Umsorgt werden und umsorgen - Leben mit mehreren Langzeiterkrankungen (Leila) : eine qualitative Studie zum Beitrag von APN in integrierter Versorgung

Hintergrund: Das Leben mit mehreren chronischen Krankheiten ist komplex und führt zu einer erhöhten Pflege- und Betreuungsbedürftigkeit. Zur Förderung der integrierten Versorgung wurde ein dreijähriges Projekt namens «Leben mit Langzeiterkrankung» (Leila) initiiert. Ziel: Das Projekt hatte zum Ziel, Leistungen von Pflegeexpertinnen in Advanced Practice Nursing (APN) für chronisch erkrankte Menschen in Zusammenarbeit mit Hausarztpraxen zu entwickeln. Folgende Fragestellungen wurden untersucht: 1. Wie erleben Patient(inn)en, Zuweisende und Pflegeexpertinnen APN das Leila-Dienstleistungsangebot? 2. Wie gestalten sich Zuweisungsprozesse? 3. Wie erleben die Beteiligten die Zusammenarbeit und die APN-Rollenausübung? Methode: Es wurde ein qualitativer Ansatz gemäß Grounded Theory nach Corbin und Strauss gewählt, um Erfahrungen mit Leila und Interaktionen der an Leila beteiligten Personen zu untersuchen. Dabei wurden 38 Interviews mit Patient(inn)en, die mit multiplen chronischen Krankheiten leben, deren betreuende Pflegeexpertinnen APN und zuweisenden Ärzt(inn)en durchgeführt und evaluiert. Ergebnisse: «Umsorgt werden und umsorgen» zeigte sich als zentrale Kategorie. Diese beschreibt wie auf die Patient(inn)en eingegangen wurde, sie einbezogen und ernst genommen wurden. Die Hauptkategorie «Den Alltag gestalten» zeigt, dass die Patient(inn)en lernten, mit den Folgen chronischer Erkrankungen im Alltag umzugehen. «Alle Ressourcen nutzen» legt dar, wie Potenziale und Stärken eingesetzt wurden. Schlussfolgerungen: Die Ergebnisse zu Zuweisungs- und Kooperationsprozessen ergaben, dass die APN-Rollenanerkennung und -ausübung noch ausgehandelt werden muss. Zukünftige APN-Angebote für diese Patient(inn)engruppe sollten nebst Ärztenetzwerken in weitere Dienstleistungen und die Spitex integriert werden. Background: Living with multiple chronic diseases is complex and leads to enhanced care needs. To foster integrated care a project called “Living with chronic disease” (Leila) was initiated. Aim: The aim was to develop an Advanced Practice Nursing (APN) service in collaboration with medical centers for persons who are living with multiple chronic diseases. The following research questions were addressed: 1. What are patients' experiences, referring physicians and APNs with the Leila-Service? 2. How are referral processes performed? 3. How do the involved groups experience collaboration and APN role development? Methods: A qualitative approach according grounded theory of Corbin and Strauss was used to explore the experiences with the Leila project and the interaction of the persons involved. 38 interviews were conducted with patients who are living with multiple chronic diseases, their APN's and the referring physicians. Results: The findings revealed “Being cared for and caring” as main category. The data demonstrated how patients responded to their involvement into care and that they were taken as serious partners in the care process. The category “organizing everyday life” describes how patients learned to cope with the consequences of living with multiple chronic diseases. “Using all resources” as another category demonstrates how capabilities and strengths were adopted. Conclusions: The results of the cooperation- and allocation processes showed that the APN recognition and APN role performance have to be negotiated. Prospective APN-services for this patient population should be integrated along with physician networks and other service providers including community health nursing

Hobbies (Falco cuvieri and F. subbuteo) versus bats over Kampala skies

No Abstract

Genetic associations at 53 loci highlight cell types and biological pathways relevant for kidney function.

Reduced glomerular filtration rate defines chronic kidney disease and is associated with cardiovascular and all-cause mortality. We conducted a meta-analysis of genome-wide association studies for estimated glomerular filtration rate (eGFR), combining data across 133,413 individuals with replication in up to 42,166 individuals. We identify 24 new and confirm 29 previously identified loci. Of these 53 loci, 19 associate with eGFR among individuals with diabetes. Using bioinformatics, we show that identified genes at eGFR loci are enriched for expression in kidney tissues and in pathways relevant for kidney development and transmembrane transporter activity, kidney structure, and regulation of glucose metabolism. Chromatin state mapping and DNase I hypersensitivity analyses across adult tissues demonstrate preferential mapping of associated variants to regulatory regions in kidney but not extra-renal tissues. These findings suggest that genetic determinants of eGFR are mediated largely through direct effects within the kidney and highlight important cell types and biological pathways

Seasonal Changes in Nycthemeral Availability of Sympatric Temperate Mixed Forest Rodents: The Predators’ Perspective

