Inter-annual and decadal changes in teleconnections drive continental-scale synchronization of tree reproduction

Climate teleconnections drive highly variable and synchronous seed production (masting) over large scales. Disentangling the effect of high-frequency (inter-annual variation) from low-frequency (decadal trends) components of climate oscillations will improve our understanding of masting as an ecosystem process. Using century-long observations on masting (the MASTREE database) and data on the Northern Atlantic Oscillation (NAO), we show that in the last 60 years both high-frequency summer and spring NAO, and low-frequency winter NAO components are highly correlated to continent-wide masting in European beech and Norway spruce. Relationships are weaker (non-stationary) in the early twentieth century. This finding improves our understanding on how climate variation affects large-scale synchronization of tree masting. Moreover, it supports the connection between proximate and ultimate causes of masting: indeed, large-scale features of atmospheric circulation coherently drive cues and resources for masting, as well as its evolutionary drivers, such as pollination efficiency, abundance of seed dispersers, and natural disturbance regimes

Carcinomatous Meningitis: The Natural History of Successfully Treated Metastatic Bladder Cancer

Carcinomatous meningitis due to bladder cancer is a rare entity reported only in case reports. Optimal therapy is thus poorly defined with earlier cases reporting an unsuccessful outcome. Here we report a case of late carcinomatous meningitis secondary to transitional cell carcinoma (TCC) of the bladder occurring in a patient in complete remission. He was successfully treated with intrathecal methotrexate and whole brain irradiation and experienced prolonged survival after treatment. With modern chemotherapy increasing complete remissions and survival rates in patients with TCC, more and more patients are being reported with carcinomatous meningitis. We raise the question of whether central nervous system prophylaxis should be considered in patients with TCC achieving a complete remission to chemotherapy in the metastatic setting

Co-Creating a strategy for Transforming Person Centred Cultures

Introduction: Transforming healthcare systems to support person-centred practice reflects environments where individual values and beliefs are respected and where healthful cultures can flourish. However, there are significant challenges within healthcare systems that impact on the development of healthful workplace cultures. The nursing and midwifery professions need to play an influential role in formulating health policy and decision-making to contribute to health and social care systems that are underpinned by person-centredness. This paper reports the use of a practice development approach underpinned by the Person-Centred Practice Framework to co-create a strategy for nurses and midwives that will enable the development of person-centred healthcare practices. The key objectives are to demonstrate the processes that support co-creation to build consensus on what is strategically important to nurses and midwives; to gain an understanding of the value of external facilitation throughout the process and exploring the challenges encountered during the development of the strategy. Methods: Practice Development methodology was the approach used with skilled facilitation adopted to enable the working with values and beliefs, defining purpose and vision and establishing agreed working principles and behaviours. Consensus building methods were used to co-create draft strategy priorities further defined by wider stakeholder engagement. Results: A 5-year strategy was co-created with senior nursing and midwifery leaders, inclusive of key strategic priority areas and strategic actions. The seven priority areas align to the Person-Centred Practice Framework with underpinning shared purpose and values. (1) Developing Person-Centred Cultures, (2) Creating a Supportive Practice Environment, (3) Building Research Capacity, (4) Building a Dynamic Workforce, (5) Fostering Leadership at all Levels, (6) Enhancing Digital Informatics and New Technologies, (7) Delivering High Quality, (8) Safe Person-Centred Care. Together they provide a roadmap for implementation across the many nursing and midwifery contexts providing a solid foundation for leading and supporting person-centred practice across a large local health district with a focus on what matters most while continuing to be innovative in approaches to practice. The development of a clear shared purpose of person-centred practice and the exploration of values were critical first steps in the development of the strategy and provided a clear foundation from which the nursing and midwifery leaders could utilise for the ongoing strategic priorities and action discussions. Implications for practice: The development of nursing and midwifery strategy using Practice Development Methodology and the Person-centred Practice Framework enables critical dialogue that supports nursing and midwifery leaders identify key influences over nursing and midwifery practice. This approach not only fosters a sense of ownership and engagement among nurses and midwives but also ensures that their values, beliefs, and professional insights are integral to the strategic direction of healthcare practices. By aligning the strategy with the Person-Centred Practice Framework, nurses and midwives are better able to develop a shared understanding of person-centred practice where the individual needs and preferences of patients, families and staff are acknowledged. Overall, this strategy represents a significant step forward in supporting the professional development of nurses and midwives, enhancing the quality of patient care, and fostering a healthful culture where continuous improvement and innovation are at the forefront of the healthcare system

