title: Usability and feasibility of PreventS-MD webapp for stroke prevention.

authors: Feigin, Valery L.

subjects: Epidemiology

abstract: BACKGROUND: Most strokes and cardiovascular diseases (CVDs) are potentially preventable if their risk factors are identified and well controlled. Digital platforms, such as the PreventS-MD webapp (PreventS-MD) may aid health care professionals (HCPs) in assessing and managing risk factors and promoting lifestyle changes for their patients. 
METHODS: This is a mixed methods cross-sectional 2-phase survey using a largely positivist (quantitative and qualitative) framework. During phase 1, a prototype of PreventS-MD was tested internationally by 59 of 69 consenting HCPs of different backgrounds, age, sex, working experience and specialities using hypothetical data. Collected comments/suggestions from the study HCPs in phase 1 were reviewed and implemented. In phase 2, a near-final version of PreventS-MD was developed and tested by 58 of 72 consenting HCPs using both hypothetical and real patient (n=10) data. Qualitative semi-structured interviews with real patients (n=10) were conducted, and 1-month adherence to the preventative recommendations was assessed by self-reporting. The four System Usability Scale (SUS) groups of scores (0-50 unacceptable; 51-68 poor, 68-80.3 good; >80.3 excellent) were used to determine usability of PreventS-MD. 
FINDINGS: 99 HCPs from 27 countries (45% from low- to middle-income countries) participated in the study, out of whom 10 HCPs were involved in the development of PreventS before the study, and therefore were not involved in the survey. Of the remaining 89 HCPs 69 consented to the first phase of the survey, out of whom 59 completed the first phase of the survey (response rate 86%) and 58 HCPs completed the second phase of the survey (response rate 84%). The SUS scores supported good usability of the prototype (mean score=80.2; 95% CI [77.0-84.0]) and excellent usability of the final version of PreventS-MD (mean score=81.7; 95%CI [79.1-84.3]) in the field. Scores were not affected by the age, sex, working experience or speciality of the HCPs. One month follow-up of the patients confirmed the high level of satisfaction/acceptability of PreventS-MD and (100%) adherence to the recommendations. 
INTERPRETATION: The PreventS-MD webapp has a high level of usability, feasibility and satisfaction by HCPs and individuals at risk of stroke/CVD. Individuals at risk of stroke/CVD demonstrated a high level of confidence and motivation in following and adhering to preventative recommendations generated by PreventS-MD.

text: Usability and feasibility of PreventS-MD webapp for stroke prevention. BACKGROUND: Most strokes and cardiovascular diseases (CVDs) are potentially preventable if their risk factors are identified and well controlled. Digital platforms, such as the PreventS-MD webapp (PreventS-MD) may aid health care professionals (HCPs) in assessing and managing risk factors and promoting lifestyle changes for their patients. 
METHODS: This is a mixed methods cross-sectional 2-phase survey using a largely positivist (quantitative and qualitative) framework. During phase 1, a prototype of PreventS-MD was tested internationally by 59 of 69 consenting HCPs of different backgrounds, age, sex, working experience and specialities using hypothetical data. Collected comments/suggestions from the study HCPs in phase 1 were reviewed and implemented. In phase 2, a near-final version of PreventS-MD was developed and tested by 58 of 72 consenting HCPs using both hypothetical and real patient (n=10) data. Qualitative semi-structured interviews with real patients (n=10) were conducted, and 1-month adherence to the preventative recommendations was assessed by self-reporting. The four System Usability Scale (SUS) groups of scores (0-50 unacceptable; 51-68 poor, 68-80.3 good; >80.3 excellent) were used to determine usability of PreventS-MD. 
FINDINGS: 99 HCPs from 27 countries (45% from low- to middle-income countries) participated in the study, out of whom 10 HCPs were involved in the development of PreventS before the study, and therefore were not involved in the survey. Of the remaining 89 HCPs 69 consented to the first phase of the survey, out of whom 59 completed the first phase of the survey (response rate 86%) and 58 HCPs completed the second phase of the survey (response rate 84%). The SUS scores supported good usability of the prototype (mean score=80.2; 95% CI [77.0-84.0]) and excellent usability of the final version of PreventS-MD (mean score=81.7; 95%CI [79.1-84.3]) in the field. Scores were not affected by the age, sex, working experience or speciality of the HCPs. One month follow-up of the patients confirmed the high level of satisfaction/acceptability of PreventS-MD and (100%) adherence to the recommendations. 
INTERPRETATION: The PreventS-MD webapp has a high level of usability, feasibility and satisfaction by HCPs and individuals at risk of stroke/CVD. Individuals at risk of stroke/CVD demonstrated a high level of confidence and motivation in following and adhering to preventative recommendations generated by PreventS-MD.

