology are the primary factor determining the provenance of high-fluoride groundwater in the basin. Fluoride mainly originated from the dissolution of fluorine-bearing minerals, and is affected by the alkaline groundwater environment, cation exchange, adsorption, and evaporation. The landforms on the east side of Nansi Lake are low hills and piedmont sedimentary plains, where the aquifers consist of karst fissure water and overlying porewater. High F- groundwater is not observed in this area due to its rapid flow and Ca2+-enriched hydrochemical characteristics. The anthropogenic input (such as fertilizer application on farms and illegal industrial pollutant discharge), contribute F- to groundwater in varying degrees, especially in the shallow aquifers east of the lake and in some parts west of the lake. This work is a clear example of how natural processes together with human activities can affect the chemical quality of groundwater, which is essential to safeguard the sustainable management of water resources in semi-arid areas.

Adaptive variability in children's conceptual models of division

This study examined whether different types of commonly used mathematical tasks affect how children think about whole number division problems. Prior research suggested that children tend to rely on the partitive model to understand whole number division, which is likely problematic when students transition to learning about fraction division. We assessed variability in correct whole number division problem-solving strategies among 63 elementary school children (41.5% female, 58.5% male, 0% nonbinary/gender expansive; 69.2% White, 10.7% multiracial, 6.1% Black, 4.6% Latino, 3.3% other/unidentified, 6.1% preferred not to answer). Each participant was asked to demonstrate four whole number division problems in each of three contexts (within participants): objects, story problems, and number lines. Most children displayed understanding of multiple conceptual models of division, but strategies varied by context. Story problems elicited partitive models, number lines elicited quotative models, and objects elicited both. Finally, elementary school children used strategies adaptively. Number line representations may afford conceptual connections between earlier-learned whole number concepts and analogous later-learned fraction concepts, supporting the integration of children's whole number and fraction knowledge.

Interaction mechanism and spatial effect of cross-regional haze pollution based on a multisectoral economy-energy-environment (3E) model and the evidence from China

The transboundary characteristics and multisectoral factor interaction mechanism of haze pollution have aroused widespread attention but remain understudied. This article proposes a comprehensive conceptual model that clarifies regional haze pollution, further establishes a theoretical framework on a cross-regional, multisectoral economy-energy-environment (3E) system, and attempts to empirically investigate the spatial effect and interaction mechanism employing a spatial-econometrics model based on China's province-level regions. The results demonstrate that (1) regional haze pollution is a transboundary atmospheric state formed by the accumulation and agglomeration of various emission pollutants; moreover, there is a "snowball" effect and a spatial spillover effect. (2) The formation and evolution of haze pollution are driven by the multisectoral factors of 3E system interaction, and the findings still hold after theoretical and empirical analysis and robustness tests. (3) Significant spatial autocorrelation exists for the 3E factors, presenting different clustering modes with a dynamic spatiotemporal evolution, particularly in the high-high (H-H) mode and low-low (L-L) mode. (4) Significant heterogeneous impacts of economic and energy factors on haze pollution are identified, namely, an inverted "U-shaped" relationship and a positive linear association, respectively. Further spatial analysis demonstrates a strong spatial spillover and obvious path dependence among local and neighboring regions. Policymakers are advised to consider multisectoral 3E system interaction and cross-regional collaboration. Integr Environ Assess Manag 2023;19:1525-1543. © 2023 SETAC.

Mapping trust relationships in organ donation and transplantation: a conceptual model

The organ donation and transplantation (ODT) system heavily relies on the willingness of individuals to donate their organs. While it is widely believed that public trust plays a crucial role in shaping donation rates, the empirical support for this assumption remains limited. In order to bridge this knowledge gap, this article takes a foundational approach by elucidating the concept of trust within the context of ODT. By examining the stakeholders involved, identifying influential factors, and mapping the intricate trust relationships among trustors, trustees, and objects of trust, we aim to provide a comprehensive understanding of trust dynamics in ODT. We employ maps and graphs to illustrate the functioning of these trust relationships, enabling a visual representation of the complex interactions within the ODT system. Through this conceptual groundwork, we pave the way for future empirical research to investigate the link between trust and organ donation rates, informed by a clarified understanding of trust in ODT. This study can also provide valuable insights to inform interventions and policies aimed at enhancing organ donation rates.

Symptoms and impacts of familial chylomicronemia syndrome: a qualitative study of the patient experience

BACKGROUND

Familial chylomicronemia syndrome (FCS) is a rare, hereditary, metabolic disorder. FCS causes high levels of triglycerides in the blood, which can lead to abdominal pain, xanthomas, and acute pancreatitis (AP). Volanesorsen, along with adherence to a very low-fat diet is used to reduce triglyceride levels in individuals with FCS. We aimed to understand the symptoms of FCS and their impact on health-related quality of life (HRQoL).

METHODS

Interviews were conducted with individuals with genetically confirmed FCS in the UK and Spain, some of whom had been treated with volanesorsen. Interview guides were developed with input from a patient advocacy group to explore the symptoms, impacts and management of FCS. Interviews were conducted by telephone and were recorded and transcribed. Data were analyzed using thematic analysis and saturation was recorded.

RESULTS

Seventeen interviews were conducted with individuals with FCS (aged 27-68 years), thirteen of whom were currently/previously treated with volanesorsen. Episodes of AP were the most impactful reported symptom, resulting in severe abdominal pain, nausea, vomiting, fever, bloating and appetite loss. Other symptoms and functional issues included abdominal pain, gastrointestinal symptoms, impaired cognitive function and fatigue. These had an impact on work, social activities, relationships and psychological wellbeing. These symptoms and impacts were illustrated in a conceptual model, including management strategies. The challenges of managing a low-fat diet and experience with volanesorsen were discussed.

CONCLUSION

Individuals with FCS experience a range of interrelated symptoms and functional limitations which impact their broader HRQoL. Treatments which alleviate symptoms and reduce the incidence of AP episodes have the potential to improve the HRQoL of these individuals.

Estimation of the impact of combined sewer overflows on surface water quality in a sparsely monitored area

Combined sewer overflows (CSOs) can have a severe negative, local impact on surface water systems. To assure good ecological surface water quality and drinking water production that meets the demands, the impact of sewer system overflows on the surrounding water bodies for current and future climate conditions needs to be assessed. Typically, integrated, detailed hydrological and hydrodynamic water quantity and quality models are used for this purpose, but often data and computational resource requirements limit their applicability. Therefore, an alternative computationally efficient, integrated water quantity and quality model of sewer systems and their receiving surface waters is proposed to assess the impact of CSOs on surface water quality in a sparsely observed area. A conceptual model approach to estimate CSO discharges is combined with an empirical model for estimating CSO pollutant concentrations based on waste water treatment plant influent observations. Both methods are compared with observations and independent results of established reference methods as to evaluate their performance. The methodology is demonstrated by modelling the current impact of CSOs on the water abstraction area of a major drinking water production centre in Flanders, Belgium. It is concluded that the proposed conceptual models achieve similar results for daily WWTP effluent and CSO frequency, whereby the accumulated CSO volume is similar to more detailed full hydrodynamic models. Further, the estimated pollutant concentrations correspond with another dataset based on high resolution sampled overflows. As a result, the proposed computational efficient method can give insights in the impact of CSOs on the water quality at a catchment level and can be used for planning monitoring campaigns or performing analyses of e.g. the current and future water availability for a data scarce areas.

