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British left-wing politics does not know what to think about mothers. In left-wing women’s movements, motherhood has been recognised as essential and difficult; necessary for future revolutions, not least in raising future revolutionaries. In less radical circles, it has been understood as a crucial contribution to the functioning of society, often forming the basis of women’s claims to citizenship and maternalist forms of politics. On the other hand, motherhood has been seen as a ‘natural’ function of women and a private responsibility, rather than a public good or a collective act which needs comprehensive state support. The family, in this reading, is a rather conservative force, better left to social reactionaries. Mothering has added additional hurdles to the gendered obstacles women already face in pursuing politics as activists or elected representatives. Perhaps because of this, many mothers in politics have sought to downplay or distance themselves from their roles as mothers, emphasising instead their contributions as workers and activists who can be fully committed to the left cause. Feminist historians have often followed their lead and have tended to write around political mothers’ maternal roles in their scholarship. This roundtable develops themes first explored in our November 2023 workshop, generously supported by the Royal Historical Society.
Celiac disease (CD), an autoimmune disorder triggered by gluten, impacts about one percent of the population. Only one-third receive a diagnosis, leaving the majority unaware of their condition. Untreated CD can lead to gut lining damage, resulting in malnutrition, anemia, and osteoporosis. Our primary goal was to identify at-risk groups and assess the cost-effectiveness of active case finding in primary care.
Methods
Our methodology involved systematic reviews and meta-analyses focusing on the accuracy of CD risk factors (chronic conditions and symptoms) and diagnostic tests (serological and genetic). Prediction models, based on identified risk factors, were developed for identifying individuals who would benefit from CD testing in routine primary care. Additionally, an online survey gauged individuals’ preferences regarding diagnostic certainty before initiating a gluten-free diet. This information informed the development of economic models evaluating the cost-effectiveness of various active case finding strategies.
Results
Individuals with dermatitis herpetiformis, a family history of CD, migraine, anemia, type 1 diabetes, osteoporosis, or chronic liver disease showed one and a half to two times higher risk of having CD. IgA tTG, and EMA demonstrated good diagnostic accuracy. Genetic tests showed high sensitivity but low specificity. Survey results indicated substantial variation in preference for certainty from a blood test before initiating a gluten-free diet. Cost-effectiveness analyses showed that, in adults, IgA tTG at a one percent pre-test probability (equivalent to population screening) was the most cost effective. For non-population screening strategies, IgA EMA plus HLA was most cost effective. There was substantial uncertainty in economic model results.
Conclusions
While population-based screening with IgA tTG appears the most cost effective in adults, decisions for implementation should not solely rely on economic analyses. Future research should explore whether population-based CD screening aligns with UK National Screening Committee criteria and requires a long-term randomized controlled trial of screening strategies.
Most patients with long-term conditions (LTC) receive regular blood tests to monitor disease progression and response to treatment and to detect complications. There is currently no robust evidence to inform recommendations on monitoring. Creating this evidence base is challenging because the benefits and harms of testing are dependent on what is done in response to the test results.
Methods
We identified a list of commonly used tests. We defined a series of filtering questions to determine whether there was evidence to support the rationale of monitoring, such as “Can the general practitioner do anything in response to an abnormal test result?” Through a series of rapid reviews we identified evidence to answer each question. The evidence was presented at a consensus meeting where clinicians and patients voted for inclusion, exclusion, or further analysis. A process evaluation was performed alongside this. Further analyses were performed using routinely collected healthcare data and by performing incidence analyses, emulating randomized controlled trials (RCTs), and modeling disease progression.
Results
We tested this methodology on three common LTCs: chronic kidney disease (CKD), type 2 diabetes mellitus (T2DM), and hypertension. We found sufficient evidence to include hemoglobin A1C and estimated glomerular filtration rate (eGFR) for monitoring patients with T2DM; hemoglobin and eGFR for patients with CKD; and eGFR for patients with hypertension. The consensus panel excluded four tests, while 10 tests were selected for further analysis. The emulated RCTs will investigate the effect of regular monitoring with certain tests on health outcomes among routinely monitored patients. In addition, we will investigate the signal-to-noise ratio of each test over time using a modeling approach.
Conclusions
The cost effectiveness of the evidence-based testing panels needs to be tested in clinical practice. We are currently developing an intervention package and are planning to run a feasibility trial. This program of work has the potential to change how LTCs are monitored in primary care, ultimately improving patient outcomes and leading to more efficient use of healthcare resources.