year: 2023-07-24

title: Trends in soil carbon and nutrients of hill-country pastures receiving different phosphorus fertilizer loadings for 20 years

authors: Schipper, Louis A.

subjects: soil carbon

abstract: There are few records of long-term trends in soil C and N in grazed pasture systems but recent measurements have demonstrated unexplained losses on New Zealand lowlands. To determine whether losses were also occurring in hill country pastures, we analyzed archived soil samples collected between 1983 and 2006 from two slope classes (steep and easy) at the Whatawhata Research Centre. Soils were Ultic Hapludand and Typic Haplohumult on the easy slopes (10–20°), and Typic Haplohumult on the steeper slopes (30–40°). Soil samples (0–75 mm) had been collected from paddocks that were fertilized with six different loading rates of P (ranging from 0 to 100 kg P ha⁻¹ year⁻¹ since 1985). This range of P loadings allowed us to determine whether P inputs would regulate trends in soil C and N. While there were significant temporal trends in C and N (P < 0.05), these were not unidirectional and trends were not dependent on P loading rate. On average, soil C initially increased during the first 6 years of the trial at 0.270% C year⁻¹ (1.56 t ha⁻¹ year⁻¹) and 0.156% C year⁻¹ (1.06 t ha⁻¹ year⁻¹) on easy and steep slopes, respectively. Subsequently, there was no significant trend in soil C on the easy slopes but soil C declined at −0.066% year⁻¹ (0.45 t ha⁻¹ year⁻¹) on the steep slopes. Similarly, soil N increased between 1983 and 1989 at 0.025% N year⁻¹ (144 kg ha⁻¹ year⁻¹) and 0.012% N year⁻¹ (82 kg ha⁻¹ year⁻¹) on easy and steep slopes, respectively. Post-1989, small but significant losses of total N were measured on the steep slopes of 0.004% year⁻¹ (27 kg N ha⁻¹ year⁻¹) (P < 0.05) with no trend on the easy slopes. Two potential causal factors for these decadal-scale patterns were identified, operating via changes in primary productivity. These were lower S inputs from 1989 due to a change in fertilizer type, and a series of relatively dry summers during the 1990s. These significant inter-annual trends in soil C and N complicate attempts to measure long-term changes in soil organic matter associated with land use change and management practices. This study has demonstrated the potential error associated with infrequent soil sampling to determine long-term trends in soil C and N; large gains or losses could have been detected at Whatawhata depending on when sampling started and finished. Understanding these long-term trends in soil organic matter dynamics and driving factors requires more long-term sampling trials.

text: Trends in soil carbon and nutrients of hill-country pastures receiving different phosphorus fertilizer loadings for 20 years There are few records of long-term trends in soil C and N in grazed pasture systems but recent measurements have demonstrated unexplained losses on New Zealand lowlands. To determine whether losses were also occurring in hill country pastures, we analyzed archived soil samples collected between 1983 and 2006 from two slope classes (steep and easy) at the Whatawhata Research Centre. Soils were Ultic Hapludand and Typic Haplohumult on the easy slopes (10–20°), and Typic Haplohumult on the steeper slopes (30–40°). Soil samples (0–75 mm) had been collected from paddocks that were fertilized with six different loading rates of P (ranging from 0 to 100 kg P ha⁻¹ year⁻¹ since 1985). This range of P loadings allowed us to determine whether P inputs would regulate trends in soil C and N. While there were significant temporal trends in C and N (P < 0.05), these were not unidirectional and trends were not dependent on P loading rate. On average, soil C initially increased during the first 6 years of the trial at 0.270% C year⁻¹ (1.56 t ha⁻¹ year⁻¹) and 0.156% C year⁻¹ (1.06 t ha⁻¹ year⁻¹) on easy and steep slopes, respectively. Subsequently, there was no significant trend in soil C on the easy slopes but soil C declined at −0.066% year⁻¹ (0.45 t ha⁻¹ year⁻¹) on the steep slopes. Similarly, soil N increased between 1983 and 1989 at 0.025% N year⁻¹ (144 kg ha⁻¹ year⁻¹) and 0.012% N year⁻¹ (82 kg ha⁻¹ year⁻¹) on easy and steep slopes, respectively. Post-1989, small but significant losses of total N were measured on the steep slopes of 0.004% year⁻¹ (27 kg N ha⁻¹ year⁻¹) (P < 0.05) with no trend on the easy slopes. Two potential causal factors for these decadal-scale patterns were identified, operating via changes in primary productivity. These were lower S inputs from 1989 due to a change in fertilizer type, and a series of relatively dry summers during the 1990s. These significant inter-annual trends in soil C and N complicate attempts to measure long-term changes in soil organic matter associated with land use change and management practices. This study has demonstrated the potential error associated with infrequent soil sampling to determine long-term trends in soil C and N; large gains or losses could have been detected at Whatawhata depending on when sampling started and finished. Understanding these long-term trends in soil organic matter dynamics and driving factors requires more long-term sampling trials.