Ecological risk assessment of the Paraíba River estuary (Brazil): Plan for a tier 1 screening phase for the ecotoxicological line of evidence

The knowledge produced in temperate regions is still used today to evaluate environmental problems in the tropics, without taking into consideration environmental differences, such as local conditions, the sensitivity and ecology of species, and exposure routes of contaminants, essential for understanding and determining the fate and toxicity of chemicals. Considering that Environmental Risk Assessment (ERA) studies for tropical systems are scarce and need to be adjusted, the present study aims at contributing to the awareness and development of tropical ecotoxicology. The estuary of the Paraíba River in Northeast Brazil was selected as a model study-case, as it is a large estuary, subjected to a heavy human pressure due to the numerous social, economic and industrial activities. The present study describes the framework for the problem formulation phase of the ERA process; it first includes a detailed integration of the scientific information available on the study area, to then derive the conceptual model, and finally present the analysis plan for the tier 1 screening phase. The latter is designed to be fundamentally supported by the ecotoxicological line of evidence, to ascertain, without delay, where and why there are environmental problems (i.e., adverse biological effects); ecotoxicological tools developed in temperate climates will be optimized to assess water quality in a tropical system. In addition to its intrinsic value for protecting the study area, the results of the present study are expected to provide an important baseline for conducting ERA in similar tropical aquatic systems across the globe.

A multi-phase approach for developing a conceptual model for human resources for health observatory (HRHO) toward integrating data and evidence: a case study of Iran

BACKGROUND

Evidence-informed policymaking on human resources for health (HRH) has been directly linked with health system productivity, accessibility, equity, quality, and efficiency. The lack of reliable HRH data has made the task of planning the HRH more difficult in all settings.

AIM

This study aimed to develop a conceptual model to integrate HRH data and evidence.

METHODS

The current study is a mixed-method study conducted in three phases: a rapid literature review, a qualitative phase, and an expert panel. Firstly, the electronic databases were searched up to 2018. Then, in the qualitative phase, semi-structured interviews with 50 experts were conducted. Data analysis was performed using the content analysis approach. After several expert panels, the draft of the model was validated with 15 key informants via two Delphi rounds.

RESULTS

Our proposed model embraces all dominant elements on the demand and supply side of the HRH in Iran. The conceptual model consists of several components, including input (regulatory system, structure, functions), educational system (pre-service and in-service education), health labor market structure, process (technical infrastructure), and output (productions, policymaking process). We considered networking toward sustainable interaction among stakeholders, and also the existence of capacity to integrate HRH information and produce evidence for actions.

CONCLUSION

The proposed model can be considered a platform for developing a harmonized system based on the HRH data flow to evidence-informed decision-making via networking. We proposed a step-by-step approach for the sustainability of establishing a national human resources for health observatory (HRHO). The proposed HRHO model can be replicable and flexible enough to be used in different context domains.

Understanding health literacy from a traditional Chinese medicine perspective

Health literacy is critical to improving individual and public health. However, indigenous perceptions of health are largely absent from Western-derived measurements, contributing to disparities in health outcomes between indigenous and non-indigenous populations. China is the country with the world's largest population and only officially introduced the term "health literacy" in 2008. Current measures of health literacy in China are primarily based on Western-derived constructs, which have been shown to have poor comparability to the unique dual medical system in China. Given its significant importance to health management globally, understanding health perceptions from a traditional Chinese medicine perspective is essential. This review explores the concept and core elements of indigenous health literacy, evaluates the existing definitions and measurement tools as applied to the concept, and proposes a new model of traditional Chinese medicine health literacy.

Impacts of human activities on the supply of marine ecosystem services: A conceptual model for offshore wind farms to aid quantitative assessments

Increased pressures from human activities may cause cumulative ecological effects on marine ecosystems. Increasingly, the study of ecosystem services is applied in the marine environment to assess the full effects of human activities on the ecosystem and on the benefits it provides. However, in the marine environment, such integrated studies have yet to move from qualitative and score-based to fully quantitative assessments. To bridge this gap, this study proposed a 4-tiered method for summarizing available knowledge and modelling tools to aid in quantitative assessments of ecosystem services supply. First, the ecosystem functioning mechanisms underlying the supply of services are conceptually mapped. Second, the impacts of the human activity of interest are summarized and linked to the first conceptual model in a case-specific model of ecosystem services supply. Third, indicators are selected that would best represent changes in the most important parameters of the conceptual model in a quantitative manner. Fourth, the knowledge gained in the previous steps is used to select models that are most useful to quantify changes in ecosystem services supply under the human pressure of interest. This approach was applied to the case study of offshore wind energy in the Belgian part of the North Sea, which is one of the most rapidly expanding industries in the marine environment globally. This study provides a useful tool to proceed towards quantification of marine ecosystem services, highlighting the need for a fully integrated approach to developing environmental impact assessment tools.

Investigating the revised international marketing strategies during COVID-19 based on resources and capabilities of the firms: A mixed method approach

This paper aims to identify the revised international marketing strategies in communication during the COVID-19 pandemic by utilizing the firm's resources and capabilities. We conducted in-depth interviews and a questionnaire survey with key stakeholders of retail organizations which changed their digital marketing strategies during COVID-19. The data is collected from 587 respondents from different parts of the world through resource orchestration theory. The qualitative findings support a high degree of association among the firm's resources and capabilities, leveraging processes based on the revised international marketing strategies during the COVID-19 pandemic. We have developed a conceptual model based on these findings with six variables: leveraging process of the firm's capabilities information technology-related resources; information technology-related capabilities, dynamic capabilities, environmental uncertainty, and leveraging process of the firm's resources. However, environmental uncertainty and leveraging of the firm's resources were not influential in forming digital marketing strategies during COVID-19. This study proposes a new process for international marketing managers in business organizations to restructure the resources within their organizations by creating new capabilities and leveraging them.

Comparison of Literature Review, Social Media Listening, and Qualitative Interview Research Methods in Generating Patient-Reported Symptom and Functional Impact Concepts of Presbyopia

INTRODUCTION

To compare the insights obtained about the experience of individuals with presbyopia (age-related impaired near vision) across three different sources of qualitative data: a structured targeted literature review, a social media listening (SML) review, and qualitative concept elicitation (CE) interviews with individuals with presbyopia and healthcare professionals (HCPs). The number of concepts identified, depth of data, cost and time implications, and value of the patient insights generated were explored and compared for each method.

