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Numerous studies show that women are less likely than men to express attitudes and opinions about politics. To explore the origins of this gender gap, we use data from a series of surveys of the general public and international relations scholars in the United States between 2014 and 2023. These data show that the gender gap in political expression exists, even among knowledge elites; female IR scholars say they don’t know the answer to survey questions at higher rates than their male colleagues. We also find that differences in political knowledge explain a significant part of the gap in political expression; the highly educated female scholars we surveyed were less likely than women in the general public to say they didn’t know the answer to survey questions. At the same time, factors other than knowledge, including confidence, also matter. Our public opinion survey shows that women select extreme answers, such as “strongly agree/disagree” rather than simply “agree/disagree,” at lower rates than men. Despite high levels of education among the female scholars we surveyed, they too are more hesitant than their male counterparts to select extreme answers. These findings have important implications for civic participation as well as for the recognition of women’s expertise within the academy and society more broadly.
Emergency department (ED) visits for epilepsy are common, costly, and often clinically unnecessary. Configuration of care pathways (CPs) that could divert people away from ED offer an alternative. The aim was to measure patient and carer preferences for alternative CPs and to explore the feasibility of implementing the preferred CPs in the National Health Service (NHS) England with a wider group of stakeholders.
Methods
Formative work (provider survey, service-user interviews, knowledge exchange, and think-aloud piloting) informed a discrete choice experiment (DCE) with six attributes: access to care plan, conveyance, time, epilepsy specialist today, general practitioner (GP) notification, and epilepsy specialist follow-up. This was hosted online with random assignment to two of three scenarios (home, public, or atypical). Logistic regression generated preference weights that were used to calculate the utility of CPs. The highest ranked CPs plus a status quo were discussed at three online knowledge exchange workshops. The nominal group technique was used to ascertain stakeholder views on preference evidence and to seek group consensus on optimal feasible alternatives.
Results
A sample of 427 people with epilepsy and 167 friends or family completed the survey. People with epilepsy preferred paramedics to have access to care plan, non-conveyance, one to three hours, epilepsy specialists today, GP notification, and specialist follow-up within two to three weeks. Family and friends differed when considering atypical seizures, favoring conveyance to urgent treatment centers and shorter time. Optimal configuration of services from service users’ perspectives outranked current practice. Knowledge exchange (n=27 participants) identified the optimal CP as feasible but identified two scenarios for resource reallocation: care plan substitutes specialist advice today and times of strain on NHS resources.
Conclusions
Preferences differed to current practice but had minimal variation by seizure type or stakeholder. This study clearly identified optimal and feasible alternative CPs. The mixed-methods approach allowed for robust measurement of preferences, whilst knowledge exchange examined feasibility to enhance implementation of optimal alternative CPs in the future.
Technology is central in supporting older people with their daily tasks and independence at home. This project aimed to identify technologies that can be built into residential environments (e.g., appliances, fixtures, or fittings) to support older people in activities of daily living (ADL) through a horizon scan (HS) informed by public insights on unmet needs and priorities.
Methods
A survey of members of the public was conducted to prioritize outcomes included within an evidence and gap map (EGM) framework. The EGM aimed to illustrate the current landscape of technologies supporting ADL in residential settings (e.g., care homes) and innovation gaps. The EGM results were shared with end users in a workshop discussion on the current range of technologies aimed at supporting ADL in residential settings. This was facilitated using vignettes to elicit views on unmet needs and priorities for technology development. The workshop informed the scope of the HS to identify and prioritize emerging technologies that could address unmet needs.
Results
This project successfully embedded public involvement throughout to identify innovation gaps in technologies supporting ADL, unmet needs among end users, and potential solutions to these needs. The HS identified 190 technologies that were ready to market. All the technologies had potential to address identified unmet needs and could be built into the residential environment to support older people with ADL and to improve their quality of life, independence, and safety at home. Horizon scanning research can meaningfully involve stakeholders and take direction from their insights to enable voices less often heard to drive innovation in areas where it is needed.
Conclusions
Involving stakeholders in research using evidence synthesis and qualitative methods helps to gain a better understanding of gaps in innovation, the related unmet needs, and the technologies that might address these needs. Public involvement in the survey and workshop influenced the conduct and interpretation of the EGM, the scope of the HS, and the interpretation of the findings.