year: 2010

title: Haumanu Hauora: refining public health institution policy to include Māori and climate change

authors: Masters-Awatere, Bridgette

abstract: The deepening climate crisis generates specific impacts that will exacerbate the already disproportionately negative health outcomes experienced by Indigenous people. Disparate health outcomes have not spontaneously emerged, but rather have been foreshadowed by existing inequities. This article summarizes a sample of the work from a two-year research project in Aotearoa New Zealand to understand existing policy processes and ascertain the extent to which health institutions give serious consideration to climate change impacts on Māori (Indigenous people) with health vulnerabilities. Speaking to tāngata whenua (Indigenous Māori), District Health Board (DHB) employees, and subject matter experts (SMEs), it was clear that policy processes were ad hoc and problematically silenced consistent Māori input. While research participants expressed their experiences of, and aspirations for, dealing with climate change, their voices were not evident in DHB policy development processes. The deficit within existing policy process reflects a lack of preparedness in the face of climate change. Despite clear resilience and adaptation strategies, structural change is needed to address identified disadvantages. Through a co-designed policy framework (“Haumanu Hauora”), we guide policy formation to mitigate climate change risk to Māori (and others). Central to the revised policy framework is the creation of space for both internal and external Māori voices to ensure consistent Māori input throughout the policy process. We also introduce a commissioning, refining, and monitoring stage (that includes evaluation). Haumanu Hauora considers whānau-centered healthcare knowledge, needs, resources, and aspirations, to contribute to a transformed and responsive health system. Above all, we believe that strengthening health institution responsiveness to Māori health needs is essential.

text: Haumanu Hauora: refining public health institution policy to include Māori and climate change The deepening climate crisis generates specific impacts that will exacerbate the already disproportionately negative health outcomes experienced by Indigenous people. Disparate health outcomes have not spontaneously emerged, but rather have been foreshadowed by existing inequities. This article summarizes a sample of the work from a two-year research project in Aotearoa New Zealand to understand existing policy processes and ascertain the extent to which health institutions give serious consideration to climate change impacts on Māori (Indigenous people) with health vulnerabilities. Speaking to tāngata whenua (Indigenous Māori), District Health Board (DHB) employees, and subject matter experts (SMEs), it was clear that policy processes were ad hoc and problematically silenced consistent Māori input. While research participants expressed their experiences of, and aspirations for, dealing with climate change, their voices were not evident in DHB policy development processes. The deficit within existing policy process reflects a lack of preparedness in the face of climate change. Despite clear resilience and adaptation strategies, structural change is needed to address identified disadvantages. Through a co-designed policy framework (“Haumanu Hauora”), we guide policy formation to mitigate climate change risk to Māori (and others). Central to the revised policy framework is the creation of space for both internal and external Māori voices to ensure consistent Māori input throughout the policy process. We also introduce a commissioning, refining, and monitoring stage (that includes evaluation). Haumanu Hauora considers whānau-centered healthcare knowledge, needs, resources, and aspirations, to contribute to a transformed and responsive health system. Above all, we believe that strengthening health institution responsiveness to Māori health needs is essential.

year: 2023-05-05