METHODS

Keyword searches in bibliographic databases and review of abstracts identified 120 relevant publications; in-depth targeted literature review of the qualitative studies identified key symptoms/functioning concepts. SML was conducted using publicly accessible social media sources with focus on ophthalmologic diseases using a pre-defined search string. Relevant posts from individuals with presbyopia (n = 270) were analysed and key concepts identified. Semi-structured CE interviews were conducted with individuals with presbyopia (US n = 30, Germany n = 10, France n = 10), and HCPs (US = 3, France n = 2, Germany n = 1, Japan n = 1) who were experienced in treating presbyopia. Verbatim transcripts were coded using thematic analysis. A conceptual model summarised concepts identified across sources RESULTS: Out of the total of 158 concepts identified across the three sources, qualitative CE interviews yielded the highest number of concepts (n = 151/158, 96%), with SML yielding a third of the concepts (n = 51/158, 32%) and the literature review yielding the fewest concepts (n = 33/158, 21%). Qualitative CE interviews provided greater depth of data than SML and literature reviews. SML and literature reviews were less costly and quicker to run than qualitative CE interviews and also were less burdensome for participants.

CONCLUSION

Qualitative CE interviews are considered the gold standard in providing greater depth of understanding of the patient experience, and more robust data. However, research requirements, budget, and available time should be considered when choosing the most appropriate research method. More time and cost-effective SML and literature review methods can be used to supplement qualitative CE interview data and provide early identification of measurement concepts. More research and regulatory guidance into less traditional qualitative methods, however, are needed to increase the value of SML and literature review data.

Comparative analysis of nitrate evolution patterns during pollution episodes: Method development and results from Tianjin, China

Particulate nitrate plays an increasingly important role in the formation of air pollution process, while the main mechanisms of nitrate concentration change are different in each stage, same as the driving factors. In this study, we proposed an episode-based analysis to illustrate the typical nitrate evolution patterns and identify the possible impacting factors in different evolution stages. Applying into twelve air pollution episodes, three typical patterns of nitrate evolution were abstracted, and the corresponding conceptual models were constructed. All the pollution episodes were grouped by their evolving shapes, which were driven by physical and chemical processes. Episodes started slowly typically arose from gradual pollutant accumulation, both locally and regionally, and chemical formation under high humidity. Type 1 ("hump-shaped type"), accounting for 66.3 % of the total episode durations, including two "peak" concentrations, displays a rapid growth rate which could up to 4.6 μg m^-3 h^-1 in average, mainly relying on the sharp drop in the planetary boundary layer height. Short scavenging processes and thoroughly dissipated stages of the pollution episodes always accompanied by strong north wind affected by Siberia-Mongolia cold current. Type 2 ("triangle-shaped type", 24.3 %) shows a gentle growth rate and short duration. Compared with Type 1, chemical process may be more important "source" for the increase of nitrate concentration during Type 2. Type 3 ("trapezoid-shaped type", 9.4 %) presents a long platform stage, during which high humidity (RH > 90 %) provides favorable conditions for wet removal and secondary production, and the updraft can carry pollutants to high altitude. The source and sink are roughly balanced for Type 3. Our study highlights the importance of pattern identification for understanding the nitrate evolution behavior, it may also provide insights for pollution prediction and scientific mitigation strategies.

An integrated framework for industrial symbiosis performance evaluation in an energy-intensive industrial park in China

Industrial symbiosis (IS) is an important tool to achieve green development for industrial parks. It is necessary to evaluate the IS performance for monitoring and managing the development of IS system. This study proposed an integrated framework to assess the IS performance based on the energy-intensive industrial park. Firstly, we established a Conceptual model of symbiotic coupling of three industries (iron and steel, thermal power, and cement). Then, the conceptual model was applied to extend the existing IS system in the energy-intensive industrial park. Finally, the IS performance of the extended IS system was evaluated. We verified this framework in Red flag cannel park (RFCP). The IS performance assessment in RFCP found that the existing IS activities produced significant multiple benefits and environmental impact reduction. For example, the existing IS activities produced 970.20 kt of low-carbon benefits, which accounted for 19% of the CO₂ emissions in RFCP. However, after extending the existing symbiotic system combined with the conceptual model proposed in this study, we found that there still was a large amount of symbiotic potential (the reuse of waste heat, BF slag, gypsum) waiting to be developed in RFCP. In addition, we also found that the resilience of existing IS network in RFCP was weak and need to be further perfected. In general, in the further development and perfection of IS system in RFCP, the manager should not only focus on the development of IS activities among energy-intensive enterprises but also strive to foster more influential enterprises to enhance the anti-risk ability of IS network. The result indicates the integrated framework can provide support for the development and perfection of IS system in energy-intensive industrial parks.

A simplified model for analyzing rainwater retention performance and irrigation management of green roofs with an inclusion of water storage layer

Rainwater retention and water content in green roofs are primarily influenced by structural configurations (i.e., soil layer, vegetation layer, and water storage layer) and climatic factors (i.e., rainfall and evapotranspiration (ET)). Based on the principle of water balance, this study proposes a conceptual model for simulating water flow in green roofs with water storage layers. Three green roof model experiments were conducted from August 1st, 2020 to July 31st, 2021 for calibrating and verifying the conceptual model. The proposed model was solved iteratively using a newly developed program in Visual Basic. The results showed that the conceptual model can capture the dynamic variations in the rainwater retention and water content of green roofs well. The average Nash-Sutcliffe efficiency coefficient is 0.65 and the average error is 6%. The annual rainwater retention capacity (RRC) of green roofs in the perennial rainy climate model was on average 28% higher than that in the seasonal rainy climate model. At the expense of water stress, high ET plants significantly increased the annual RRC of green roofs at a low level. As the water storage layer depth increased from zero to 150 mm, the annual RRC of green roofs increased by 41%, and the water stress decreased by 49%. Compared with an increase in water holding capacity and soil depth, the response of the annual RRC and water stress of green roofs for increasing water storage layer depth is much greater. As per climate of Southern China region, the water storage layer depth of 100 mm is found to obtain optimal rainwater retention and irrigation management in green roof with similar soil thickness (100 mm).

Residential addiction treatment providers: Identifying the role of social context in worker health and turnover

Increased lethality and availability of addictive substances has strained US addiction treatment services, further exacerbating workforce shortages in these settings. The emotional and physical health toll of providing treatment may contribute to shortages. This community-initiated qualitative study aimed to identify conditions that affect provider health and turnover in residential addiction treatment from a Total Worker Health® perspective. Providers (direct service, supervisors, leaders) working in nonprofit residential treatment facilities in Massachusetts were recruited by role and geography to participate in interviews and focus groups. NVivo12 facilitated coding and analysis. 25% of transcripts were double coded to assess interrater reliability and coding consistency (mean Kappa = 0.82). Providers (N = 49) participated in 33 interviews and 4 focus groups. Many participants reported personal addiction histories. Analysis revealed how socio-contextual factors originating outside of residential facilities were dominant influences on "downstream" working conditions, worker health, staff turnover, and by extension, client care. Four primary socio-contextual themes surfaced:1) Changes in type and potency of substances and client need not reliably accompanied by shifts in treatment practices; 2) challenges balancing state requirements and state-provided resources; 3) influence of structural discrimination and addiction stigma on pay and professional advancement; and 4) geographic location of facilities shape work and quality of life. Results were used to develop a conceptual model for residential addiction treatment to illustrate pathways by which ecological factors interact to affect provider health and turnover. Findings indicate that protecting health and wellbeing of providers-many of whom are in addiction recovery themselves- is integral to improving addiction treatment. From this workforce's perspective, recent changes in socio-contextual factors have intensified already challenging working conditions (job demands, pay, advancement), negatively impacting worker health, turnover, and client care. Any interventions to improve treatment outcomes or working conditions in nonprofit addiction facilities must consider larger socio-contextual factors influencing these organizations.