Prenatal vitamin D deficiency is widely reported and may affect perinatal outcomes. In this secondary analysis of the UK Pregnancies Better Eating and Activity Trial, we examined vitamin D status and its relationship with selected pregnancy outcomes in women with obesity (BMI ≥ 30 kg/m2) from multi-ethnic inner-city settings in the UK. Determinants of vitamin D status at a mean of 17 ± 1 weeks’ gestation were assessed using multivariable linear regression and reported as percent differences in serum 25-hydroxyvitamin D (25(OH)D). Associations between 25(OH)D and clinical outcomes were examined using logistic regression. Among 1089 participants, 67 % had 25(OH)D < 50 nmol/l and 26 % had concentrations < 25 nmol/l. In fully adjusted models accounting for socio-demographic and anthropometric characteristics, 25(OH)D was lower among women of Black (% difference = −33; 95 % CI: −39, −27), Asian (% difference = −43; 95 % CI: −51, −35) and other non-White (% difference = −26; 95 % CI: −35, −14) ethnicity compared with women of White ethnicity (n 1086; P < 0·001 for all). In unadjusted analysis, risk of gestational diabetes was greater in women with 25(OH)D < 25 nmol/l compared with ≥ 50 nmol/l (OR = 1·58; 95 % CI: 1·09, 2·31), but the magnitude of effect estimates was attenuated in the multivariable model (OR = 1·33; 95 % CI: 0·88, 2·00). There were no associations between 25(OH)D and risk of preeclampsia, preterm birth or small for gestational age or large-for-gestational-age delivery. These findings demonstrate low 25(OH)D among pregnant women with obesity and highlight ethnic disparities in vitamin D status in the UK. However, evidence for a greater risk of adverse perinatal outcomes among women with vitamin D deficiency was limited.
Australian novelist George Turner’s 1987 novel The Sea and Summer is one of the world’s first climate fiction novels, although James Edmond’s 1911 story, ‘The Fool and His Inheritance’, is a precursor to the genre. The early emergence of Australian climate fiction is not surprising given the country’s vulnerability to anthropogenic climate change. This chapter investigates the 35-year history of Australian climate fiction through an analysis of six novels, contemplating how environment, history and culture shape the use of genre, form and theme. It examines slow violence and flooding in The Sea and Summer; the intertwining of colonisation, environmental destruction and dispossession in Alexis Wright’s The Swan Book (2013); the use of the uncanny to explore the impact of ‘settlement’ in Jennifer Mills’s Dyschronia (2018); the effect of a changing climate on generations in James Bradley’s Clade (2015); and the psychological ramifications of the 2019–20 bushfires, evident through motifs of missing bodies and an invisible menace in Richard Flanagan’s The Living Sea of Waking Dreams (2020) and Inga Simpson’s The Last Woman in the World (2021). These novels, which are shaped by their production in a country with a fragile environment and a history of colonisation, offer varying visions of hope and despair.
OBJECTIVES/GOALS: Anti-cancer therapies, such as chemotherapy, can induce senescence. Senescent cells may produce factors that can promote tumor progression. In this study, we will investigate the effect of senolytics and anti-cancer treatment on fibroblasts, which are a part of the tumor microenvironment, and patient-derived colorectal cancer organoids. METHODS/STUDY POPULATION: We will induce senescence in fibroblast lines via irradation. Induction of senescence will be confirmed by monitoring SASP production, changes in morphology and proliferation rates, and senescence-associated b-galactosidase activity. To investigate the efficacy of senolytics on senescence-induced fibroblasts and CRC tumor organoids, we will creat a dose response curve and calculate IC50 values for proliferating fibroblast, senescent fibroblasts and CRC organoids. To identify the synergistic effects of anti-cancer and senolytic compounds, including Navitoclax and Dasatinib, on fibroblasts and CRC organoids, we will create dose matrixes using senolytics at concentrations that were shown to have senolytic activity and drugs from an anti-cancer library. RESULTS/ANTICIPATED RESULTS: If senescence is induced in the fibroblast lines, we expect to see no changes in confluency over 4 days, the morphology will change from a thin, spindly shape to a flattened shape, and senescence-associated b-galactosidase activity will be observed. After the fibroblast lines are treated with potential senolytic compounds, we would expect to see decreased viability in the senescence-induced fibroblast lines when compared to proliferating fibroblast lines. We predict that the viability of CRC organoid lines will slightly decrease at high concentrations of the senolytic due to overall toxicity. We expect that the senolytic and anti-cancer compounds will have a synergistic effect. Senolytic activity could reduce the senescent cell population that was developed in response to anti-cancer therapy. DISCUSSION/SIGNIFICANCE: There is an increased interest in identifying compounds that selectively promote apoptosis in senescent cells. This study uses a cell-based approach to validate senolytic activity of compounds with senolytic potential in senescence-induced fibroblast lines and investigates the synergistic effects of senolytics and anti-cancer compounds on CRC.
Many patients with Fontan physiology are unable to achieve the minimum criteria for peak effort during cardiopulmonary exercise testing. The purpose of this study is to determine the influence of physical activity and other clinical predictors related to achieving peak exercise criteria, signified by respiratory exchange ratio ≥ 1.1 in youth with Fontan physiology.
