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1. Wetland ecosystems throughout the world are threatened by drainage and intensification of agriculture. Consequently, many wetland species of conservation concern are now restricted to fewer and smaller sites, and maintaining these species often requires intensive habitat management. 2. In Western Europe, breeding wader populations have declined severely as a result of wetland degradation, but very high levels of prédation on eggs and chicks are now preventing population recovery. Wet grassland management for breeding waders has focussed on providing suitable nesting habitats, but the potential for management of landscape features to influence prédation rates remains largely unknown. 3. Using a 7-year study of breeding lapwing Vanellus vanellus and redshank Tringa totanus we first identify features that influence nest predation, and then use this information to compare the magnitude of change in nest predation rates that could potentially result from future landscape management scenarios. 4. As lapwing nest predation rates are higher (i) in fields further from patches of tall vegetation, (ii) close (<50 m) to field edges in wet fields, (iii) further from field edges in dry fields and (iv) in areas of low lapwing nesting density, we modelled a series of realistic scenarios in which the area of tall vegetation and the extent and distribution of surface water were varied across the reserve, to quantify the magnitude of change in nest predation rate that could potentially have been achieved through management. 5. Modelled scenarios of changes in surface water and area of tall vegetation indicated that reduced surface flooding combined with removal of tall vegetation could result in significant increases in lapwing nest predation rates in areas with low nesting densities and nests in field centres. By contrast, a ~20% reduction in nest prédation, corresponding to -100 more chicks hatching per year, is predicted in scenarios with expansion of tall vegetation in areas with high lapwing nest density and nests close to field edges. 6. Synthesis and applications. These management scenarios suggest that, for breeding waders in wet grassland landscapes, creating areas of tall vegetation and concentrating surface flooding (to encourage high nesting densities and influence nesting distribution) can potentially help to reduce the unsustainably high levels of nest prédation that are preventing population recovery.

Background Antimicrobial stewardship (AMS) describes activities concerned with safe-guarding antibiotics for the future, reducing drivers for the major global public health threat of antimicrobial resistance (AMR), whereby antibiotics are less effective in preventing and treating infections. Appropriate antibiotic prescribing is central to AMS. Whilst previous studies have explored the effectiveness of specific AMS interventions, largely from uni-professional perspectives, our literature search could not find any existing evidence evaluating the processes of implementing an integrated national AMS programme from multi-professional perspectives. Methods This study sought to explain mechanisms affecting the implementation of a national antimicrobial stewardship programme, from multi-professional perspectives. Data collection involved in-depth qualitative telephone interviews with 27 implementation lead clinicians from 14/15 Scottish Health Boards and 15 focus groups with doctors, nurses and clinical pharmacists (n = 72) from five Health Boards, purposively selected for reported prescribing variation. Data was first thematically analysed, barriers and enablers were then categorised, and Normalisation Process Theory (NPT) was used as an interpretive lens to explain mechanisms affecting the implementation process. Analysis addressed the NPT questions ‘ which group of actors have which problems , in which domains, and what sort of problems impact on the normalisation of AMS into everyday hospital practice’ . Results Results indicated that major barriers relate to organisational context and resource availability. AMS had coherence for implementation leads and prescribing doctors; less so for consultants and nurses who may not access training. Conflicting priorities made obtaining buy-in from some consultants difficult; limited role perceptions meant few nurses or clinical pharmacists engaged with AMS. Collective individual and team action to implement AMS could be constrained by lack of medical continuity and hierarchical relationships. Reflexive monitoring based on audit results was limited by the capacity of AMS Leads to provide direct feedback to practitioners. Conclusions This study provides original evidence of barriers and enablers to the implementation of a national AMS programme, from multi-professional, multi-organisational perspectives. The use of a robust theoretical framework (NPT) added methodological rigour to the findings. Our results are of international significance to healthcare policy makers and practitioners seeking to strengthen the sustainable implementation of hospital AMS programmes in comparable contexts.

Background mHealth holds the potential to educate rural communities in developing countries such as Malawi, on issues which over-burdened and under staffed health centres do not have the facilities to address. Previous research provides support that mHealth could be used as a vehicle for health education campaigns at a community level; however the limited involvement of potential service users in the research process endangers both user engagement and intervention effectiveness. Methods This two stage qualitative study used participatory action research to inform the design and development of an mHealth education intervention. First, secondary analysis of 108 focus groups (representing men, women, leadership, elderly and male and female youth) identified four topics where there was a perceived health education need. Second, 10 subsequent focus groups explored details of this perceived need and the acceptability and feasibility of mHealth implementation in Chikwawa, Malawi. Results Stage 1 and Stage 2 informed the design of the intervention in terms of target population, intervention content, intervention delivery and the frequency and timing of the intervention. This has led to the design of an SMS intervention targeting adolescents with contraceptive education which they will receive three times per week at 4 pm and will be piloted in the next phase of this research. Conclusion This study has used participatory methods to identify a need for contraception education in adolescents and inform intervention design. The focus group discussions informed practical considerations for intervention delivery, which has been significantly influenced by the high proportion of users who share mobile devices and the intervention has been designed to allow for message sharing as much as possible.

