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Social entrepreneurship is presented by its supporters as an alternative to traditional charity, viewing those who would be beneficiaries on a charitable model as customers instead. In this essay, I explore the idea of social entrepreneurship as an alternative model for service-provision by thinking about the specific service of women’s refuges. I ask whether it would be possible to shift women’s refuges out of the government or charitable sectors and into the market. I also consider two speculative proposals for market-based provision.
The grief of relatives of patients who died of COVID-19 in an intensive care unit (ICU) has exacted an enormous toll worldwide.
Aims
To determine the prevalence of probable prolonged grief disorder (PGD) at 12 months post-loss and beyond. We also sought to examine circumstances of the death during the COVID-19 pandemic that might pose a heightened risk of PGD, and the associations between probable PGD diagnosis, quality of life and social disconnection.
Method
We conducted an observational, cross-sectional multicentre study of the next of kin of those who died of COVID-19 between March 2020 and December 2021. Participants were recruited from ICUs in South-East London. The Prolonged Grief Disorder Scale (PG-13-R), Quality-of-Life Scale (QOLS) and Oxford Grief-Social Disconnection Scale (OG-SD) were used.
Results
A total of 73 relatives were recruited and assessed, all of them over a year after their loss. Twenty-five (34.2%; 95% CI 23.1–45.4%) relatives of patients who died in the ICU met the criteria for PGD. Those who met the criteria had significantly worse quality of life (QOLS score mean difference 26; 95% CI 17–34; P < 0.001) and endorsed greater social disconnection (OG-SD score means difference 41; 95% CI 27–54; P < 0.001).
Conclusions
The findings suggest that rates of PGD are elevated among relatives of patients who died of COVID-19 in the ICU. This, coupled with worse quality of life and greater social disconnection experienced by those meeting the criteria, suggests the need to attend to the social deprivations and social dysfunctions of this population group.
This systematic review and meta-analysis will review randomized control trials for localized bladder cancer, evaluating surgical and pathologic outcomes of ORC versus RARC.
Methods:
Randomized studies evaluating adults with non-metastatic bladder cancer who underwent a radical cystectomy. Randomized trials were selected for final review. Data was extracted and analyzed with Revman 5 software. The primary outcome was complication rates within 90 days. Secondary outcomes included postoperative quality of life, estimated intraoperative blood loss, and other perioperative outcomes. Continuous variables were reported using mean difference with 95% confidence intervals, and dichotomous variables were reported using risk difference with 95% confidence intervals with RARC as the experimental group and ORC as the reference group.
Results:
Of 134 articles screened, six unique randomized studies were selected. For Grade I-II complications, the risk ratio (RR) was 0.92 (95% CI [0.79,1.08], p = 0.33), and for Grade III-V complications, RR 0.93 (95% CI [0.73,1.18], p = 0.59). RARC resulted in decreased blood loss (95% CI [−438.08, −158.44], p < 0.00001) and longer operative time (95% CI [55.23, 133.13], p < 0.00001). Quality of life using the EORTC-QLQ-30 global health score at 3 months post-op appeared to favor RARC with a mean difference of 4.46 points (95% CI [1.78, 7.15], p = 0.001). Pathologic outcomes neither statistically nor clinically favored one modality, as there was no significant difference between mean lymph node yield (p = 0.49), positive lymph nodes (p = 1.00), and positive surgical margins (p = 0.85) between the surgical modalities.
Conclusions:
Although one surgical modality is not overtly superior, the choice may be decided by mitigating individual operative risk factors like intraoperative blood loss, operative time, post-operative quality of life, as well as institutional costs and learning curve among surgeons.
Three North Carolina Medicaid surveys conducted from 2000 to 2012 reported increasing numbers of Hispanic children enrolled in Medicaid and much lower trust in providers expressed by their adult caregiver respondents compared with responses for non-Hispanic Black and White children. To verify and explain this apparent trust chasm, we used bivariate and regression analyses. The variables employed included trust (dependent variable); child’s race/ethnicity, age, and sex; satisfaction and health status scales; two utilization measures; respondent’s age, sex, and education; geographical region; and population density of county of residence. Race/ethnicity was strongly associated with trust (p < .001), controlling for other independent variables. Access, satisfaction, and respondent’s age and education were also significant. Our results fit the Behavioral Model for Vulnerable Populations, which maps the role of significant variables in health-seeking behavior. After analyzing the concept of trust, we argue that lower acculturation explains lower Hispanic trust compared with non-Hispanic Blacks. We suggest policies to improve acculturation.
