Cognitive Functions After Traumatic Brain Injury. A 30-year Follow-up Study

Many cognitive deficits after TBI (traumatic brain injury) are well known, such as memory and concentration problems, as well as reduced information-processing speed. What happens to patients and cognitive functioning after immediate recovery is poorly known. Cognitive functioning is flexible and may be influenced by genetic, psychological and environmental factors decades after TBI. The general aim of this thesis was to describe the long-term cognitive course after TBI, to find variables that may contribute to it, and how the cognitive functions after TBI are associated with specific medical factors and reduced survival. The original study group consisted of 192 patients with TBI who were originally assessed with the Mild Deterioration Battery (MDB) on average two years after the injury, during the years 1966 – 1972. During a 30-year follow-up, we studied the risks for reduced survival, and the mortality of the patients was compared with the general population using the Standardized Mortality Ratio (SMR). Sixty-one patients were re-assessed during 1998-2000. These patients were evaluated with the MDB, computerized testing, and with various other neuropsychological methods for attention and executive functions. Apolipoprotein-E (ApoE) genotyping and magnetic resonance imaging (MRI) based on volumetric analysis of the hippocampus and lateral ventricles were performed. Depressive symptoms were evaluated with the short form of the Beck depression inventory. The cognitive performance at follow-up was compared with a control group that was similar to the study group in regard to age and education. The cognitive outcome of the patients with TBI varied after three decades. The majority of the patients showed a decline in their cognitive level, the rest either improved or stayed at the same level. Male gender and higher age at injury were significant risk factors for the decline. Whereas most cognitive domains declined during the follow-up, semantic memory behaved in the opposite way, showing recovery after TBI. In the follow-up assessment, the memory decline and impairments in the set-shifting domain of executive functions were associated with MRI-volumetric measures, whereas reduction in information-processing speed was not associated with the MRI measures. The presence of local contusions was only weakly associated with cognitive functions. Only few cognitive methods for attention were capable of discriminating TBI patients with and without depressive symptoms. On the other hand, most complex attentional tests were sensitive enough to discriminate TBI patients (non-depressive) from controls. This means that complex attention functions, mediated by the frontal lobes, are relatively independent of depressive symptoms post-TBI. The presence of ApoE4 was associated with different kinds of memory processes including verbal and visual episodic memory, semantic memory and verbal working memory, depending on the length of time since TBI. Many other cognitive processes were not affected by the presence of ApoE4. Age at injury and poor vocational outcome were independent risk factors for reduced survival in the multivariate analysis. Late mortality was higher among younger subjects (age < 40 years at death) compared with the general population which should be borne in mind when assessing the need for rehabilitation services and long-term follow-up after TBI.

Enabling Change in Universities: Enhancing Education for Sustainable Development with Tools for Quality Assurance

