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Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Traditional clinical training has often lacked the leadership and management skills necessary for practitioners to effectively drive change. Despite facing systemic pressures and resource limitations, clinicians can be agents of change by innovating within their work environments. Practising self-care and understanding the benefits of Lifestyle Medicine are essential for healthcare practitioners to sustain their wellbeing and energy for these changes. The transformation of healthcare environments to encourage healthier choices can profoundly affect the wellbeing of both staff and patients. Large-scale change can be fostered by engaging with the community and connecting patients to local groups and activities. The UK has seen examples of successful Lifestyle Medicine projects and we explore some examples of success in this chapter. To innovate in healthcare, one must be clear about their motivation, be prepared to initiate projects without initial funding, plan for their evaluation, and ensure that the projects are enjoyable for all participants involved.
Coronavirus disease-2019 precipitated the rapid deployment of novel therapeutics, which led to operational and logistical challenges for healthcare organizations. Four health systems participated in a qualitative study to abstract lessons learned, challenges, and promising practices from implementing neutralizing monoclonal antibody (nMAb) treatment programs. Lessons are summarized under three themes that serve as critical building blocks for health systems to rapidly deploy novel therapeutics during a pandemic: (1) clinical workflows, (2) data infrastructure and platforms, and (3) governance and policy. Health systems must be sufficiently agile to quickly scale programs and resources in times of uncertainty. Real-time monitoring of programs, policies, and processes can help support better planning and improve program effectiveness. The lessons and promising practices shared in this study can be applied by health systems for distribution of novel therapeutics beyond nMAbs and toward future pandemics and public health emergencies.
Giant coronary artery aneurysms and myocardial fibrosis after Kawasaki disease may lead to devastating cardiovascular outcomes. We characterised the vascular and myocardial outcomes in five selected Kawasaki disease patients with a history of giant coronary artery aneurysms that completely regressed.
Methods:
Five patients were selected who had giant coronary artery aneurysm in early childhood that regressed when studied 12–33 years after Kawasaki disease onset. Coronary arteries were imaged by coronary CT angiography, and coronary artery calcium volume scores were determined. We used endocardial strain measurements from CT imaging to assess myocardial regional wall function. Calprotectin and galectin-3 (gal-3) as biomarkers of inflammation and myocardial fibrosis were measured by enzyme-linked immunosorbent assay.
Results:
The five selected patients with regressed giant coronary artery aneurysms had calcium scores of zero, normal levels of calprotectin and gal-3, and normal appearance of the coronary arteries by coronary computed tomography angiography. CT strain demonstrated normal peak systolic and diastolic strain patterns in four of five patients. In one patient with a myocardial infarction at the time of Kawasaki disease diagnosis at the age of 10 months, CT strain showed altered global longitudinal strain, reduced segmental peak strain, and reduced diastolic relaxation patterns in multiple left ventricle segments.
Conclusions:
These patients illustrate that regression of giant aneurysms after Kawasaki disease is possible with no detectable calcium, normal biomarkers of inflammation and fibrosis, and normal myocardial function. Individuals with regressed giant coronary artery aneurysm still require longitudinal surveillance to assess the durability of this favourable outcome.
Given the importance of angiostrongyliasis as an emerging infectious disease of humans, companion animals, and wildlife, the current study focused on the transmission dynamics of first- and third-stage larvae of the parasitic nematode, Angiostrongylus cantonensis. The migration of infective larvae and their subsequent distribution within the Lymnaeidae snail, Bullastra lessoni, were investigated over time using microscopic examination of histological sections and fresh tissue. Snails were divided into four anatomical regions: (i) anterior and (ii) posterior cephalopedal masses, (iii) mantle skirt and (iv) visceral mass. The viability of free-swimming third-stage larvae, after their release from snail tissues, was evaluated in vitro by propidium iodide staining and infectivity by in vivo infection of Wistar rats. Snails were sequentially dissected over time to assess the number and anatomical distribution of larvae within each snail and hence infer their migration pathway. Herein, ongoing larval migratory activity was detected over 28 days post-infection. A comparison of infection rates and the larval distribution within the four designated snail regions demonstrated a significant relationship between anatomical region and density of infective larvae, with larvae mostly distributed in the anterior cephalopedal mass (43.6 ± 10.8%) and the mantle skirt (33.0 ± 8.8%). Propidium iodide staining showed that free-swimming third-stage larvae retained viability for between 4 and 8 weeks when stored under laboratory conditions. In contrast to viability, larval infectivity in rats remained for up to 2 weeks only. Knowledge gained from the current work could provide information on the development of new approaches to controlling the transmission of this parasite.
Emerging research is now demonstrating that zoos are not hedonic venues for personal fulfillment, but fulfill a more eudaimonic value of self-actualization that exemplifies the personal expressiveness, vitality, and direction zoo users seek as members of a larger community pursuing social change to protect wildlife and natural systems. In Chapter 11, we explore the issue of collective identity theory in the context of zoo experiences, suggesting that zoos have a much more direct value as catalysts for social change than has been reported in the peer-reviewed literature to date. Here, we focus in a fresh way on the zoo movement itself, exploring how complementary and collective work across the sector can produce society-level change – a far departure from the idea of inspiring an individual, through a single zoo visit, to individual-level action that might hopefully add up to something meaningful, at some point. We describe, for example, how a community of practice working across a distributed network of zoos, aquariums, and nature centers has been equipped to deliver coordinated, context-relevant conservation education and messaging to advance a conservation ethic and spark action among potential allies.