The Park Hill estate in Sheffield was one of the most monumental and experimental projects in twentieth-century British housing. Designed by two young architects, Jack Lynn and Ivor Smith, it was constructed between 1957 and 1961 under the city’s Labour-led council, one of the country’s most visionary post-war local authorities. The estate has been celebrated for its ’streets in the sky’ design, an architectural approach associated with Alison and Peter Smithson which sought to salvage and recreate patterns of working-class community and social life from the slums that were razed during the rebuilding of Britain’s cities. This article deconstructs mythologies that have come to dominate narratives about Park Hill and its approach to community. It shows that the design of the estate did not recreate the pattern of nineteenth-century housing which formerly stood on the site, nor was it conceived to recreate the working-class community which had existed there. In doing so, this article reassesses the supposed political radicalism of the British welfare state in the early post-war period. While Park Hill has been acclaimed as architecturally innovative, its politics were not straightforwardly progressive. Like much post-war reconstruction, it sprang from a dialogue with older liberal frameworks of welfare delivery.
The Foundation Programme (Box 15.1) was instituted in 2005 and brought together the preregistration house officer grade and the first year of the senior house officer grade (UK Foundation Programme Office 2015). This created an integrated two-year programme, governed by a single curriculum produced by the Academy of Medical Royal Colleges (2016). The majority of students completing undergraduate medical training in the UK will enter the Foundation Programme directly after leaving medical school.
As the COVID-19 pandemic took hold in the USA in early 2020, it became clear that knowledge of the prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among asymptomatic individuals could inform public health policy decisions and provide insight into the impact of the infection on vulnerable populations. Two Clinical and Translational Science Award (CTSA) Hubs and the National Institutes of Health (NIH) set forth to conduct a national seroprevalence survey to assess the infection’s rate of spread. This partnership was able to quickly design and launch the project by leveraging established research capacities, prior experiences in large-scale, multisite studies and a highly skilled workforce of CTSA hubs and unique experimental capabilities at the NIH to conduct a diverse prospective, longitudinal observational cohort of 11,382 participants who provided biospecimens and participant-reported health and behavior data. The study was completed in 16 months and benefitted from transdisciplinary teamwork, information technology innovations, multimodal communication strategies, and scientific partnership for rigor in design and analytic methods. The lessons learned by the rapid implementation and dissemination of this national study is valuable in guiding future multisite projects as well as preparation for other public health emergencies and pandemics.
OBJECTIVES/GOALS: The primary goals of this study are 1) expand our understanding of the neural circuitry influenced by the neuropeptide Neuromedin U (NMU) via its receptor Neuromedin U Receptor 2 (NMUR2), and 2) provide alternative top-down mechanisms for how NMU regulates high fat food intake and cocaine taking. METHODS/STUDY POPULATION: Immunohistochemistry (IHC) for NMUR2 and cell markers was performed on rat brain tissue containing the medial prefrontal cortex (mPFC). To identify the source of the presynaptic NMUR2, anterograde tracing from the paraventricular nucleus or dorsal raphe nucleus to the mPFC utilizing an AAV2- dsRed-synaptobrevin fusion protein were performed (n=3) and will be followed by IHC. Using in vivo calcium imaging technology (InScopix nVista), neuronal activity (calcium transients) was recorded from the mPFC of two awake, freely behaving rats. Each animal underwent a single session of 30 minutes baseline activity, intraperitoneal NMU administration, and 30 minutes of post-treatment activity. Activity was then processed and recorded as distinct events using the InScopix data acquisition software. RESULTS/ANTICIPATED RESULTS: Medial prefrontal cortex staining for NMUR2 revealed a characteristic “beads on a string” motif, consistent with presynaptic receptor expression. Furthermore, we expect the anterograde tracing experiment will show colocalization of the dsRed-synaptobrevin fusion protein with NMUR2 on synaptic inputs into the medial prefrontal cortex. Following quantification of pre- and post- treatment events using the InScopix data acquisition software, total events during the pre- and post-treatment time periods were calculated. In these studies, both animals demonstrated a clear increase in calcium transient activity between pre- and post- treatment evaluations, suggesting that NMU administration increases the neuronal activity of neurons in the prefrontal cortex. DISCUSSION/SIGNIFICANCE: This research provides a new site of action for the known therapeutic effects of NMU. We demonstrate the presence of presynaptic NMUR2 in the mPFC and show that systemic administration of NMU increases mPFC neuronal activity. This illustrates NMU may act as a top-down mediator for substance use disorders and binge eating behaviors.