Surgeon Strategies to Patient-Centered Decision-making in Cancer Care: Validation and Applications of a Conceptual Model

We sought to construct and validate a model of cancer surgeon approaches to patient-centered decision-making (PCDM) and compare applications of that model relative to surgical specialties. Ten PCDM strategies were assessed using a cross-sectional survey administered online to 295 board-certified cancer surgeons. Structural equation modeling was used to empirically validate and compare approaches to PCDM. Within the full sample, 7 strategies comprised a latent construct labeled, "physical & emotional accessibility," associated with surgeon approaches to PCDM (β = 0.37, p < .05). Three individual strategies were included: "expectations (Q4)" (β = 0.52, p < .05), "decision preferences (Q5) (β = 0.47, p < .05), and "access medical information (Q3)" (β = 0.75). Surgical specialties for subgroup analysis were classified as general/other (67.6%) or hepato-pancreato-biliary and upper gastrointestinal (HPB/UGI) (34.2%). For general/other surgeons, 7 individual strategies composed the model of surgeon approaches to PCDM, with "time (Q6) (β = 0.70, p < .001) and "therapeutic relationship building (Q9)" (β = 0.69, p < .001) being the strongest predictors. The HPB/UGI model included 2 latent constructs labeled "physical accessibility" (β = 0.72, p < .05) and "creating a decision-making dialogue" (β = 0.62) as well as the individual strategy, "effective communication (Q8)" (β = 0.51, p < .05). Although models of surgeon PCDM varied, there were 4 overlapping strategies, including effective communication. Tailoring models of PCDM may improve surgeon uptake and thus, overall patient satisfaction with their cancer care.

The structure design of integrated urban drainage systems: A view of robust optimization

Rapid urbanization puts a lot of pressure on urban water pollution from point and non-point sources, calling for the practical, specific, and integrated management of urban drainage systems (UDS). The structural design of an integrated UDS is essential for highly complex and uncertain urban water management. In this study, we developed a multi-objective robust optimization model to explore the optimal structures of UDS considering system uncertainty. We applied this model to City B, northern China, to illustrate its effectiveness. The results show that the model can produce optimal designs with a more robust performance in terms of structural uncertainty. When the uncertainty degree ranges from 5% to 20%, a considerable extra cost (increased by 1.10-2.68 times) is required to improve the robustness of UDS. With the increase in structural uncertainty, the fraction of the cost invested in the stormwater subsystem increased from 10.2% to 27.2%. The findings showed that stormwater management is efficient in coping with system uncertainty. The research results promote an understanding of robust urban drainage systems.

Risk management in sustainable supply chain: a knowledge map towards intellectual structure, logic diagram, and conceptual model

The global spread of COVID-19, international trade protectionism, geopolitical conflicts, and climate change presents challenges and risks to sustainable supply chains (SSCs). In recent years, scholarly interest in sustainable supply chain risk management (SSCRM) has continued to rise. A helpful literature review is necessary to enable supply chain practitioners to apply empirical findings from academic research or conceptual frameworks to their operations to maintain the stability and competitiveness of sustainable supply chains. The knowledge map of SSCRM is explored in this study using both quantitative and qualitative analysis. A total of 793 articles were retrieved to reveal the knowledge map of SSCRM. Scientometric and context analysis are combined in quantitative analysis to identify the intellectual structure of risk management research related to SSC. Then, a critical review is conducted in qualitative analysis to summarize and analyze the motivations, strategies, approaches, and tools of SSCRM. Combining the quantitative and qualitative analysis results, a conceptual model is constructed for SSCRM from three aspects: (1) risk identification, (2) risk assessment, and (3) risk mitigating and responding. Finally, future research directions are suggested based on the conceptual model for guiding the theories and practice of SSCRM. This study can work as a roadmap for providing appropriate risk management policies and toolkits to SSC, which could advance theoretical thinking on how to mitigate SSC risks.

Patient Experience in Early-Stage Parkinson's Disease: Using a Mixed Methods Analysis to Identify Which Concepts Are Cardinal for Clinical Trial Outcome Assessment

INTRODUCTION

Qualitative research on patient experiences in early-stage Parkinson's disease (PD) is limited. It is increasingly acknowledged that clinical outcome assessments used in trials do not fully capture the range of symptoms/impacts that are meaningful to people with early-stage PD. We aimed to conceptualize the patient experience in early-stage PD and identify, from the patient perspective, those cardinal symptoms/impacts which might be more useful to measure in clinical trials.

METHODS

In a mixed-methods analysis, 50 people with early-stage PD and nine relatives were interviewed. Study design and results interpretation were led by a multidisciplinary group of patient, clinical, regulatory, and outcome measurements experts, and patient organization representatives. Identification of the cardinal concepts was informed by the relative frequency of reported concepts combined with insights from patient experts and movement disorder specialists.

RESULTS

A conceptual model of the patient experience of early-stage PD was developed. Concept elicitation generated 145 unique concepts mapped across motor and non-motor symptoms, function, and impacts. Bradykinesia/slowness (notably in the form of "functional slowness"), tremor, rigidity/stiffness, mobility (particularly fine motor dexterity and subtle gait abnormalities), fatigue, depression, sleep/dreams, and pain were identified as cardinal in early-stage PD. "Functional slowness" (related to discrete tasks involving the upper limbs, complex mobility tasks, and general activities) was deemed to be more relevant than "difficulty" to patients with early-stage PD, who report being slower at completing tasks rather than encountering significant impairment with task completion.

CONCLUSION

Patient experiences in early-stage PD are complex and wide-ranging, and the currently available patient-reported outcome (PRO) instruments do not evaluate many early-stage PD concepts such as functional slowness, fine motor skills, and subtle gait abnormalities. The development of a new PRO instrument, created in conjunction with people with PD, that fully assesses symptoms and the experience of living with early-stage PD, is required.

Presenting a conceptual model for designing hospital architecture with a patient-centered approach based on the patient's lived experience of sense of place in the therapeutic space

BACKGROUND

In recent years, among managers and designers of health-care spaces, there has been a growing tendency to move toward hospital design by combining patient perceptions and expectations of the physical environment of the care area. The main idea of this study was to present a conceptual model of hospital architecture in our country with a patient-centered approach based on some factors that were affecting the sense of place. This model determined the architectural features of treatment spaces from a patient's lived experience that could have a positive mental effect on patients as well. The main question of the research was how to adapt the objective perception to the patient's mental perception to create a sense of place in the hospital space?