Enabling Change in Universities: Enhancing Education for Sustainable Development with Tools for Quality Assurance This thesis deals with enabling change in universities, more explicitly enhancing education for sustainable development with tools for quality assurance. Change management is a discipline within management that was developed in the 1980s because business changed from being predictable to unpredictable. The PEST mnemonic is a method to categorize factors enabling change; such as political, economic, socio-cultural and technological factors, which all affect higher education. A classification of a change, in either hard or soft, can help understanding the type of change that an organization is facing. Hard changes are more applied to problems that have clear objectives and indicators, with a known cause of the problem. Soft changes are applied to larger problems that affect the entire organization or beyond it. The basic definition for sustainable development is: the future generations should have similar opportunities as the previous. The UN has set as a global goal an integration of education for sustainable development (ESD) at all levels of education during 2005- 2014. The goal is set also in universities, the graduates of which are future leaders for all labor markets. The objective for ESD in higher education is that graduates obtain the competence to take economic, social and environmental costs and benefits into account when making decisions. Knowledge outcomes should aim for systematic and holistic thinking, which requires cross disciplinary education. So far, the development of ESD has not achieved its goals. The UN has identified a need for more transdisclipnary research in ESD. A joint global requirement for universities is quality assurance, the aim of which is to secure and improve teaching and learning. Quality, environmental and integrated management systems are used by some universities for filling the quality assurance requirements. The goal of this thesis is to open up new ways for enhancing ESD in universities, beyond the forerunners; by exploring how management systems could be used as tools for promoting ESD. The thesis is based on five studies. In the first study, I focus on if and how tools for quality assurance could be benefitted for promoting ESD. It is written from a new perspective, the memetic, for reaching a diversity of faculty. A meme is an idea that diffuses from brain to brain. It can be applied for cultural evolution. It is a theory that is based on the evolutionary theory by Darwin, applied for social sciences. In the second Paper, I present the results from the development of the pilot process model for enhancing ESD with management systems. The development of the model is based on a study that includes earlier studies, a survey in academia and an analysis of the practice in 11 universities in the Nordic countries. In the third study, I explore if the change depends on national culture or if it is global. It is a comparative study on both policy and implementation level, between the Nordic countries and China. The fourth study is a single case study based on change management. In this study, I identify what to consider in order to enable the change: enhancing ESD with tools for quality assurance in universities. In the fifth Paper, I present the results of the process model for enhancing ESD with management systems. The model was compared with identified drivers and barriers for enhancing ESD and for implementing management systems. Finally, the process model was piloted and applied for identifying sustainability aspects in curricula. Action research was chosen as methodology because there are not already implemented approaches using quality management for promoting ESD, why the only way to study this is to make it happen. Another reason for choosing action research is since it is essential to involve students and faculty for enhancing ESD. Action based research consists of the following phases: a) diagnosing, b) planning action, c) taking action and d) evaluating action. This research was made possible by a project called Education for Sustainable Development in Academia in the Nordic countries, ESDAN, in which activities were divided into these four phases. Each phase ended with an open seminar, where the results of the study were presented. The objective for the research project was to develop a process for including knowledge in sustainable development in curricula, which could be used in the quality assurance work. Eleven universities from the Nordic countries cooperated in the project. The aim was, by applying the process, to identify and publish examples of relevant sustainability aspects in different degree programs in universities in the Nordic countries. The project was partly financed by the Nordic Council of Ministers and partly by the participating pilot universities. Based on the results of my studies, I consider that quality, environmental and integrated management systems can be used for promoting ESD in universities. Relevant sustainability aspects have been identified in different fields of studies by applying the final process model. The final process model was compared with drivers and barriers for enhancing ESD and for implementing management systems in universities and with succeeding with management systems in industry. It corresponds with these, meaning that drivers are taken into account and barriers tackled. Both ESD and management systems in universities could be considered successful memes, which can reflect an effective way of communication among individuals. I have identified that management systems could be used as tools for hard changes and to support the soft change of enhancing ESD in universities with management system. Based on the change management study I have summarized recommendations on what to consider in order to enable the studied change. The main practical implications of the results are that the process model could be applied for assessment, benchmarking and communication of ESD, connected to quality assurance, when applied. This is possible because the information can be assembled in one picture, which facilitates comparison. The memetic approach can be applied for structuring. It is viable to make comparative studies between cultures, for getting insight in special characteristics of the own culture. Action based research is suitable for involving faculty. Change management can be applied for planning a change, which both enhancing ESD and developing management systems are identified to be.

Liiketoimintatiedonhallinnan hyödyntämisen esteet päätettäessä palveluista. Case: Kunnalliset pelastustoimen liikelaitokset ja eriytetyt taseyksiköt