The COVID-19 pandemic has highlighted the impact work can have on healthcare workers and the importance of staff support services. Rapid guidance was published to encourage preventive and responsive support for healthcare workers.
Aims
To understand mental healthcare staff's help-seeking behaviours and access to support at work in response to the COVID-19 pandemic, to inform iterative improvements to provision of staff support.
Method
We conducted a formative appraisal of access to support and support needs of staff in a National Health Service mental health trust. This involved 11 semi-structured individual interviews using a topic guide. Five virtual staff forums were additional sources of data. Reflexive thematic analysis was used to identify key themes.
Results
Peer-based, within-team support was highly valued and sought after. However, access to support was negatively affected by work pressures, physical distancing and perceived cultural barriers.
Conclusions
Healthcare organisations need to help colleagues to support each other by facilitating open, diverse workplace cultures and providing easily accessible, safe and reflective spaces. Future research should evaluate support in the evolving work contexts imposed by COVID-19 to inform interventions that account for differences across healthcare workforces.
Chukchansi belongs to the Yokuts language family (ISO 639 code: yok) ancestrally spoken in the San Joaquin valley of Central California and in the adjacent foothills of the Sierra Nevada. The headquarters of the Chukchansi tribe is located in Coarsegold and many members of the tribe live in and around Madera and Fresno counties. As shown in the map in Figure 1, there are three major territories of the Yokuts: Northern Valley Yokuts, Foothill Yokuts, and Southern Valley Yokuts. While the territory of the Chukchansi is in the foothills area, the dialect is linguistically Northern Valley (Whistler & Golla 1986), as shown in Figure 2. Yawelmani, a Yokuts language that has been a subject of extensive linguistic research (e.g. Newman 1944, Archangeli 1983, Weigel 2005), is a dialect of the Southern Valley Yokuts. It is unclear to what extent Yokuts varieties are mutually intelligible. Yokuts is often considered to be a part of a larger Penutian language family (e.g. Dixon & Kroeber 1913, Sapir 1921, DeLancey & Golla 1997). While the status of Penutian as a macro-family is disputed, Yokuts is very likely related to the Miwok and Costanoan language families of California (Callaghan 1997).
When a liberal-democratic state signs a treaty or wages a war, does its whole polity do those things? In this article, we approach this question via the recent social ontological literature on collective agency. We provide arguments that it does and that it does not. The arguments are presented via three considerations: the polity's control over what the state does; the polity's unity; and the influence of individual polity members. We suggest that the answer to our question differs for different liberal-democratic states and depends on two underlying considerations: (1) the amount of discretion held by the state's officeholders; (2) the extent to which the democratic procedure is deliberative rather than aggregative.
In this chapter, the authors trace out the “natural history” of an intensely collaborative multisited comparison, which was distinct from many other comparative research projects because research at each site was carried out by a PhD-level anthropologist who was involved in the scientific development of the project rather than only in the implementation of a centrally directed project. It draws on their experiences with this once-in-a-lifetime opportunity, a large, US National Institutes of Health–funded multisite project, to discuss ways in which that comparative research could have been even more powerful, things that future comparative research should strive to avoid, recommended best practices, and what the authors would call “minimum adequate” approaches to comparative ethnography.