MATERIALS AND METHODS

This research was qualitative with a phenomenological approach, conducted between July and December 2020. Purposeful sampling consisted of 23 patients, 13 males in the male surgery unit and 10 females in the gynecology unit, who were interviewed in-depth. They were hospitalized for at least 3 days in two hospitals (Dr. Pirooz in Lahijan and Ghaem in Rasht). The data were analyzed by the Colaizzi method.

RESULTS

The results consisted of 530 primary codes, 57 subthemes, and 7 main themes. The main themes were hospital location, access to hospital, hospital identity, hospital dependency, hospital attachment, human interactions in the hospital, and hospital evaluation.

CONCLUSION

The hospital form guided the patient, and the hospital function directed and obviated the patient's needs. The healing environment and human interactions with it caused the patient to be satisfied with the hospital environment.

Microplastics contamination of groundwater: Current evidence and future perspectives. A review

Groundwater is a primary water source which supplies more than 2 billion people. The increasing population and urbanization of rural areas stresses and depletes the groundwater systems, reducing the groundwater quality. Among the emerging contaminants, microplastics (MPs) are becoming an important issue due to their persistency in the environment. Seepage through the pores and fractures as well as the interaction with colloidal aggregates can partially affect the MPs dynamics in the subsoil, making the detection of the MPs in the groundwater systems challenging. Based on literature, a critical analysis of MPs in groundwater is presented from a hydrogeological point of view. In addition, a review of the MPs data potentially affecting the groundwater systems are included. MPs in groundwater may have several sources, including the atmosphere, the interaction with surface water bodies, urban infrastructures, or agricultural soils. The characterization of both the groundwater dynamics and the heterogeneity of MPs is suggested, proposing a new framework named "Hydrogeoplastic Model". MPs detection methods aimed at characterizing the smaller fragments are necessary to clarify the fate of these contaminants in the aquifers. This review also aims to support future research on MP contamination in groundwater, pointing out the current knowledge and the future risks which could affect groundwater resources worldwide.

Understanding the patient experience of chronic kidney disease stages 2-3b: a qualitative interview study with Kidney Disease Quality of Life (KDQOL-36) debrief

Background

Qualitative patient interviews and patient-reported outcome instruments are important tools to understand the patient experience of disease. The aim of this study was to use patient interviews to identify concepts relevant and important to patients living with chronic kidney disease (CKD) stages 2–3b, develop a comprehensive conceptual model of the patient experience and debrief the Kidney Disease Quality of Life 36-item instrument (KDQOL-36) for patients with CKD stages 2–3b.

Methods

Concept elicitation interviews were conducted with patients with CKD stages 2–3b to identify signs/symptoms and impacts most relevant and important to patients (i.e., ‘salient’ concepts) and develop a conceptual model for the disease. Based on the salient concepts identified in the interviews, new items were proposed to supplement the KDQOL-36. Cognitive debriefing was performed to evaluate the KDQOL-36 and the additional items.

Results

A total of 31 patients were interviewed in this study (22 for concept elicitation and 15 for cognitive debriefing). The interviews identified 56 concepts (33 signs/symptoms and 23 impacts), 17 of which had not been identified in a previous literature review. Four signs/symptoms (‘fatigue/lack of energy/tiredness’, ‘sleep problems’, ‘increased urination [including nocturia]’ and ‘swelling in legs/ankles/feet’) and two impacts (‘anxiety/worry’ and ‘general negative emotional/mental impact’) were identified as salient. Of the salient signs/symptoms, three were not covered by the KDQOL-36 (sleep problems, increased urination and swelling in legs/ankles/feet) and were represented during cognitive debriefing interviews through four additional items (trouble falling asleep, trouble staying asleep, increased urination [including nocturia] and swelling in legs/ankles/feet) generated in the style of the KDQOL-36. All patients found the KDQOL-36 plus the four additional items relevant, and the majority found them clear.

Conclusions

By identifying previously unknown concepts and augmenting the understanding of which are most important to patients, a comprehensive conceptual model was developed for patients who have CKD stages 2–3b. This study also demonstrates the suitability of the KDQOL-36 for patients who have CKD stages 2–3b and provides suggestions for how the instrument could be further developed to more comprehensively capture patient experience.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-022-02826-3.

Environmental variables affecting an arid coastal nebkha

Foredunes in arid coastal dune systems comprise nebkhas, which originate by interactions between vegetation and aeolian sedimentation. While continuous foredunes in temperate climates have been widely studied, knowledge of interactions between biotic and abiotic drivers in foredunes formed by nebkha is still scarce. With the aim of exploring variables affecting arid foredunes, a range of morphological, sedimentological, and vegetation characteristics were measured on a single nebkha formed by a Traganum moquinii plant located in the foredune of Caleta de Famara beach (Lanzarote, Canary Islands). Variables were sampled at 120 plots in a 0.5 × 0.5 m square grid. A two-step process using multiple linear regression (MLR) analyses was developed to characterize 1) the influence that morphological variables and distance from the sea have on plant and sediment patterns on nebkha, and 2) the influence of plants on depositional sediment characteristics. Results indicate close relationships between distance from the sea, plant coverage, and sediment patterns. Empirical results were used to develop a conceptual model that explains the spatial distribution of bio- and geo-morphological characteristics of an arid nebkha foredune.

Using Structural Equation Modeling to Untangle Pathways of Risk Factors Associated with Incident Type 2 Diabetes: the Lifelines Cohort Study

Risk factors for type 2 diabetes are multifaceted and interrelated. Unraveling the complex pathways of modifiable risk factors related to incident type 2 diabetes will help prioritize prevention targets. The current analysis extended a previously proposed conceptual model by Bardenheier et al. (Diabetes Care, 36(9), 2655–2662, 2013) on prediabetes with a cross-sectional design. The model described the pathways of four aspects of modifiable risk factors in relation to incident type 2 diabetes, including socioeconomic status (income and education); lifestyle behaviors (diet quality, physical activity, TV watching, smoking, risk drinking, and unhealthy sleep duration); clinical markers (HDL-cholesterol, triglycerides, BMI, and waist circumference); and blood pressure. We performed structural equation modeling to test this conceptual model using a prospective population-based sample of 68,649 participants (35–80 years) from the Lifelines cohort study. During a median follow-up of 41 months, 1124 new cases of type 2 diabetes were identified (incidence 1.6%). The best-fitting model indicated that among all modifiable risk factors included, waist circumference had the biggest direct effect on type 2 diabetes (standardized β-coefficient 0.214), followed by HDL-cholesterol (standardized β-coefficient − 0.134). Less TV watching and more physical activity were found to play an important role in improving clinical markers that were directly associated with type 2 diabetes. Education had the biggest positive effects on all lifestyle behaviors except for unhealthy sleep duration. Our analysis provides evidence to support that structural equation modeling enables a holistic assessment of the interplay of type 2 diabetes risk factors, which not only allows the estimation of their total effects but also prioritization of prevention targets. Regarding the current guideline for diabetes prevention, waist management in addition to BMI control (clinical level), as well as less TV watching in addition to more physical activity (behavioral level), may provide additional public health benefits. Better education would be the main societal goal for the prevention of type 2 diabetes.