Pelastuslaitosten liiketoimintatiedonhallinnalla, tietoperusteisuudella ja tietojohtamisella on tulevaisuudessa merkittävä rooli päätettäessä palveluista. Julkisen pelastustoimen kuntien liikelaitoksina ja eriytettyinä taseyksiköinä toimivien pelastuslaitosten haasteet tulevat olemaan jatkossa tehokkaiden ja vaikuttavien palveluiden strategisessa johtamisessa ja suunnittelussa. Näistä asioista päättäminen on kriittinen vaihe onnistumisen kannalta. Päätöksenteko eri tasoilla tarvitsee tuekseen toiminnasta ja palveluista kanavoitua analysoitua tietoa. Asiakastarpeesta lähtevä vaikuttavuus ja laatu korostuvat. Liiketoimintatiedonhallinta ja tietoperusteisuus haastavat pelastuslaitoksen johtamisjärjestelmän. Johtamisen kyvykkyys ja henkilöstön osaaminen ovat tietoperusteisuuden ja tiedonhallinnan keskiössä. Systemaattisen liiketoimintatiedonhallinnan ja tietoperusteisuuden erottaa perinteisestä virkamiehen tietojen hyväksikäytöstä käsitteen kokonaisvaltaisuus ja järjestelmällisyys kaikessa tiedollisessa toiminnassa. Tämä kattaa tietojärjestelmät, mittarit, prosessit, strategian suunnitelmat, asiakirjat, raportoinnin, kehittämisen ja tutkimuksen. Liiketoimin-tatiedonhallinta ja tietojohtaminen linkittävät kaiken toisiinsa muodostaen keskinäisriippuvaisen yhtenäisen järjestelmän ja kokonaisvaltaisen ymmärryksen. Tutkimukseni on laadullinen tutkimus jossa tiedon keruu ja analysointi on toteutettu toisiaan tukevilla tutkimusotteilla. Metodologia nojaa teorialähtöiseen systemaattiseen analyysiin, jossa on valikoituja osia sisällön analyysistä. Tutkimuksessa on käytetty aineisto- ja menetelmätriangulaatioita. Tutkimuksen aineisto on kerätty teemahaastatteluilla valittujen kohde pelastuslaitosten asiantuntijoilta palveluiden päätös- ja suunnittelutasolta, johtoryhmistä ja joh-tokunnista. Haastatteluja varten tutkija on tutustunut kohdepelastuslaitosten palveluita mää-rittävään tiedolliseen dokumentaatioon kuten palvelutasopäätöksiin ja riskianalyyseihin. Ai-neisto keruun kohteiksi valikoitui pääkaupunkiseudun alueen pelastuslaitokset: Helsingin kaupungin pelastuslaitos sekä Itä-, Keski- ja Länsi-Uudenmaan pelastuslaitokset. Tulosten mukaan pelastuslaitosten keskeiset liiketoimintatiedonhallinnan esteet muodostuvat johtamisen ongelmista, organisaation muutosvastarinnasta ja päätöksenteon tietoperusteen puutteesta. Nämä ilmenevät strategisen johtamisen puutteina, vaikuttavuuden mittaamisen sekä tiedon jalostamisen ongelmina. Keskeistä tiedollista yhdistävää ja linkittävää tekijää ei tunnisteta ja löydetä. Tiedollisessa liiketoimintatiedonhallinnan prosessityössä voisi olla tulos-ten mukaan mahdollisuuksia tämän tyhjiön täyttämiseen. Pelastuslaitoksille jää tulevaisuudessa valinta suunnasta johon ne haluavat edetä tiedonhal-linnan, tietojohtamisen ja tietoperusteisuuden kanssa. Tämä vaikuttaa kehitykseen ja tavoitteeseen keskeisistä palveluiden päätöksentekoa tukevista johtamis- ja tietojärjestelmistä, tietoa kokoavista ja luovista dokumenteista sekä organisaation joustavasta rakenteesta. Tietoprosessiin, tiedon prosessimaiseen johtamiseen ja systemaattiseen tiedonhallintaan meneminen vaikuttaa tutkimuksen tulosten mukaan lupaavalta mahdollisuudelta. Samalla se haastaa pelauslaitokset suureen kulttuuriseen muutokseen ja asettaa uusien vaikuttavuusmittareiden tuottaman tiedon ennakoivan hyväksynnän vaateen strategiselle suunnittelulle. Tämä vaatii pelastuslaitosten johdolta ja henkilöstöltä osaamista, yhteisymmärrystä, muutostarpeiden hyväksyntää sekä asiakkaan asettamista vaikuttavuuden keskiöön.

Interleukin-6 promoter polymorphisms (-174 G/C) in Malaysian patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that involves the inflammation of various organs upon deposition of immune complexes and is characterized by uncontrolled B cell hyperactivity. Despite intensive research on the etiology of the disease, the exact cause of the onset of SLE is unknown. The pathogenesis of the disease has been proposed to be associated with the imbalance of T helper type 1 (Th1) and Th2 cytokine activities. Elevated serum levels of interleukin-6 (IL-6), a Th2 cytokine with various functions in the regulation of human biological systems, are observed in SLE patients. In the present study, 100 Malaysian SLE patients and 100 controls were evaluated in order to determine the association of polymorphisms existing in the promoter region of the IL-6 gene with the onset of SLE. The homozygous G genotype was found to be significant in SLE patients (&#967;² = 33.754; P = 0.00000000625), whereas the heterozygous G/C genotype was significant in the controls (&#967;²= 25.087; P = 0.000000548). We suggest that the C allele might have a masking effect on the G allele when both alleles are present in heterozygous individuals. However, we did not observe any significant association of the homozygous C allele with the onset of SLE or with protection from the disease (&#967;² = 1.684; P = 0.194366).