Keywords Nurse practitioner, home visiting, long-term conditions, health outcomes Aim THE AIM of this integrative review was to explore the potential for nurse practitioners in New Zealand to visit people diagnosed with long-term conditions in their own homes. The outcome of a reduction in health care seeking due to timely nurse practitioner interventions is improved quality of life for patients and a reduction in health-care spending (Coppa et al., 2018; Echeverry et al., 2015; Hall et al., 2014). (Advanced nurse practitioner interviewee; Collins, 2019, p. 6) Role clarity for nurse practitioners and effective relationships within teams are pivotal to promoting teamwork in health care, which in turn enables high-quality patient care and increased patient engagement (Kilpatrick et al., 2021). When nurse practitioners support complex hospital discharges with home visits, this alleviates some of the pressures on primary, secondary and tertiary-care services while providing equitable care.

Objectives1.5 million people in the UK have mild to moderate learning disabilities. STIs and bloodborne viruses (BBVs) are over-represented in people experiencing broader health inequalities, which include those with mild learning disabilities. Self-managed care, including self-sampling for STIs/BBVs, is increasingly commonplace, requiring agency and health literacy. To inform the development of a partner notification trial, we explored barriers and facilitators to correct use of an STI/BBV self-sampling pack among people with mild learning disabilities.MethodsUsing purposive and convenience sampling we conducted four interviews and five gender-specific focus groups with 25 people (13 women, 12 men) with mild learning disabilities (July–August 2018) in Scotland. We balanced deductive and inductive thematic analyses of audio transcripts to explore issues associated with barriers and facilitators to correct use of the pack.ResultsAll participants found at least one element of the pack challenging or impossible, but welcomed the opportunity to undertake sexual health screening without attending a clinic and welcomed the inclusion of condoms. Reported barriers to correct use included perceived overly complex STI/BBV information and instructions, feeling overwhelmed and the manual dexterity required for blood sampling. Many women struggled interpreting anatomical diagrams depicting vulvovaginal self-swabbing. Facilitators included pre-existing STI/BBV knowledge, familiarity with self-management, good social support and knowing that the service afforded privacy.ConclusionIn the first study to explore the usability of self-sampling packs for STI/BBV in people with learning disabilities, participants found it challenging to use the pack. Limiting information to the minimum required to inform decision-making, ‘easy read’ formats, simple language, large font sizes and simpler diagrams could improve acceptability. However, some people will remain unable to engage with self-sampling at all. To avoid widening health inequalities, face-to-face options should continue to be provided for those unable or unwilling to engage with self-managed care.

Birds exhibit various forms of anti-predator behaviours to avoid reproductive failure, with mobbing—observation, approach and usually harassment of a predator—being one of the most commonly observed. Here, we investigate patterns of temporal variation in the mobbing response exhibited by a precocial species, the northern lapwing ( Vanellus vanellus ). We test whether brood age and self-reliance, or the perceived risk posed by various predators, affect mobbing response of lapwings. We quantified aggressive interactions between lapwings and their natural avian predators and used generalized additive models to test how timing and predator species identity are related to the mobbing response of lapwings. Lapwings diversified mobbing response within the breeding season and depending on predator species. Raven Corvus corax , hooded crow Corvus cornix and harriers evoked the strongest response, while common buzzard Buteo buteo , white stork Ciconia ciconia , black-headed gull Chroicocephalus ridibundus and rook Corvus frugilegus were less frequently attacked. Lapwings increased their mobbing response against raven, common buzzard, white stork and rook throughout the breeding season, while defence against hooded crow, harriers and black-headed gull did not exhibit clear temporal patterns. Mobbing behaviour of lapwings apparently constitutes a flexible anti-predator strategy. The anti-predator response depends on predator species, which may suggest that lapwings distinguish between predator types and match mobbing response to the perceived hazard at different stages of the breeding cycle. We conclude that a single species may exhibit various patterns of temporal variation in anti-predator defence, which may correspond with various hypotheses derived from parental investment theory.

Since the early twentieth century there has been widespread loss and degradation of wetlands resulting from land drainage and agricultural intensification. Many breeding wader populations in wetlands across Western Europe have declined severely as a consequence of this habitat loss, and their ranges are now increasingly restricted to nature reserves. The habitat requirements of these species, and management actions to achieve these conditions, are well-established but the recovery of many populations may be limited by high levels of predation of eggs and chicks. In this thesis, I assess the distribution of mammalian predators and their small mammal prey in a landscape managed for breeding waders within lowland wet grasslands, and use these findings to consider the potential for habitat management to reduce levels of nest predation for lapwing, Vanellus vanellus, and redshank, Tringa totanus. Within these wet grasslands, I show that small mammals are almost entirely restricted to tall vegetation, which is rare and typically occurs only in verges outside fields. Lapwing nest predation rates are lower when nests are closer to these verges and when there is more verge in the surrounding landscape. Lapwing nest predation is also lower when nests are closer to field edges in drier fields, and further from field edges in wetter fields. Red foxes are the primary nest predator, and nest predation rates of lapwing and redshank, and fox use of tracking plots, are lower when lapwing nest densities are higher. Modelled scenarios of potential influence of future changes in reserve management indicate that changes in surface flooding would have little impact on lapwing nest predation, but removal of verges could result in significant increases of ~10%. Combining environmental factors associated with nest predation with realistic habitat modifications can be a useful tool for assessing the potential scale of consequences of management actions.