Historical changes from shifting land use, the natural meandering of waterways, and the aftereffects of erosion complicate modern environments and obfuscate precontact landscapes. Although archaeologists can create stratified sampling models or employ systematic surveys, traditional field methodologies are often not suitable for site discovery, thereby limiting knowledge of ancient cultural landscapes. Many water systems in southern Louisiana, and in many parts of the world, have been covered or concealed in backswamps by natural geomorphological processes, development, or environmental degradation. Investigation standards that do not account for these changes will not be effective at identifying archaeological sites in such transformed landscapes. Discoveries made during ongoing archaeological research in Iberville Parish, Louisiana, provide examples of what can be missed and offer solutions through changes in archaeological field methods. This article advocates for a mixed-methodology approach, drawing from historical research and shallow geophysics to look at landforms and landscape changes. Strictly following state survey guidelines can muddle the archaeological record, particularly in places subject to significant landscape change from historical land-use alteration. By applying these approaches, we offer a way to reconstruct ancient landscapes and landforms that are culturally significant but often missed given the nature of modern environmental conditions.
SARS-CoV-2 superspreading occurs when transmission is highly efficient and/or an individual infects many others, contributing to rapid spread. To better quantify heterogeneity in SARS-CoV-2 transmission, particularly superspreading, we performed a systematic review of transmission events with data on secondary attack rates or contact tracing of individual index cases published before September 2021 prior to the emergence of variants of concern and widespread vaccination. We reviewed 592 distinct events and 9,883 index cases from 491 papers. A meta-analysis of secondary attack rates identified substantial heterogeneity across 12 chosen event types/settings, with the highest transmission (25–35%) in co-living situations including households, nursing homes, and other congregate housing. Among index cases, 67% reported zero secondary cases and only 3% (287) infected >5 secondary cases (“superspreaders”). Index case demographic data were limited, with only 55% of individuals reporting age, sex, symptoms, real-time polymerase chain reaction (PCR) cycle threshold values, or total contacts. With the data available, we identified a higher percentage of superspreaders among symptomatic individuals, individuals aged 49–64 years, and individuals with over 100 total contacts. Addressing gaps in the literature regarding transmission events and contact tracing is needed to properly explain the heterogeneity in transmission and facilitate control efforts for SARS-CoV-2 and other infections.
Background:Candida spp can cause a variety of infections known as candidiasis, ranging from severe invasive infections to superficial mucosal infections of the mouth and vagina. Fluconazole, a triazole antifungal, is commonly prescribed to treat candidiasis but increasing fluconazole resistance is a growing concern for several Candida spp. Although C. albicans has historically been the most common cause of candidiasis, other species are increasingly common and antifungal resistance is more prevalent in these non-albicans species, including C. glabrata, C. parapsilosis, and C. tropicalis, which were the focus of this analysis. Methods: We used the PINC AI healthcare data (PHD) database to examine fluconazole resistance for inpatient isolates between 2012 and 2021 from 187 US acute-care hospitals with at least 1 Candida spp culture with a fluconazole susceptibility result over the entire period. We calculated annual percentage fluconazole resistance for C. glabrata, C. tropicalis, and C. parapsilosis isolates using the clinical laboratory interpretation for resistance. Results: We identified 4,264 C. glabrata, 2,482 C. parapsilosis, and 2,283 C. tropicalis isolates between 2012 and 2021 with susceptibility results. The percentage of C. glabrata isolates resistant to fluconazole doubled between 2020 and 2021 (14.6% vs 29.3%) (Fig. 1a). The percentage of C. parapsilosis isolates resistant to fluconazole steadily increased since 2017 (Fig. 1b), with an 82% increase in 2021 compared with 2020 (3.8% in 2020 vs 6.9% in 2021). Fluconazole resistance among C. tropicalis isolates varied over the years, with a 0.3% decrease in 2021 from 2020 (Fig. 1c). Of hospitals reporting at least 1 result each year 2020–2021, 44% observed an increase in the proportion of C. glabrata isolates resistant to fluconazole in 2021 compared to 2020. Conclusions: Our analysis highlights a concerning increase in fluconazole resistance among C. glabrata and C. parapsilosis isolates in 2021 compared with previous years. Further investigation of the observed increases in fluconazole resistance among these Candida spp could provide further insight on potential drivers of resistance or limitations in reported results from large databases. More analyses are needed to understand rates, sites of Candida infections, and risk factors (eg, antifungal exposure) associated with resistance.
Substance use disorders are associated with significant physical health comorbidities, necessitating an integrated treatment response. However, service fragmentation can preclude the management of physical health problems during addiction treatment. (Osborne et al, 2022). Northeast England continues to have the highest morbidity /mortality with regards to substance use (ONS, 2022). Therefore, it is essential that staff in addiction health settings innovate to address physical health.