Information professionals and copyright literacy: a multinational study

Purpose: The purpose of this paper is to present findings from a multinational survey on copyright literacy of specialists from libraries and other cultural institutions. Design/methodology/approach: This paper is based on a multinational survey of copyright literacy competencies of Library and Information Science (LIS) professionals and those who work in the cultural heritage sector (archives and museums), conducted in 13 countries, namely Bulgaria (BG), Croatia (CR), Finland (FI), France (FR), Hungary (HU), Lithuania (LT), Mexico (MX), Norway (NO), Portugal (PT), Romania (RO), Turkey (TR), UK and USA in the period July 2013-March 2015. An online survey instrument was developed in order to collect data from professionals regarding their familiarity with, knowledge and awareness of, and opinions on copyright-related issues. Findings: Findings of this study highlight gaps in existing knowledge of copyright, and information about the level of copyright literacy of LIS and cultural sector professionals. Also attitudes toward copyright learning content in academic education and continuing professional development training programs are investigated. Originality/value: This study aimed to address a gap in the literature by encompassing specialists from the cultural institutions in an international comparative context. The paper offers guidance for further understanding of copyright in a wider framework of digital and information literacy; and for the implementation of copyright policy, and the establishment of copyright advisor positions in cultural institutions. The recommendations support a revision of academic and continuing education programs learning curriculum and methods

Increased growth and reduced summer drought limitation at the southern limit of Fagus sylvatica\textit{Fagus sylvatica} L., despite regionally warmer and drier conditions

Tree populations at the equatorward edge of their distribution are predicted to respond to increased temperature and drought with declining performance. Empirical studies of $\textit{Fagus sylvatica}$ L., one of the most studied tree species in Europe, have broadly supported these predictions. Using a network of tree ring chronologies from northern Greece, we showed that growth in populations of this species at their southeast distribution limit was limited by summer temperature and precipitation, particularly at low elevations. Furthermore, decadal periods of lower precipitation and higher temperature in the twentieth century were associated with multi-year growth depressions. However, since 1990, growth trends were positive across the network, despite continued dry and hot summer conditions. Growth trends were not correlated with either elevation or tree age. Additionally, correlations between growth and temperature and precipitation were weaker in recent decades. These results are consistent with another recent report from the Balkan Peninsula, and indicate that forests in this region may be more resistant to regional climate change than previously considered.AHP received funding from the Department of Geography, University of Cambridge and Clare College, Cambridge

Climate change and plant reproduction: trends and drivers of mast seeding change

Climate change is reshaping global vegetation through its impacts on plant mortality, but recruitment creates the next generation of plants and will determine the structure and composition of future communities. Recruitment depends on mean seed production, but also on the interannual variability and among-plant synchrony in seed production, the phenomenon known as mast seeding. Thus, predicting the long-term response of global vegetation dynamics to climate change requires understanding the response of masting to changing climate. Recently, data and methods have become available allowing the first assessments of long-term changes in masting. Reviewing the literature, we evaluate evidence for a fingerprint of climate change on mast seeding and discuss the drivers and impacts of these changes. We divide our discussion into the main characteristics of mast seeding: interannual variation, synchrony, temporal autocorrelation, and mast frequency. Data indicate that masting patterns, are changing, but the direction of that change varies, likely reflecting the diversity of proximate factors underlying masting across taxa. Experiments to understand the proximate mechanisms underlying masting, in combination with the analysis of long-term datasets, will enable us to understand this observed variability in the response of masting. This will allow us to predict future shifts in masting patterns, and consequently ecosystem impacts of climate change via its impacts on masting.</p