Nurses' attitudes toward computers before and two months after training

This study examined nurses' attitudes toward computers before training and 2 months after training. A quantitative approach and a nonexperimental survey design were used in this study. Stronge and Brodt's (1985) instrument, Nurses' Attitudes Toward Computerization Questionnaire, was used to assess 27 nurses' attitudes prior to and 2 months after computer training. Demographic variables also were collected on the questionnaires. The results of this study showed that, overall, nurses had positive attitudes towards computers in both questionnaires. The results of the first questionnaire were consistent with other studies. There were no studies that involved a follow-up questionnaire using Stronge and Brodt's (1985) instrument. Attitude scores of Questionnaire 2 were higher than attitude scores of Questionnaire 1. More time for nursing tasks, less time for quality patient care, and threat to job security questions were found to be statistically significant. This study found no statistical significance between attitudes and demographic variables. Younger nurses a~d nurses with fewer years of computer experience were most likely to exhibit positive attitudes. Implications for practice and future research were discussed. Some limitations were identified and discussed.

Perceptions infirmières quant à la réalisation de la collecte des données auprès de la clientèle à l'urgence, étape préalable à la formulation du jugement clinique infirmier

Depuis l’adoption de la Loi 90 en 2002, la Loi sur les infirmières et infirmiers (LII, article 36) confère une autonomie élargie aux infirmières en reconnaissant, notamment, leur compétence et leur responsabilité à l’égard de l’évaluation clinique qui est représentée dans cette loi comme l’assise de l’exercice infirmier (Pellerin, 2009; OIIQ, 2010). La collecte des données constitue une étape fondamentale du processus d’évaluation clinique (Dillon, 2007; Doyon, Brûlé & Cloutier, 2002; Pellerin, 2009; Weber & Kelley, 2007). L’infirmière d’urgence a une responsabilité majeure à l’égard de la collecte des données. En effet, elle œuvre auprès de clientèles de tous âges qui présentent des problèmes de santé variés, aigus et parfois urgents et doit souvent intervenir, sur la base de son évaluation clinique, avant qu’un diagnostic n’ait été établi ou que le patient n’ait été vu par le médecin (Newberry & Criddle, 2005). Or, malgré toute l’importance que revêtent dorénavant l’évaluation clinique et la collecte des données au sens de la loi, ce rôle de l’infirmière semble tarder à s’actualiser dans la pratique clinique. Le but de cette étude qualitative descriptive consiste à explorer les perceptions d’infirmières, de gestionnaires en soins infirmiers et d’infirmières ressources cliniques d’urgence relativement à la réalisation de la collecte des données. La norme clinique « collecte des données » (assessment) de l’Emergency Nurses Association (1999) constitue le cadre de référence de l’étude. Cinq entrevues individuelles semi-dirigées de 60 minutes ainsi qu’un groupe de discussion de 90 minutes ont été réalisés auprès d’infirmières d’urgence. Un deuxième groupe de discussion a également réuni deux gestionnaires en soins infirmiers et deux infirmières ressources cliniques de l’urgence. Les données recueillies ont été analysées selon l’approche proposée par Miles et Huberman (2003). Les résultats obtenus démontrent que les infirmières considèrent la collecte des données comme un aspect fondamental de leur pratique à l’urgence, qui contribue à améliorer la qualité et la sécurité des soins dispensés. Or, les résultats révèlent également que leur compréhension de la collecte des données est variable, que leur pratique est aléatoire et largement influencée par le modèle biomédical. Plusieurs facteurs influencent la pratique des infirmières relativement à la collecte des données notamment : la conception individuelle de la collecte des données et du rôle infirmier, les relations et l’interaction avec les membres de l’équipe des soins infirmiers et les autres professionnels ainsi que le soutien de l’organisation et des gestionnaires en soins infirmiers. Ce dernier facteur semble prépondérant dans le contexte de l’urgence et démontre que le soutien des gestionnaires et des infirmières ressources cliniques influence de façon importante la pratique dans les milieux cliniques. Cette étude propose des pistes de réflexion sur la formation académique, la formation continue, l’administration des soins infirmiers et la collaboration interprofessionnelle qui pourraient faciliter l’actualisation du rôle des infirmières à l’égard de la collecte des données et de l’évaluation clinique afin d’améliorer la qualité des soins dispensés à l’urgence.

Les conceptions et préférences des infirmières quant aux modalités de l'organisation de leur travail.