Methods
A review of the literature identified little research relating to physical health care in addiction and recovery settings. Our service protocol for blood testing was used to set the audit standards. The blood testing assessed electronic communication and electronic records. Physical health nurses take blood on request and email blood results to a medical/clinician inbox. The total sample was 1128 since pathway inception in March 2022.A sample size of 70 was selected via systematic sampling using n-15th person. Descriptive analyses of data followed by qualitative exploration with the physical health team was completed. The audit was registered locally.
Results
Of the sample size of 70 whose records were reviewed, we noted that blood tests were reviewed by medics (100%) with 98.6% of these reviews being within 6 hours of notification by the physical health team. Action plans were documented for blood results requests and communicated by email to physical health team (100%). 84.3% of the action plans were completed by physical health team on receipt of emails. Non completion of action plans in 15.7% of cases was related to client being hospitalised or disengaging from services (which might include relocation out of area or transfer into the criminal justice system).
Conclusion
Within our service, we have patients who struggle to attend conventional pathways e.g., GP. In view of the previously stated morbidity and mortality it is important that we are able to offer blood testing with timely follow up and action plans when appropriate to these patients.
Our service has good liaison with local services and bespoke partnerships to cater for the homeless amongst other subgroups. We used this audit to also improve processes and patient safety with plans for a re-audit. There was no previous nor national comparison for these data.
Frontal ablation, the combination of submarine melting and iceberg calving, changes the geometry of a glacier's terminus, influencing glacier dynamics, the fate of upwelling plumes and the distribution of submarine meltwater input into the ocean. Directly observing frontal ablation and terminus morphology below the waterline is difficult, however, limiting our understanding of these coupled ice–ocean processes. To investigate the evolution of a tidewater glacier's submarine terminus, we combine 3-D multibeam point clouds of the subsurface ice face at LeConte Glacier, Alaska, with concurrent observations of environmental conditions during three field campaigns between 2016 and 2018. We observe terminus morphology that was predominately overcut (52% in August 2016, 63% in May 2017 and 74% in September 2018), accompanied by high multibeam sonar-derived melt rates (4.84 m d−1 in 2016, 1.13 m d−1 in 2017 and 1.85 m d−1 in 2018). We find that periods of high subglacial discharge lead to localized undercut discharge outlets, but adjacent to these outlets the terminus maintains significantly overcut geometry, with an ice ramp that protrudes 75 m into the fjord in 2017 and 125 m in 2018. Our data challenge the assumption that tidewater glacier termini are largely undercut during periods of high submarine melting.
The COVID-19 pandemic triggered a large and immediate drop in employment among U.S. workers, along with major expansions of unemployment insurance (UI) and work from home. We use Current Population Survey and Social Security application data to study employment among older adults and their participation in disability and retirement insurance programs through the second year of the pandemic. We find ongoing improvements in employment outcomes among older workers in the labor force, along with sustained higher levels in the share no longer in the labor force during this period. Applications for Social Security disability benefits remain depressed, particularly for Supplemental Security Income. In models accounting for the expiration of expanded UI, we find some evidence that the loss of these additional financial supports resulted in an increase in disability claiming. Social Security retirement benefit claiming is approximately 3% higher during the second year of the pandemic.
Predeath grief conceptualizes complex feelings of loss experienced for someone who is still living and is linked to poor emotional well-being. The Road Less Travelled program aimed to help carers of people with rarer dementias identify and process predeath grief. This study evaluated the feasibility, acceptability, and preliminary effectiveness of this program.
Design:
Pre–post interventional mixed methods study.
Setting:
Online videoconference group program for carers across the UK held in 2021.
Participants:
Nine family carers of someone living with a rare form of dementia. Eight were female and one male (mean age 58) with two facilitators.
Intervention:
The Road Less Travelled is an online, facilitated, group-based program that aims to help carers of people with rarer dementias to explore and accept feelings of grief and loss. It involved six fortnightly 2-hour sessions.
Measurements:
We collected measures for a range of well-being outcomes at baseline (T1), post-intervention (T2), and 3 months post-intervention (T3). We conducted interviews with participants and facilitators at T2.
Results:
Participant attendance was 98% across all sessions. Findings from the semistructured interviews supported the acceptability of the program and identified improvements in carer well-being. Trends in the outcome measures suggested an improvement in quality of life and a reduction in depression.
Conclusion:
The program was feasible to conduct and acceptable to participants. Qualitative reports and high attendance suggest perceived benefits to carers, including increased acceptance of grief, and support the need for a larger-scale pilot study to determine effectiveness.