Self-management toolkit and delivery strategy for end-of-life pain: the mixed-methods feasibility study

Background: Pain affects most people approaching the end of life and can be severe for some. Opioid analgesia is effective, but evidence is needed about how best to support patients in managing these medicines. Objectives: To develop a self-management support toolkit (SMST) and delivery strategy and to test the feasibility of evaluating this intervention in a future definitive trial. Design: Phase I – evidence synthesis and qualitative interviews with patients and carers. Phase II – qualitative semistructured focus groups and interviews with patients, carers and specialist palliative care health professionals. Phase III – multicentre mixed-methods single-arm pre–post observational feasibility study. Participants: Phase I – six patients and carers. Phase II – 15 patients, four carers and 19 professionals. Phase III – 19 patients recruited to intervention that experienced pain, living at home and were treated with strong opioid analgesia. Process evaluation interviews with 13 patients, seven carers and 11 study nurses. Intervention: Self-Management of Analgesia and Related Treatments at the end of life (SMART) intervention comprising a SMST and a four-step educational delivery approach by clinical nurse specialists in palliative care over 6 weeks. Main outcome measures: Recruitment rate, treatment fidelity, treatment acceptability, patient-reported outcomes (such as scores on the Brief Pain Inventory, Self-Efficacy for Managing Chronic Disease Scale, Edmonton Symptom Assessment Scale, EuroQol-5 Dimensions, Satisfaction with Information about Medicines Scale, and feasibility of collecting data on health-care resource use for economic evaluation). Results: Phase I – key themes on supported self-management were identified from evidence synthesis and qualitative interviews. Phase II – the SMST was developed and refined. The delivery approach was nested within a nurse–patient consultation. Phase III – intervention was delivered to 17 (89%) patients, follow-up data at 6 weeks were available on 15 patients. Overall, the intervention was viewed as acceptable and valued. Descriptive analysis of patient-reported outcomes suggested that interference from pain and self-efficacy were likely to be candidates for primary outcomes in a future trial. No adverse events related to the intervention were reported. The health economic analysis suggested that SMART could be cost-effective. We identified key limitations and considerations for a future trial: improve recruitment through widening eligibility criteria, refine the SMST resources content, enhance fidelity of intervention delivery, secure research nurse support at recruiting sites, refine trial procedures (including withdrawal process and data collection frequency), and consider a cluster randomised design with nurse as cluster unit. Limitations: (1) The recruitment rate was lower than anticipated. (2) The content of the intervention was focused on strong opioids only. (3) The fidelity of intervention delivery was limited by the need for ongoing training and support. (4) Recruitment sites where clinical research nurse support was not secured had lower recruitment rates. (5) The process for recording withdrawal was not sufficiently detailed. (6) The number of follow-up visits was considered burdensome for some participants. (7) The feasibility trial did not have a control arm or assess randomisation processes. Conclusions: A future randomised controlled trial is feasible and acceptable

Climatically controlled reproduction drives interannual growth variability in a temperate tree species.

Climatically controlled allocation to reproduction is a key mechanism by which climate influences tree growth and may explain lagged correlations between climate and growth. We used continent-wide datasets of tree-ring chronologies and annual reproductive effort in Fagus sylvatica from 1901 to 2015 to characterise relationships between climate, reproduction and growth. Results highlight that variable allocation to reproduction is a key factor for growth in this species, and that high reproductive effort ('mast years') is associated with stem growth reduction. Additionally, high reproductive effort is associated with previous summer temperature, creating lagged climate effects on growth. Consequently, understanding growth variability in forest ecosystems requires the incorporation of reproduction, which can be highly variable. Our results suggest that future response of growth dynamics to climate change in this species will be strongly influenced by the response of reproduction