Problématique : De par les fonctions qu’elles exercent à différentes étapes du continuum de soins, les infirmières jouent un rôle de premier plan dans l’offre des services de santé. La qualité des services repose en grande partie sur du personnel infirmier motivé, judicieusement déployé et travaillant dans des conditions qui permettent d’optimiser leur expérience de travail. Cependant, différentes études suggèrent que les modalités actuelles d’organisation du travail ne permettent pas toujours de créer des conditions et des environnements susceptibles d’optimiser le travail des infirmières et leur qualité de vie au travail (Institute of Medicine, 2001; Hickam & al., 2003; Shojania, Duncan, McDonald, & Wachter, 2001). Une meilleure compréhension des conceptions et préférences des infirmières est utile pour guider les actions dans les milieux de soins visant à améliorer l’organisation du travail infirmier. Objectifs : Cette recherche qualitative descriptive a pour but d’explorer les conceptions et préférences des infirmières par rapport aux modalités d’organisation de leur travail pouvant améliorer leur qualité de vie au travail, dans un contexte de centre hospitalier et plus spécifiquement, dans une unité de médecine. Méthodologie : Des entrevues semi-dirigées ont été effectuées auprès de huit infirmières. La technique d’analyse de contenu a été utilisée pour analyser les résultats de l’étude. Le modèle conceptuel de l’organisation du travail de Filion-Côté qui a été utilisé s’oriente autour des processus de soins, la dotation en personnel et l’environnement de travail. Résultats : Cette étude a établi que les conceptions de l’organisation du travail partagées par les infirmières touchent deux principales dimensions soit la définition des rôles et la répartition des tâches ainsi que l’organisation du travail en temps que modes de coordination du travail et d’interaction entre les membres de l’équipe de travail. Cette analyse a aussi démontré que les principales préférences des infirmières sont exprimées à propos des éléments ayant trait à la disponibilité adéquate du personnel nécessaire à l’exécution des différentes tâches, le soutien du supérieur immédiat, le soutien de l’administration au développement professionnel et de la pratique ainsi que l’aménagement des conditions matérielles de travail. On peut aussi constater que plusieurs préférences exprimées par les infirmières donnent écho à leurs conceptions de l’organisation du travail. Conclusion : Cette étude a permis de comprendre les conceptions et les préférences des infirmières par rapport à l’organisation de leur travail. Elle aura ainsi permis d’identifier plusieurs modalités sur lesquels les gestionnaires peuvent agir pour développer des projets d’organisation du travail, soit la dotation en personnels des milieux des soins, le soutien des équipes, la communication et l’aménagement de l’environnement physique des soins. De plus, les infirmières ont elles-mêmes un rôle à jouer pour modifier positivement leur milieu de travail et peuvent influencer plusieurs de ces modalités.

Functions satisfying holonomic q-differential equations

In a similar manner as in some previous papers, where explicit algorithms for finding the differential equations satisfied by holonomic functions were given, in this paper we deal with the space of the q-holonomic functions which are the solutions of linear q-differential equations with polynomial coefficients. The sum, product and the composition with power functions of q-holonomic functions are also q-holonomic and the resulting q-differential equations can be computed algorithmically.

Visión y análisis de las propuestas de reforma al Sistema General de Seguridad Social en Salud en Colombia, vigencia 2012-2013

Con la Constitución Política de 1991, se inicia una nueva estructura funcional en el país a partir de los preceptos consagrados en la carta magna como un estado social de derecho, situación que no fue ajena al sector salud en el cual se estableció la seguridad social como un servicio público basado en los principios fundamentales de universalidad, solidaridad y eficiencia, enunciados que fueron plasmados entre otros en la Ley 100 de 1993, la cual incorporó estos elementos que resultaban innovadores en el contexto. Hoy después de 18 años de promulgada la Ley, se ha generado un modelo estructural que ha permitido mejorar los resultados en esta área, que si bien posee falencias en algunos de sus componentes (Acceso, Flujo de Recursos, Salud Pública), las mismas pueden ser superadas, con una reforma estructural al sistema que elimine los intereses particulares de los diferentes actores al momento de su elaboración y promulgación. Uno de los avances significativos en la reforma al sistema es la promulgación de la salud como derecho fundamental, inherente al ser humano, otorgando el carácter de inalienable, imprescriptible y sagrado, dejando en segundo plano su condición prestacional establecida. El derecho a la salud tendrá como eje principal la salud pública armonizada con la promoción y prevención, diagnóstico y tratamiento integral de la enfermedad, las cuales deben ser articuladas con las políticas sociales, ambientales, culturales y económicas que permitan incidir en los determinantes sociales de la salud para mejorar la calidad de vida de la población. La reforma a la salud en el eje de la financiación como se encuentra propuesta, no generará cambios sustanciales toda vez que se avanza hacia un sistema en que el estado será el principal actor con las funciones afiliación, recaudo, pago, giro o transferencia de los recursos, responsable de la información. Sin embargo la administración del riesgo en salud seguirá delegada, función que es determinante para la administración de los recursos del sistema, en resumen se demuestra el interés del estado en retomar la gobernanza y su empoderamiento como administrador de lo público, sin que esto responda a las necesidades de cambio en el sistema de salud.