High-quality evidence from prospective longitudinal studies in humans is essential to testing hypotheses related to the developmental origins of health and disease. In this paper, the authors draw upon their own experiences leading birth cohorts with longitudinal follow-up into adulthood to describe specific challenges and lessons learned. Challenges are substantial and grow over time. Long-term funding is essential for study operations and critical to retaining study staff, who develop relationships with participants and hold important institutional knowledge and technical skill sets. To maintain contact, we recommend that cohorts apply multiple strategies for tracking and obtain as much high-quality contact information as possible before the child’s 18th birthday. To maximize engagement, we suggest that cohorts offer flexibility in visit timing, length, location, frequency, and type. Data collection may entail multiple modalities, even at a single collection timepoint, including measures that are self-reported, research-measured, and administrative with a mix of remote and in-person collection. Many topics highly relevant for adolescent and young adult health and well-being are considered to be private in nature, and their assessment requires sensitivity. To motivate ongoing participation, cohorts must work to understand participant barriers and motivators, share scientific findings, and provide appropriate compensation for participation. It is essential for cohorts to strive for broad representation including individuals from higher risk populations, not only among the participants but also the staff. Successful longitudinal follow-up of a study population ultimately requires flexibility, adaptability, appropriate incentives, and opportunities for feedback from participants.
One of the hallmarks of John Eekelaar’s extraordinary body of family law scholarship is its clarity. As a student of family law, many decades ago, I was a grateful beneficiary of John’s ability to explain extraordinarily clearly how the law worked, or why it did not work well enough. Also several years ago now, as a teacher of family law, John’s articles would always be at the top of any reading list. If I ever find an aspect of family law hard to understand, or baffling, John Eekelaar’s analysis can be relied upon to be illuminating and wise.
If ever there was a baffling question in family law, it is the relatively new one of what we mean by the word ‘mother’. According to the Oxford English Dictionary (OED), ‘mother’ is defined as:
The female parent of a human being; a woman in relation to a child or children to whom she has given birth; (also, in extended use) a woman who undertakes the responsibilities of a parent towards a child, esp. a stepmother.
]
In its ordinary language meaning, a mother is, therefore, a female parent, a woman who has given birth, and/or a woman who undertakes the responsibilities of a parent. The legal definition of motherhood is different. In obiter comments in The Ampthill Peerage, Lord Simon said that ‘[m]otherhood, although a legal relationship, is based on a fact, being proved demonstrably by parturition’. When a child is born as a result of fertility treatment, according to the Human Fertilisation and Embryology Act 2008, ‘[t]he woman who is carrying or has carried a child as a result of the placing in her of an embryo or of sperm and eggs, and no other woman, is to be treated as the mother of the child’. Following the High Court and Court of Appeal judgments in R (on the application of McConnell) v. Registrar General for England and Wales (McConnell ), it is clear that a child’s mother is the person who gave birth to her, even if that person is a man.
This chapter considers the legacy of the 1984 Warnock Report, and its continued impact on the regulation of assisted conception, embryo research and surrogacy in the UK. On the one hand, it is extraordinary that a regulatory system grounded in recommendations made only six years after the birth of the first ‘test tube baby’ has stood the test of time so well. The HFEA regulatory model – in which an ‘arm’s-length body’ issues licences, backed up by criminal sanctions, and in which primary legislation is supplemented by regularly updated codes of practice – has proved remarkably resilient, and has since been used to regulate other areas of medical practice. On the other hand, there may be disadvantages in trying to regulate a twenty-first-century industry using tools that were designed for a very different age. The chapter looks at two developments that the Warnock Report did not anticipate and hence did not make provision for in its recommendations: the emergence of a lucrative market in fertility services; and the increasing acceptance that fertility treatment should be available to would-be parents who do not conform with the ‘two-parent family, with both father and mother’ model.
In the UK, decisions taken on behalf of patients who lack capacity must be in their best interests, but the meaning of ‘best interests’ has evolved. The Mental Capacity Act 2005 codified the law relating to adults who lack capacity, offering a checklist of factors relevant to best interests assessment, including the person’s ‘past and present wishes and feelings’ and the ‘beliefs and values that would be likely to influence’ their decisions. Since 2013, the courts have gone further and, in some circumstances, seem to treat the patient’s wishes as the decisive factor. Now, a gap exists between what the statute says and its judicial interpretation. Doctors seeking guidance on how to weigh the patient’s own wishes when making a best interests decision will receive divergent advice from the legislation, guidance from the National Institute for Health and Care Excellence (NICE), and the law reports. This chapter suggests this discrepancy is unnecessarily confusing for health care professionals, patients and their families. If there is, or should be, a rebuttable presumption in favour of making the patient’s wishes decisive, the law would preferably state this clearly and unequivocally.
