Introduction: Shared decision-making is considered to be a key aspect of woman-centered care and a strategy to improve communication, respect, and satisfaction. This scoping review identified studies that used a shared decision-making support strategy as the primary intervention in the context of perinatal care. Methods: A literature search of PubMed, CINAHL, Cochrane Library, PsycINFO, and SCOPUS databases was completed for English-language studies conducted from January 2000 through November 2019 that examined the impact of a shared decision-making support strategy on a perinatal decision (such as choice of mode of birth after prior cesarean birth). Studies that only examined the use of a decision aid were excluded. Nine studies met inclusion criteria and were examined for the nature of the shared decision-making intervention as well as outcome measures such as decisional evaluation, including decisional conflict, decisional regret, and certainty. Results: The 9 included studies were heterogeneous with regard to shared decision-making interventions and measured outcomes and were performed in different countries and in a variety of perinatal situations, such as women facing the choice of mode of birth after prior cesarean birth. The impact of a shared decision-making intervention on women’s perception of shared decision-making and on their experiences of the decision-making process were mixed. There may be a decrease in decisional conflict and regret related to feeling informed, but no change in decisional certainty. Discussion: Despite the call to increase the use of shared decision-making in perinatal care, there are few studies that have examined the effects of a shared decision-making support strategy. Further studies that include antepartum and intrapartum settings, which include common perinatal decisions such as induction of labor, are needed. In addition, clear guidance and strategies for successfully integrating shared decision-making and practice recommendations would help women and health care providers navigate these complex decisions.
Manure application can spread antimicrobial resistance (AMR) from manure to soil and surface water. This study evaluated the role of the soil texture on the dynamics of antimicrobial resistance genes (ARGs) in soils and surrounding surface waters. Six dairy farms with distinct soil textures (clay, sand, and peat) were sampled at different time points after the application of manure, and three representative ARGs sul1, erm(B), and tet(W) were quantified with qPCR. Manuring initially increased levels of erm(B) by 1.5 ± 0.5 log copies/kg of soil and tet(W) by 0.8 ± 0.4 log copies/kg across soil textures, after which levels gradually declined. In surface waters from clay environments, regardless of the ARG, the gene levels initially increased by 2.6 ± 1.6 log copies/L, after which levels gradually declined. The gene decay in soils was strongly dependent on the type of ARG (erm(B) < tet(W) < sul1; half-lives of 7, 11, and 75 days, respectively), while in water, the decay was primarily dependent on the soil texture adjacent to the sampled surface water (clay < peat < sand; half-lives of 2, 6, and 10 days, respectively). Finally, recovery of ARG levels was predicted after 29–42 days. The results thus showed that there was not a complete restoration of ARGs in soils between rounds of manure application. In conclusion, this study demonstrates that rather than showing similar dynamics of decay, factors such as the type of ARG and soil texture drive the ARG persistence in the environment.
MULTIFILE
n the work package described in this report, members are investigating whether a cooperative of farmers can become self-sufficient in energy and fertilization by using manure and organic waste flows in combination with anaerobic fermentation. The aim is to link the nutrient cycle (from manure to digestate to green fertilizer consisting of, for example, nitrate, phosphate, potassium, and trace elements) to a self-sufficient energy system, by the combined production of electricity, green gas, green fuels, and green fertilizers. Within this research such a system is called a circular multi commodity system (CMCS). In effect linking, the nutrient cycle with an energy production chain. In addition, other energy sources and sinks can also play a role in the system such as wind, solar PV and storage (e.g. batteries or hydrogen). For this symbiosis of production techniques to succeed in practice, intensive cooperation between arable farmers and dairy farmers is needed. Farmers supply part of the input from the biofermenter and receive green fertilizers at the end of the process, which are used as a substitute for fertilizer. The case is based on a cooperative of farmers with a minimal geographical spread and maximum diversity in type of business. In this way, the current waste and nutrient chain is being replaced by a more sustainable and closed cycle. This could provide significant environmental benefits: reduction of the environmental impact through the use of fertilizer, reduction of dependence on fossil raw materials, and reduction of CO2 emissions.