Identification of plasmodium vivax proteins with potential role in invasion using sequence redundancy reduction and profile hidden markov models

Background: This study describes a bioinformatics approach designed to identify Plasmodium vivax proteins potentially involved in reticulocyte invasion. Specifically, different protein training sets were built and tuned based on different biological parameters, such as experimental evidence of secretion and/or involvement in invasion-related processes. A profile-based sequence method supported by hidden Markov models (HMMs) was then used to build classifiers to search for biologically-related proteins. The transcriptional profile of the P. vivax intra-erythrocyte developmental cycle was then screened using these classifiers. Results: A bioinformatics methodology for identifying potentially secreted P. vivax proteins was designed using sequence redundancy reduction and probabilistic profiles. This methodology led to identifying a set of 45 proteins that are potentially secreted during the P. vivax intra-erythrocyte development cycle and could be involved in cell invasion. Thirteen of the 45 proteins have already been described as vaccine candidates; there is experimental evidence of protein expression for 7 of the 32 remaining ones, while no previous studies of expression, function or immunology have been carried out for the additional 25. Conclusions: The results support the idea that probabilistic techniques like profile HMMs improve similarity searches. Also, different adjustments such as sequence redundancy reduction using Pisces or Cd-Hit allowed data clustering based on rational reproducible measurements. This kind of approach for selecting proteins with specific functions is highly important for supporting large-scale analyses that could aid in the identification of genes encoding potential new target antigens for vaccine development and drug design. The present study has led to targeting 32 proteins for further testing regarding their ability to induce protective immune responses against P. vivax malaria.

Measuring and testing for the systemically important financial institutions

This paper analyzes the measure of systemic importance ∆CoV aR proposed by Adrian and Brunnermeier (2009, 2010) within the context of a similar class of risk measures used in the risk management literature. In addition, we develop a series of testing procedures, based on ∆CoV aR, to identify and rank the systemically important institutions. We stress the importance of statistical testing in interpreting the measure of systemic importance. An empirical application illustrates the testing procedures, using equity data for three European banks.

Influence of agricultural management, sward structure and food resources on grassland field use by birds in lowland England.

Agricultural management of grassland in lowland Britain has changed fundamentally in the last 50 years, resulting in spatial and structural uniformity within the pastoral landscape. The full extent to which these changes may have reduced the suitability of grassland as foraging habitat for birds is unknown. This study investigated the mechanisms by which these changes have impacted on birds and their food supplies. We quantified field use by birds in summer and winter in two grassland areas of lowland England (Devon and Buckinghamshire) over 3 years, relating bird occurrence to the management, sward structure and seed and invertebrate food resources of individual fields. Management intensity was defined in terms of annual nitrogen input. There was no consistent effect of management intensity on total seed head production, although those of grasses generally increased with inputs while forbs were rare throughout. Relationships between management intensity and abundance of soil and epigeal invertebrates were complex. Soil beetle larvae were consistently lower in abundance, and surface-active beetle larvae counts consistently higher, in intensively managed fields. Foliar invertebrates showed more consistent negatively relationships with management intensity. Most bird species occurred at low densities. There were consistent relationships across regions and years between the occurrence of birds and measures of field management. In winter, there was a tendency towards higher occupancy of intensively managed fields by species feeding on soil invertebrates. In summer, there were few such relationships, although many species avoided fields with tall swards. Use of fields by birds was generally not related to measures of seed or invertebrate food abundance. While granivorous species were perhaps too rare to detect a relationship, in insectivores the strong negative relationships (in summer) with sward height suggested that access to food may be the critical factor. While it appears that intensification of grassland management has been deleterious to the summer food resources of insectivorous birds that use insects living within the grass sward, intensification may have been beneficial to several species in winter through the enhancement of soil invertebrates. Synthesis and applications. We suggest that attempts to restore habitat quality for birds in grassland landscapes need to create a range of management intensities and sward structures at the field and farm scales. A greater understanding of methods to enhance prey accessibility, as well as abundance, for insectivorous birds is required.