This chapter identifies international trends in end-of-life law reform from analysing ten case studies of reform from the United Kingdom, the United States, Canada, Australia, the Netherlands and Belgium. A key finding is that law reform is more likely to succeed when supported by ‘good process’. This includes effective consultation with key stakeholders and engaging with experts. Social science evidence is also increasingly influential in both legislative and judicial reform, particularly in relation to how assisted dying systems can operate safely in practice. Other factors contributing to reform are the support or advocacy of key individuals or groups, shifts in community sentiment, and changes in political composition of parliaments. The chapter also concludes that law reform is ultimately a political exercise. Compromise is often required for a law to pass. This has implications for designing effective end-of-life law, pointing to the need for critical evaluation of both proposed laws and how existing laws operate in practice. The chapter concludes with reflections about the future of end-of-life law.
To describe the perceived qualities of successful palliative care (PC) providers in the emergency department (ED), barriers and facilitators to ED–PC, and clinicians’ perspectives on the future of ED–PC.
Method
This qualitative study using semi-structured interviews was conducted in June–August 2020. Interviews were analyzed via a two-phase Rapid Analysis. The study's primary outcomes (innovations in ED–PC during COVID) are published elsewhere. In this secondary analysis, we examine interviewee responses to broader questions about ED–PC currently and in the future.
Results
PC providers perceived as successful in their work in the ED were described as autonomous, competent, flexible, fast, and fluent in ED language and culture. Barriers to ED–PC integration included the ED environment, lack of access to PC providers at all times, the ED perception of PC, and the lack of a supporting financial model. Facilitators to ED–PC integration included proactive identification of patients who would benefit from PC, ED-focused PC education and tools, PC presence in the ED, and data supporting ED–PC. Increased primary PC education for ED staff, increased automation, and innovative ED–PC models were seen as areas for future growth.
Significance of results
Our findings provide useful information for PC programs considering expanding their ED presence, particularly as this is the first study to our knowledge that examines traits of successful PC providers in the ED environment. Our findings also suggest that, despite growth in the arena of ED–PC, barriers and facilitators remain similar to those identified previously. Future research is needed to evaluate the impact that ED–PC initiatives may have on patient and system outcomes, to identify a financial model to maintain ED–PC integration, and to examine whether perceptions of successful providers align with objective measures of the same.
Reproductive medicine is not limited to the relatively simple practice of fertilising an egg in vitro, and then transferring one or two embryos to the woman’s uterus. Rather, there are now multiple additional interventions that are intended to improve the success rates of IVF. The combination of a poor evidence base, commercialisation and patients’ enthusiasm for anything that might improve their chance of success, results in a ‘perfect storm’ in which dubious and sometimes positively harmful treatments are routinely both under-researched and oversold. In this chapter, I will argue that, although giving patients information about the inadequacy of the evidence-base behind add-on treatments is important and necessary, this should not be regarded as a mechanism through which their inappropriate use can be controlled. Instead, it may be necessary for the Human Fertilisation and Embryology Authority to categorise non-evidence-based and potentially harmful treatments as ‘unsuitable’ practices’, which should not be provided at all, rather than as treatments that simply need to be accompanied by a health warning.
Diagnosis of CHD substantially affects parent mental health and family functioning, thereby influencing child neurodevelopmental and psychosocial outcomes. Recognition of the need to proactively support parent mental health and family functioning following cardiac diagnosis to promote psychosocial adaptation has increased substantially over recent years. However, significant gaps in knowledge remain and families continue to report critical unmet psychosocial needs. The Parent Mental Health and Family Functioning Working Group of the Cardiac Neurodevelopmental Outcome Collaborative was formed in 2018 through support from an R13 grant from the National Heart, Lung, and Blood Institute to identify significant knowledge gaps related to parent mental health and family functioning, as well as critical questions that must be answered to further knowledge, policy, care, and outcomes. Conceptually driven investigations are needed to identify parent mental health and family functioning factors with the strongest influence on child outcomes, to obtain a deeper understanding of the biomarkers associated with these factors, and to better understand how parent mental health and family functioning influence child outcomes over time. Investigations are also needed to develop, test, and implement sustainable models of mental health screening and assessment, as well as effective interventions to optimise parent mental health and family functioning to promote psychosocial adaptation. The critical questions and investigations outlined in this paper provide a roadmap for future research to close gaps in knowledge, improve care, and promote positive outcomes for families of children with CHD.