Individuals have various kinds of obligations: keep promises, don’t cause harm, return benefits received from injustices, be partial to loved ones, help the needy and so on. How does this work for group agents? There are two questions here. The first is whether groups can bear the same kinds of obligations as individuals. The second is whether groups’ pro tanto obligations plug into what they all-things-considered ought to do to the same degree that individuals’ pro tanto obligations plug into what they all-things-considered ought to do. We argue for parity on both counts.
The northern lobe of the White River Ash (WRAn) is part of a bilobate distribution of tephras that originated from the Wrangell Volcanic Field near the border of Alaska, USA, and Yukon, Canada. It is distributed across northeastern Alaska and the northwestern portion of the Yukon. The timing of this eruption has seen little critical analysis relative to the younger and more extensive eastern lobe eruption of the White River Ash. We compiled 38 radiocarbon (14C) dates from above and below the WRAn, and employed several statistical approaches to identify and eliminate or down-weight outliers, combine dates, and different Bayesian models, to provide a revised age estimate for the timing of the WRAn tephra deposition. Our results indicate that the most accurate modeled age estimate for the northern lobe of the White River Ash deposition is between 1689 and 1560 cal BP, with a mean and median of 1625 and 1623 cal BP, respectively. This age range is 90 to 200 years younger than previous age estimates.
Clostridioides difficile infection (CDI) remains a significant public health concern, resulting in excess morbidity, mortality, and costs. Additional insight into the burden of CDI in adults aged <65 years is needed.
Design/Setting:
A 6-year retrospective cohort study was conducted using data extracted from United States Veterans Health Administration electronic medical records.
Patients/Methods:
Patients aged 18–64 years on January 1, 2011, were followed until incident CDI, death, loss-to-follow-up, or December 31, 2016. CDI was identified by a diagnosis code accompanied by metronidazole, vancomycin, or fidaxomicin therapy, or positive laboratory test. The clinical setting of CDI onset was defined according to 2017 SHEA-IDSA guidelines.
Results:
Of 1,073,900 patients, 10,534 had a CDI during follow-up. The overall incidence rate was 177 CDIs per 100,000 person years, rising steadily from 164 per 100,000 person years in 2011 to 189 per 100,000 person years in 2016. Those with a CDI were slightly older (55 vs 51 years) and sicker, with a higher baseline Charlson comorbidity index score (1.4 vs 0.5) than those without an infection. Nearly half (48%) of all incident CDIs were community associated, and this proportion rose from 41% in 2011 to 56% in 2016.
Conclusions:
The findings from this large retrospective study indicate that CDI incidence, driven primarily by increasing community-associated infection, is rising among young and middle-aged adult Veterans with high service-related disability. The increasing burden of community associated CDI in this vulnerable population warrants attention. Future studies quantifying the economic and societal burden of CDI will inform decisions surrounding prevention strategies.
The purpose of this study was to examine whether vehicle type based on size (car vs. other = truck/van/SUV) had an impact on the speeding, acceleration, and braking patterns of older male and female drivers (70 years and older) from a Canadian longitudinal study. The primary hypothesis was that older adults driving larger vehicles (e.g., trucks, SUVs, or vans) would be more likely to speed than those driving cars. Participants (n = 493) had a device installed in their vehicles that recorded their everyday driving. The findings suggest that the type of vehicle driven had little or no impact on per cent of time speeding or on the braking and accelerating patterns of older drivers. Given that the propensity for exceeding the speed limit was high among these older drivers, regardless of vehicle type, future research should examine what effect this behaviour has on older-driver road safety.
In his article “Carbon Emissions, Stratospheric Aerosol Injection, and Unintended Harms,” Christopher J. Preston compares the culpability of carbon emitters versus that of geoengineers deploying stratospheric aerosol injection (SAI). This comparison relies on a parallel between carbon emitters and SAI deployers that requires both to be agents. However, both are not. While the harms of geoengineering will be caused by culpable agents acting intentionally, the harms connected to climate change emerge out of the uncoordinated actions of billions of people. Taken as a large group, carbon emitters cause harm but do not constitute an agent. Taken individually, carbon emitters are agents but do not cause the harms of climate change. As a result, the parallel collapses, and Preston's “surprising” conclusion is one that he is not entitled to reach.