(1) Background: Bank voles (Clethrionomys glareolus) and Apodemus mice are of exceptional importance as prey for predators in temperate mixed forests. We hypothesized that overall prey availability would increase linearly with prey frequency, and that the daylight hours, which are considered particularly dangerous, would be used only during seasonal rodent population peaks and only in the twilight hours. (2) Methods: We conducted a two-year camera-trapping study in an inner alpine mixed forest and collected 19,138 1 min videos in 215 camera-trap nights. Prey availability was defined as the pseudo-replication-limited maximum number of the respective rodent taxon per 30 min period, summed per season. (3) Results: Overall prey availability increased with frequency, i.e., the maximum number of rodent individuals per camera-trap night. Seasonally, Apodemus mice were particularly available to predators in the summer and bank voles in the autumn after a tree mast year. In both cases, this was accompanied by a significant increase in diurnal availability. During the population peak of Apodemus mice, the nocturnal availability of bank voles decreased without a concurrent increase in absolute diurnal availability, even though the significant relative shift to diurnal activity superficially suggested this. Bank voles were active throughout the day, while Apodemus mice were nocturnal and (rarely) crepuscular. (4) Conclusions: Availability of rodents to predators, especially during daylight hours, was mainly dependent on their tree mast-induced increased frequencies. Bank voles likewise responded strongly to interspecific competition with the larger and aggressive Apodemus mice, which negatively affected availability to predators. At our seasonal level of evaluation, we conclude that nycthemeral availability of forest-dwelling rodents to generalist predators of temperate mixed forests is predominantly driven by bottom-up mechanisms

High Frequency of Apodemus Mice Boosts Inverse Activity Pattern of Bank Voles, Clethrionomys glareolus, through Non-Aggressive Intraguild Competition

Sympatric animals with similar requirements can separate their ecological niches along the microhabitat, food and time axes. There may be alternative reasons for an interspecific different activity pattern, such as intraspecific social constraints, predator avoidance or physical conditions such as temperature, precipitation and illumination. We investigated the importance of intraguild competition in a 2-year study in an inner-alpine mixed forest, using small forest rodents as our model species. Apodemus mice were the physically superior, and bank voles, Clethrionomys glareolus, the inferior competitor. We predicted that bank voles would exhibit increased diurnal activity when frequencies of the almost exclusively nocturnal Apodemus mice were high during a seed mast year. To investigate this, we recorded 19,138 1 min videos. Controlling for confounding variables, bank vole diurnal activity was significantly related to the frequency of Apodemus mice. We assume that at high densities of Apodemus mice, a purely nocturnal separation in the niche dimensions of time, habitat and microhabitat is no longer sufficient, and therefore an inverse activity pattern by the bank voles is reinforced. Our videos showed, however, that this does not require persistent aggressive meetings and we explain this by the long co-evolution of the taxa under study.</jats:p

High Frequency of Apodemus Mice Boosts Inverse Activity Pattern of Bank Voles, Clethrionomys glareolus, through Non-Aggressive Intraguild Competition

Sympatric animals with similar requirements can separate their ecological niches along the microhabitat, food and time axes. There may be alternative reasons for an interspecific different activity pattern, such as intraspecific social constraints, predator avoidance or physical conditions such as temperature, precipitation and illumination. We investigated the importance of intraguild competition in a 2-year study in an inner-alpine mixed forest, using small forest rodents as our model species. Apodemus mice were the physically superior, and bank voles, Clethrionomys&nbsp;glareolus, the inferior competitor. We predicted that bank voles would exhibit increased diurnal activity when frequencies of the almost exclusively nocturnal Apodemus mice were high during a seed mast year. To investigate this, we recorded 19,138 1 min videos. Controlling for confounding variables, bank vole diurnal activity was significantly related to the frequency of Apodemus mice. We assume that at high densities of Apodemus mice, a purely nocturnal separation in the niche dimensions of time, habitat and microhabitat is no longer sufficient, and therefore an inverse activity pattern by the bank voles is reinforced. Our videos showed, however, that this does not require persistent aggressive meetings and we explain this by the long co-evolution of the taxa under study

Winter Ecology of the Hen Harrier, Circus cyaneus: Bridging Behavioral Insights and Conservation Requirements

The hen harrier, Circus cyaneus, is a migratory raptor that relies on open grasslands as key winter habitats in Central Europe, where it predominantly preys on common voles, Microtus arvalis. However, habitat loss due to agricultural intensification, land use change, and human disturbances increasingly threatens these landscapes. Using the framework of conservation behavior, this study examines how hen harriers respond to human-induced environmental changes, how behavior-based habitat management can support conservation, and how behavioral indicators such as territoriality inform conservation planning. Based on 278 h of field observations, we analyzed space use, foraging ecology, time and energy budgets, and territoriality of wintering hen harriers. Our results indicate that non-territorial females require ~20% more energy intake than territorial females, reflecting the advantage of defending vole-rich habitats. This corresponds to an estimated daily intake of up to 8 voles for non-territorial females, compared to 4&ndash;6 voles for territorial ones. Winter territory establishment was primarily driven by vole availability, and habitat degradation due to grassland loss impaired territory formation, influencing energy allocation and conservation prospects. Our findings highlight the role of territory establishment as a quantifiable behavioral indicator for habitat quality and conservation planning. At a landscape scale, habitat alteration and loss, anthropogenic disturbances and top-down effects further shape hen harrier distribution, emphasizing the need to account for these factors in conservation strategies. Finally, we identify open research questions, especially regarding large-scale environmental pressures and cross-seasonal effects