Chapter 1 provides context for the central themes of the book, highlighting the challenges and importance of the collective conservation education mission shared by accredited zoos worldwide and situating the zoo as a unique setting for learning and potential vector of social change. We also outline the rationale for our endeavor to reconcile recent findings from various domains of social science research with zoos’ conservation mission in the context of their value to the diverse public audiences and communities they serve, pointing to opportunities for the development of new questions, approaches, and measurements of mission success that might help zoos better leverage their human and facility capacities to achieve mission-related outcomes that are valued by the public.
This chapter explores conditions that appear to support the emergence of conservation values and identities that take the form of action, looking at current understandings of human behavior and what is known about zoos’ institutional power and capacities. Returning to the relevance and impact of the zoo as a museum with conservation mission goals, we explore theories and evidence relevant to the potential of zoos as activation entities able to shift zoogoers from the process of individual-level conservation values identity work to the active (and hopefully ongoing) pursuit of a conservation agenda.
Chapter 2 delves more deeply into the recent evolution of zoos and aquariums in the conservation movement, referring to how the history of animal research impacts decision-making in zoos and highlighting conservation biology and conservation psychology as frameworks that emerged in part from conservation agendas in the zoo industry. While the default education programming and evaluation tools in most zoos continue to be based on an information transfer model of learning, here we introduce research situating the social purpose and role of the zoo that suggests this approach is not speaking to public audiences in the language of their values and expectations. We conclude with a discussion of how these findings are related and might inform new questions, approaches, and measurements of mission success, noting that a value proposition for conservation education that promotes the moral and ethical responsibilities of individuals, communities, and societies to protect and preserve wild species and wild spaces is a logical complement to existing educational programming designed to increase the factual knowledge of public audiences. We argue that zoo messaging and experiences must simultaneously help learners of all ages see themselves as embedded within natural systems – and see and value biodiversity as valuable, irreplaceable, and worthy of active protection and behavior change.
To fine-tune understandings of the cultural value of zoos today and further explore how these popular institutions can better achieve their collective conservation mission, Chapter 7 is a deep dive into one of the most important and highly valued dimensions of zoo visiting: human bonding. Having established in Chapters 3 and 5 that public audiences overwhelmingly value zoos as settings for (and of) social engagement, and tend to situate social experiences as a core function that differentiates zoos from other museum types, here we explore human bonding as a sociobiological human need – and a strong and consistent motivation and component of zoogoing – noting that on-site bonding is a social capital development process important to zoos’ collective conservation mission. We outline the sociological concept and psychological value of human bonding and use observation and evidence to assess how live animal stimuli in the safe setting of the zoo provide rich and layered opportunities for dialogue and shared meaning-making, processes that have been shown to build trust, strengthen social bonds, and contribute to the establishment of shared perceptions about valuing and caring for animals and nature.
To understand and categorize their visitors, zoos and aquariums have historically focused on demographic labels such as age, ethnicity, social group, level of formal education, and frequency of visitation, or marketing categories such as “educational” versus “leisure” visitors. Chapter 5 takes a layered look at the visiting phenomenon, noting that while natural history museums, art galleries, and zoological gardens all feature collections curated for presentation and public interpretation, the former settings are typically considered high-culture destinations for learning, whereas zoos and aquariums have no such status and are often trivialized as contexts for recreation and amusement. Building from psychological understandings of positive psychology and various conditions that provoke pleasure, fun, meaning-making, and emotional response experiences, we explore the distinct value of the zoo as a social place of educational leisure that offers public audiences many points of sensory stimulation and potential engagement due to the proximity of numerous types and taxa of live animal.
While rumblings about zoos as chaotic incarceration have persisted since the London Zoo was first made accessible to the general public, sustained challenges regarding the rights and inherent responsibilities of zoos as moral actors have been a persistent feature of zoo operations for the past fifty years. Given that several decades of social science research on larger social narratives of zoos as symbols, destinations, and public voices with authority in civil discourse can now be drawn from, we begin this chapter with an overview of the context, understandings, and assumptions that seem to ground common zoo narratives. To highlight how metaphoric and moral critiques challenge the legitimacy of zoos as moral actors and leaders in the environmental movement, as well as some counterpoints and questions that suggest the opposite, we also take a closer look at how philosophers, public audiences, zoo and animal behavior professionals, and critics perceive, present, value, and contest the civic role of zoos in contemporary society. While we do not see rhetorical and philosophical challenges to legitimacy as obstacles that necessarily prevent zoos from becoming optimally effective sites and tools for learning and associated mission outcomes, we do believe critical narratives help ground thinking about both the good and the bad that flows from the display of animals. We thus deconstruct some of the common social narratives about zoos; make a case for why zoos’ care for animals within and beyond zoo settings should be understood as an important dimension of learning and embraced as a unique opportunity to advance an urgent conservation agenda; and introduce research that begins to firmly upend the critique that zoos are not legitimate educational venues.
Nonsocial emotional and mental impacts of on-site nature stimulus experiences also emerge as a common theme when people describe zoos and zoogoing. Chapter 8 thus delves into what is known about mental models of connectedness, continuity, and belonging that appear to be linked to empathy, guilt, concern, and care – emotional responses that often arise automatically when humans encounter live animals. In addition to a psychological exploration of ions of nature and the concept of biophilia, we highlight patterns of affiliation, caring, and connectedness that emerge in zoo settings to shed light on the extent to which experiences that spark empathy toward animals can facilitate the development of moral emotional responses likely to ground or reinforce a conservation ethic. Building on primary research about the implicit connections people tend to develop during zoo visits – irrespective of the fact that zoo spaces are clearly human-designed – we demonstrate that zoo experiences overall impact humans’ capacity to connect and extend their scope of care to nonhuman entities in important ways. In particular, we consider why and how rich emotional relationships between zoo animals and the staff who care for them can and should be at the forefront of efforts to facilitate emotional connections to animals and caregiving that might build on and inform zoo users’ existing ideas, concerns, and motivations.