Factors influencing adoption of improved grassland management by small-scale dairy farmers in central Mexico and the implications for future research on smallholder adoption in developing countries

There have been limited recent advances in understanding of what influences uptake of innovations despite the current international focus on smallholder agriculture as a means of achieving food security and rural development. This paper provides a rigorous study of factors influencing adoption by smallholders in central Mexico and builds on findings to identify a broad approach to significantly improve research on and understanding of factors influencing adoption by smallholders in developing countries. Small-scale dairy systems play an important role in providing income, employment and nutrition in the highlands of central Mexico. A wide variety of practices and technologies have been promoted by the government public services to increase milk production and economic efficiency, but there have been very low levels of uptake of most innovations, with the exception of improving grassland through introduction of grass varieties together with management practices. A detailed study was conducted with 80 farmers who are already engaged with the use of this innovation to better understand the process of adoption and identify socioeconomic and farm variables, cognitive (beliefs), and social–psychological (social norms) factors associated with farmers' use of improved grassland. The Theory of Reasoned Action (TRA) was used as a theoretical framework and Spearman Rank Order correlation was conducted to analyse the data. Most farmers (92.5%) revealed strong intention to continue to use improved grassland (which requires active management and investment of resources) for the next 12 months; whereas 7.5% of farmers were undecided and showed weak intention, which was associated with farmers whose main income was from non-farm activities as well as with farmers who had only recently started using improved grassland. Despite farmers' experience of using improved grassland (mean of 18 years) farmers' intentions to continue to adopt it was influenced almost as much by salient referents (mainly male relatives) as by their own attitudes. The hitherto unnoticed longevity of the role social referents play in adoption decisions is an important finding and has implications for further research and for the design of extension approaches. The study demonstrates the value and importance of using TRA or TPB approaches to understand social cognitive (beliefs) and social–psychological (social norms) factors in the study of adoption. However, other factors influencing adoption processes need to be included to provide fuller understanding. An approach that would enable this, and the development of more generalisable findings than from location specific case studies, and contribute to broader conceptualisation, is proposed.

Legacy effects of grassland management on soil carbon to depth

The importance of managing land to optimise carbon sequestration for climate change mitigation is widely recognised, with grasslands being identified as having the potential to sequester additional carbon. However, most soil carbon inventories only consider surface soils, and most large scale surveys group ecosystems into broad habitats without considering management intensity. Consequently, little is known about the quantity of deep soil carbon and its sensitivity to management. From a nationwide survey of grassland soils to 1 m depth, we show that carbon in grasslands soils is vulnerable to management and that these management effects can be detected to considerable depth down the soil profile, albeit at decreasing significance with depth. Carbon concentrations in soil decreased as management intensity increased, but greatest soil carbon stocks (accounting for bulk density differences), were at intermediate levels of management. Our study also highlights the considerable amounts of carbon in sub-surface soil below 30cm, which is missed by standard carbon inventories. We estimate grassland soil carbon in Great Britain to be 2097 Tg C to a depth of 1 m, with ~60% of this carbon being below 30cm. Total stocks of soil carbon (t ha-1) to 1 m depth were 10.7% greater at intermediate relative to intensive management, which equates to 10.1 t ha-1 in surface soils (0-30 cm), and 13.7 t ha-1 in soils from 30-100 cm depth. Our findings highlight the existence of substantial carbon stocks at depth in grassland soils that are sensitive to management. This is of high relevance globally, given the extent of land cover and large stocks of carbon held in temperate managed grasslands. Our findings have implications for the future management of grasslands for carbon storage and climate mitigation, and for global carbon models which do not currently account for changes in soil carbon to depth with management.

Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care

Background: Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes. Objective: To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care. Methods: A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations. Results: Only to a small extent did nurses’ evoke patients’ reasons for change, stimulate collaboration, and support patients’ autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients’ communicationwasmainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation. Conclusion: The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking. Practice implications: To make patients more active, the nurses need more education and continuous training in motivational communication.