Conceptual model to analyze the effects caused by technological disaster on the physical-chemical state of the lower Doce River waters, Brazil

Research has shown the effort to develop conceptual models that relate anthropic stressors to changes in aquatic environment state. Several of these models come from the structure Drivers, Pressures, State, Impact and Response (DPSIR), which has been used since the 1990s. However, there is a lack of conceptual models that consider in its structure the connection between the damages caused in the aquatic environment and technological disasters. This research develops a general conceptual model based on the DPSIR structure incorporating technological disasters. Based on the general conceptual model guidelines and the methodological procedure associated with it, a model was developed to assess the Lower Doce River waters' state, by considering Fundão's iron-ore dam failure scenario, which took place in November 2015, in the municipality of Mariana, state of Minas Gerais, Brazil. The relevant aspects of this adaptation of the DPSIR structure were: I) it considers the combined effect of drivers and pressures that already existed in the study area with those originated from the technological disaster; and II) the causal relationships among elements of the model were explicited through a systemic conceptual map, allowing a more holistic and integrated view of the problem. The application of the conceptual model to Doce River's scenario before the disaster allowed us to verify that a set of environmental pressures was already acting in a way to stress it, making the river vulnerable. For the post-disaster scenario, it was possible to determine that the already existing vulnerability condition, caused by urbanization, agriculture¹ and mining, had been intensified by adding new pressures due to the tailings dam failure.

Living with a chronic disease: insights from patients with a low socioeconomic status

Background

Little is known about how patients with low socioeconomic status (SES) experience their chronic disease, and how it impacts health-related quality of life (HRQoL). Compared to their more affluent counterparts, worse outcomes have been reported. A better understanding of the domains of HRQoL that are relevant to these specific populations is therefore needed. We explored the experiences of living with a chronic disease in low SES persons.

Methods

A qualitative interview study was performed in Flanders, Belgium. Semi-structured interviews were conducted in chronically ill patients, selected through purposive sampling. Interviews were audio-recorded and transcribed verbatim. Analysis followed an inductive and iterative approach.

Results

Fifteen patients were interviewed. Six major themes were identified: a heavy bag to carry, loss of autonomous life, inner and outer loneliness, emotional imbalance, unmet need for support, and coping strategies. Patients experienced their illness as an additional problem on top of all other problems (i.e. financial/social problems, traumatic life events). In general, the disease burden and non-disease burden were mutually reinforcing, resulting in greater dependency, greater risk of social isolation, greater psychological distress, and greater risk of impaired HRQoL.

Conclusions

This study is the first to provide detailed insight into the experiences of living with a chronic disease in low SES persons. A conceptual model is proposed that can be used in daily clinical practice to raise awareness among clinicians and health care providers that the patient’s needs go beyond the disease itself. Future research is needed to validate and test the model.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01578-7.

Conceptualising household food insecurity in Northern Ireland: risk factors, implications for society and the economy, and recommendations for business and policy response

Household food insecurity in developed nations has been identified as a significant public health concern. Although various research on the topic exists, such as contributors to food insecurity, and implications for individual physical and mental health outcomes; there is currently a lack of consideration as to how individual implications of food insecurity such as poor physical and mental health can consequently impact on business and the wider economy. In addition, there is a lack of conceptual literature related to food insecurity. Stakeholder interviews (n = 19) were conducted, and data were used to inform the conceptual model (risk factors, potential implications for individuals, the economy and business, and opportunities for business and policy response). The main suggested implications related to business and the economy were reduced contribution to the workforce and the economy, and increased cost pressures on the National Health Service. Business responses suggested included the inclusion of initiatives to address food insecurity in corporate social responsibility strategies, and further involvement of food businesses/retailers in redistributing surplus food. Policy responses suggested included policies relating to welfare, wages and work contracts, food redistribution incentives, sustainability, and community interventions in disadvantaged areas. The resulting model is unique in conceptualising food insecurity in the Northern Ireland context, with applicability to the UK and other developed nations.

The Exemplary Practice Life of the Nurse

Nurses consistently stand out in extraordinary ways especially during a global crisis, recently confirmed in the current Covid-19 pandemic. What is opportune this time is the call for clarity around what nurses do and what society can expect from them. Nurses, as members of a global profession, need a platform to build a contemporary practice life. This paper proposes the model: The Exemplary Practice Life of the Nurse. It provides a framework to explicate the essence of the role of the nurse. The model posits four inter-related essential components or pillars that ground a nurse's behavior and commitment: professionalism, leadership, scholarly practice, and stewardship. This uncomplicated, straightforward model is universally applicable for nurses to apply in whatever roles they hold and at any point in their careers. The use of a holistic model, as a guide across a full career trajectory, supports the nurse's ability to prioritize individual pillars while understanding the inter-relationship and influence among the four pillars. The authors pose assumptions that form the basis of the registered nurse role and provide the foundation for the exemplary practice life of the nurse. They make recommendations to nurses, the profession, the workplace, the academy, and the community.

Extended parallel process model (EPPM) in evaluating lung Cancer risk perception among older smokers

Background

There is a lack of scientific literature on the application of fear appeals theories to evaluate lung cancer risk perception among smokers. The aim of the present study is to apply the Extended Parallel Process Model (EPPM) to discover the perception of the smokers about their lifetime risk of developing lung cancer (perceived susceptibility), their perception of lung cancer survival (perceived severity), response efficacy, self-efficacy, and readiness to quit.

Methods

In this cross-sectional study, 215 eligible smokers (aged 45 years and over who have smoked at least 1 pack per day in the last 5 years) were recruited. The data collection tool was designed using validate self-report questionnaires and it was contained items on the perceived risk of a smoker contracting lung cancer and perceived lung cancer survival rate. It also had questions to measure the main constructs of the EPPM and Readiness to quit (“Low_Readiness”, and “High_Readiness”). To test how the data support conceptual EPPM to data, Generalized Structural Equation Modeling (GSEM) was used.

Results

Findings showed a significant relationship between Perceived_Susceptibility and Perceived_Response Efficacy; (B = 1.16, P < 0.001); between Perceived_Susceptibility and Perceived_Self Efficacy, (B = -0.93, P < 0.001), Perceived_Severity, and Perceived_Response Efficacy (B = 1.07, P < 0.001). There was also a significant relationship between Perceived_Threat and Perceived_Response Efficacy; between Perceived_Threat and Perceived_Self Efficacy. The relationship between High_Readiness and Perceived_Self Efficacy, and between High_Readiness and Perceived_Severity also were significant. However, the relationships between High_Readiness and Perceived_Threat were not significant (P > 0.05).

Conclusion

Perceived_threat and Perceived_efficacy were important for smokers with low readiness to quit, while Perceived_efficacy was most important for smokers with high readiness to quit. These findings could be used in promoting lung cancer awareness and designing smoking cessation programs based on smokers’ stages of change.

Qualitative interviews to improve patient-reported outcome measures in late-onset Pompe disease: the patient perspective

Background

Late-onset Pompe Disease (LOPD) is a rare, heterogeneous disease manifested by a range of symptoms varying in severity. Research establishing the frequency of these symptoms and their impact on patients’ daily lives is limited. The objective of this study was to develop a conceptual model that captures the most relevant symptoms and functional limitations experienced by patients with LOPD, to inform the development of new patient-reported outcome (PRO) tools.

Methods

A preliminary conceptual model was constructed following a literature review and revised through interviews with expert clinicians to identify important and relevant concepts regarding symptoms and impacts of LOPD. This preliminary model informed the development of a qualitative patient interview guide, which was used to gather the patient perspective on symptoms and impacts relating to LOPD or its treatment (including symptom/impact frequency and levels of disturbance). Patient interviews aided further refinement of the conceptual model. The findings from the patient interviews were triangulated with the literature review and clinician interviews to identify the most relevant and significant effects of LOPD from the patient perspective.

Results

Muscle weakness, fatigue, pain, and breathing difficulties (especially while lying down) were the most common and highly disturbing symptoms experienced by patients. Limitations associated with mobility (e.g., difficulty rising from a sitting position, getting up after bending) and activities of daily living, (e.g., reduced ability to participate in social/family activities or work/study) were the most frequently reported impacts with the highest levels of disturbance on the patient’s daily life. These identified symptoms and impacts were included in the new conceptual model of disease.

Conclusions

This qualitative patient interview study, also informed by a literature review and clinician interviews, identified the most frequent and relevant symptoms and the functional impact of LOPD on patients. The study interviews also captured the patient-preferred language to describe symptoms and impacts of LOPD. The results from this study can be used to develop future PRO instruments that are tailored to the specific symptoms and impacts experienced by patients with LOPD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13023-021-02067-x.

Symptoms and impacts of ambulatory nonsense mutation Duchenne muscular dystrophy: a qualitative study and the development of a patient-centred conceptual model

Background

Duchenne muscular dystrophy is a rare genetic neuromuscular disorder, which can result in early death due to disease progression. Ataluren is indicated for the treatment of nonsense mutation Duchenne muscular dystrophy, in ambulatory individuals aged two years and older. This study explored the symptoms and impacts of nonsense mutation Duchenne muscular dystrophy and experience with ataluren.

Methods

Qualitative interviews were conducted with caregivers in the UK. Interviews were conducted by telephone, were recorded and transcribed. Data were analysed using thematic analysis and saturation was recorded.

Results

Ten interviews were conducted with parents of individuals aged 4–19 years. Key symptoms included muscle weakness and muscle breakdown, which were associated with limitations in physical function and pain. These impacted individuals’ daily activities, social activities and emotional wellbeing. These concepts and relationships were illustrated in a conceptual model, along with positive and negative moderating factors. Experience with ataluren and changes since initiation with treatment were discussed.

Conclusion

Individuals with nonsense mutation Duchenne muscular dystrophy experience a range of interrelated symptoms and functional issues which impact their broader health-related quality of life. Treatments which address this high unmet need have the potential to improve the health-related quality of life of these individuals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-021-00341-x.

A conceptual model of nurses' workplace social capital: a theory synthesis

BACKGROUND

Research has confirmed the importance of workplace social capital in the nursing workforce. Integration of the empirical evidence about nurses' workplace social capital into a scientific collection can provide a comprehensive presentation of this concept. This scientific collection can be a conduit for further research and advancement of nursing management and leadership. The purpose of this paper, therefore, is to discuss the process of developing a conceptual model of nurses' workplace social capital, an effective and concise approach to illustrate a scientific phenomenon.

METHODS

The model of nurses' workplace social capital was developed following Walker and Avant's strategy of theory synthesis. Empirical evidence relevant to nurses' workplace social capital was synthesized by systematically examining the existing literature. PubMed, CINAHL, Web of Science and Google Scholar were searched periodically from October 2017 to July 2020.

RESULTS

Our proposed conceptual model lays out the determinants and outcomes of nurses' workplace social capital and specifies the relational statements among these concepts. Nurses' workplace social capital is influenced by the organizational and individual determinants shaped by multiple layers of sub-concepts. The development and implementation of nurses' workplace social capital has three themes of consequences: 1) nurses' outcomes; 2) patients' outcomes; and 3) organizational outcomes. All the concepts and statements have been organized and aligned with the principles of "inventory of determinants or results" and "theoretical blocks".

CONCLUSION

Our theoretical synthesis offers a comprehensive picture of the current knowledge of nurses' workplace social capital. Efforts should be dedicated to evaluating, revising, and revamping this newly developed model based on future empirical evidence. Our synthesized conceptual model is the segue to more comprehensive studies about nurses' workplace social capital. Interventional programs for the development of social capital can be structured based on the identified determinants.

Development of a conceptual model of patient-reported outcomes in light chain amyloidosis: a qualitative study

BACKGROUND

Light chain (AL) amyloidosis is a plasma cell neoplasm associated with high early mortality and severe morbidity that can cause severe disability. We explored the impact of AL amyloidosis on symptoms and well-being from the perspectives of patients and health care providers who regularly care for AL patients. We intended to develop a conceptual understanding of patient-reported outcomes in AL amyloidosis to identify the context of use and concept of interest for a clinical outcome assessments tool in this disease.

METHOD

Twenty patients and ten professionals were interviewed. Patient interviews captured the spectrum of amyloidosis experience including time from diagnosis, type of organ involvement, and presence and type of treatment received. Interviews with professionals included physicians, advanced practice providers, registered nurse, and a patient advocate; these interviews covered similar topics.

RESULTS

The impact of AL amyloidosis on patients' life was multidimensional, with highly subjective perceptions of normality and meaning. Four major themes from patients and experts included diagnosis of AL amyloidosis, living with AL amyloidosis, symptom burden, and social roles. Barriers to patient-reported outcomes data collection in patients were additionally explored from experts. The themes provide a comprehensive understanding of the important experiences of symptom burden and its impact on daily life from AL amyloidosis patients' and from the perspectives of professionals who care for patients with AL amyloidosis.

CONCLUSION

These findings further the conceptual understanding and identification of a preliminary model of concept of interest for development of a clinical outcome assessments tool for AL amyloidosis.

The Synergistic Relationship Between Climate Change and the HIV/AIDS Epidemic: A Conceptual Framework

Climate change and HIV/AIDS represent two of the greatest threats to human health in the 21st century. However, limitations in understanding the complex relationship between these syndemics continue to constrain advancements in the prevention and management of HIV/AIDS in the context of a rapidly changing climate. Here, we present a conceptual framework that identifies four pathways linking climate change with HIV/AIDS transmission and health outcomes: increased food insecurity, increased prevalence of other infectious diseases, increased human migration, and erosion of public health infrastructure. This framework is based on an in-depth literature review in PubMed and Google Scholar from June 6 to June 27, 2019. The pathways linking climate change with HIV transmission and health outcomes are complex with multiple interacting factors. Food insecurity emerged as a particularly important mediator by driving sexual risk-taking behaviours and migration, as well as by increasing susceptibility to infections that are common among people living with HIV (PLWHIV). Future interventions should focus on decreasing carbon dioxide emissions globally and increasing education and investment in adaptation strategies, particularly in those areas of sub-Saharan Africa and southeast Asia heavily impacted by both HIV and climate change. Environmentally sustainable interventions such as urban gardening and investing in sustainable agriculture technologies also have significant health co-benefits that may help PLWHIV adapt to the environmental consequences of climate change.

Development of a preliminary conceptual model of the patient experience of chronic kidney disease: a targeted literature review and analysis

Background

Patient-reported outcome (PRO) instruments should capture the experiences of disease and treatment that patients consider most important in order to inform patient-centred care and product development. The aim of this study was to develop a preliminary conceptual model of patient experience in chronic kidney disease (CKD) based on a targeted literature review and to characterize existing PRO instruments used in CKD.

Methods

PubMed, EMBASE and Cochrane databases and recent society meetings were searched for publications reporting signs/symptoms and life impacts of CKD. Concepts identified in the literature review were used to develop a preliminary conceptual model of patient experience of CKD, overall, and within patient subpopulations of differing CKD causes, severities and complications. PRO instruments, identified from PRO databases, CKD literature and CKD clinical trials, were assessed for content validity, psychometric strength and coverage of concepts in the literature review.

Results

In total, 100 publications met criteria for analysis; 56 signs/symptoms and 37 life impacts of CKD were identified from these sources. The most frequently mentioned signs/symptoms were pain/discomfort (57% of publications) and tiredness/low energy/lethargy/fatigue (42%); the most commonly reported life impacts were anxiety/depression (49%) and decrements in physical functioning (43%). Signs/symptoms and life impacts varied across the subpopulations and were more frequent at advanced CKD stages. The preliminary conceptual model grouped signs/symptoms into seven domains (pain/discomfort; energy/fatigue; sleep-related; gastrointestinal-related; urinary-related; skin−/hair−/nails-related; and other) and life impacts into six domains (psychological/emotional strain; cognitive impairment; dietary habit disruption; physical function decrements; interference with social relationships; and other). Eleven PRO instruments were considered to be promising for use in CKD; all had limitations.

Conclusions

Although preliminary, the proposed conceptual model highlights key PROs for people with CKD and is intended to spur development of more tailored PRO instruments to assess these concepts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-021-02440-9.

Medication literacy: A conceptual model

BACKGROUND

Medication literacy reflects the specific literacy skills necessary to act on medication-related information. A comprehensive and clear conceptual model that reflects medication literacy is lacking. Conceptual models describe the components that represent a construct, allowing for its understanding and providing a rationale for its measurement.

OBJECTIVES

To propose a conceptual model to support the development of an instrument to measure medication literacy.

METHODS

This is a three-phase methodological study. A literature review was conducted to identify the components that should be part of the preliminary conceptual model. Subsequently, the importance of its components was judged on a Likert-5 scale. Then, the model was refined, and the dimensions and subdimensions of medication literacy were defined.

RESULTS

Forty-five experts were included, with a mean age of 39.9 (SD = 10.5) years, most of them females (86.7%) and pharmacists (80%). All components of the preliminary conceptual model were considered important to extremely important by most experts. "Dosing information", "medication name", and "processing the information received about their medication and acting upon medication instructions" were the components considered most important. In the refinement phase, we identified that the construct has four dimensions - functional literacy, communicative literacy, critical literacy, and numeracy, which include the subdimensions to access, understand, evaluate, calculate, and communicate medication-related information.

CONCLUSIONS

The conceptual model allowed identifying the components that represent medication literacy, which will support the development of an instrument for measuring the construct in Brazil.

Acceptance and commitment therapy in adult cancer survivors: a systematic review and conceptual model

PURPOSE

People with cancer experience significant physical and psychological symptoms, during as well as after primary treatment. Acceptance and Commitment Therapy (ACT), a psychological intervention, reduces both types of symptoms among individuals with chronic pain and emotional distress. Due to the unique challenges of cancer survivorship, this systematic review critically evaluates and synthesizes the literature on the context, mechanisms, and effect of ACT among adult cancer survivors.

METHODS

Articles were retrieved from the CINAHL, MEDLINE via Ovid, Web of Science, PsycInfo, Scopus, Embase, Google Scholar, and Cochrane databases. Selected grey literature portals, clinical trial registries, and conference proceedings were also searched. The NIH tools were used to assess study quality and the revised Cochrane Risk-of-Bias tool to assess risk of bias RESULTS: Thirteen articles, reporting on 537 cancer survivors with various cancer types, were included. ACT significantly reduced anxiety, depression, and fear of cancer recurrence and improved psychological flexibility and quality of life. Outcomes such as pain and insomnia were understudied. Lack of participant blinding and non-random assignment were the most common methodological issues. A conceptual model is proposed that describes the possible influencing factors of an ACT-based intervention in cancer survivors.

CONCLUSION

Review findings suggest that ACT is an effective intervention to improve some of the common concerns among cancer survivors. While all the studies in the review were recent (published 2015-2019), they examined only a limited number of outcomes. Hence, more methodologically rigorous studies which examine the effect of ACT on other troubling symptoms among cancer survivors are warranted.

IMPLICATIONS FOR CANCER SURVIVORS

Incorporating ACT into comprehensive post-treatment survivorship care can enhance psychological flexibility and reduce anxiety, depression, and fear.

Return to work of breast cancer survivors: toward an integrative and transactional conceptual model

Purpose

To propose a conceptual framework of the return to work (RTW) of breast cancer survivors (BCS) according to the transactional perspective.

Methods

The Technique for Research of Information by Animation of a Group of Experts was implemented. For each determinant in an initial list established from the literature, experts selected for the consensus exercise were firstly asked to indicate their agreement level individually, via an online questionnaire. Determinants obtaining an agreement level of 80% or over during this first phase were retained. Determinants obtaining an agreement level below 80%, and additional determinants proposed by the experts, were then discussed collectively. After discussion, experts voted via a new online questionnaire to retain (or not) each determinant. Determinants obtaining an agreement level of 80% or over after this second phase were retained. Based on the determinants selected, a conceptual model was developed following the transactional approach.

Results

Eleven experts participated in the study. Forty of the 51 determinants listed initially from the literature achieved an agreement level over 80%, and 20 were added after the individual consultation phase. Twenty-two of the 31 determinants discussed collectively were retained. In total, 62 determinants were selected to construct the conceptual model.

Conclusions

This integrative, operational, and transactional conceptual model of the RTW of BCS, constructed following an expert consensus, will help to design more efficient patient-centered intervention studies.

Implications for Cancer Survivors

Identification of the 62 determinants associated with the RTW of BCS will help design tools that are easily used by all stakeholders involved in the RTW process.