Methods:
Secondary analysis of a cross-sectional study of 8–18-year-olds with single ventricle post-Fontan palliation who underwent cardiopulmonary exercise testing (James cycle protocol) and completed a past-year physical activity survey. Bivariate associations were assessed by Wilcoxon rank-sum test and simple regression. Conditional inference forest algorithm was used to classify participants achieving respiratory exchange ratio > 1.1 and to predict peak respiratory exchange ratio.
Results:
Of the n = 43 participants, 65% were male, mean age was 14.0 ± 2.4 years, and 67.4% (n = 29) achieved respiratory exchange ratio ≥ 1.1. Despite some cardiopulmonary exercise stress test variables achieving statistical significance in bivariate associations with participants achieving respiratory exchange ratio > 1.1, the classification accuracy had area under the precision recall curve of 0.55. All variables together explained 21.4% of the variance in respiratory exchange ratio, with peak oxygen pulse being the most informative.
Conclusion:
Demographic, physical activity, and cardiopulmonary exercise test measures could not classify meeting peak exercise criteria (respiratory exchange ratio ≥ 1.1) at a satisfactory accuracy. Correlations between respiratory exchange ratio and oxygen pulse suggest the augmentation of stroke volume with exercise may affect the Fontan patient’s ability to sustain high-intensity exercise.
This paper examines the legal and ethical aspects of traceback testing, a process in which patients who have been previously diagnosed with ovarian cancer are identified and offered genetic testing so that their family members can be informed of their genetic risk and can also choose to undergo testing. Specifically, this analysis examines the ethical and legal limits in implementing traceback testing in cases when the patient is deceased and can no longer consent to genetic testing.
The inaugural data from the first systematic program of sea-ice observations in Kotzebue Sound, Alaska, in 2018 coincided with the first winter in living memory when the Sound was not choked with ice. The following winter of 2018–19 was even warmer and characterized by even less ice. Here we discuss the mass balance of landfast ice near Kotzebue (Qikiqtaġruk) during these two anomalously warm winters. We use in situ observations and a 1-D thermodynamic model to address three research questions developed in partnership with an Indigenous Advisory Council. In doing so, we improve our understanding of connections between landfast ice mass balance, marine mammals and subsistence hunting. Specifically, we show: (i) ice growth stopped unusually early due to strong vertical ocean heat flux, which also likely contributed to early start to bearded seal hunting; (ii) unusually thin ice contributed to widespread surface flooding. The associated snow ice formation partly offset the reduced ice growth, but the flooding likely had a negative impact on ringed seal habitat; (iii) sea ice near Kotzebue during the winters of 2017–18 and 2018–19 was likely the thinnest since at least 1945, driven by a combination of warm air temperatures and a persistent ocean heat flux.
Black British women's centres and groups evolved out of black women's combined exclusion from male-dominated anti-racist activism and the resurgent feminist movement of the late 1960s. And yet, despite their stable presence in many of Britain's inner cities, black women's centres and groups, and the lives of the women who forged them, have evaded historical interrogation. This article explores how black women's centres provided women with the space and time to nurture their personal experiences of sexism and racism, achieve a sense of self-sufficiency, and celebrate their heritage, which placed every member on a path towards self-discovery. This centring of the black female self was not, as black male activists believed, set on undermining the Black liberation movement, but was considered as a vital tool in the overarching mission to defeat white global supremacy. Drawing on a collection of oral history interviews, this article explores how black female activists constructed a sense of self that turned away from the homogenizing white gaze of post-war Britain. Teasing out the complexities around black female activism, selfhood, and memory, this article contributes substantially to the growing body of literature on late twentieth-century black British history.
Background: Hand hygiene by healthcare personnel is a critical infection prevention intervention. Direct observation, the most widely utilized method to observe hand hygiene practices, often provides an incomplete picture due to small sample size and altered behavior in the presence of observers. A growing number of healthcare facilities are employing electronic hand hygiene monitoring systems to capture overall compliance rates. These electronic systems can provide a wealth of data on hand hygiene practices within and across healthcare facilities. Objective: We used high-accuracy electronic monitoring data to perform a detailed analysis of hand hygiene practices across numerous facilities that varied in key hospital characteristics. Methods: In total, 11 tertiary-care facilities were equipped with an electronic hand hygiene monitoring system. Hospitals varied in size, region, area classification (urban vs rural), acuity level, and teaching status. The electronic monitoring system was composed of uniquely assigned employee badges and electronically monitored dispensers. Every recorded dispensing event was time stamped and associated with a specific healthcare worker, the location of the dispenser, and the specific product being dispensed (ie, alcohol-based hand rub [ABHR] or hand soap). The total number of dispensing events for each product type and the total number of hours worked were calculated for each healthcare worker and were used to determine hand hygiene frequency. Hospital attributes, such as size and area classification, were obtained from publicly available sources including but not limited to facility-owned websites and CMS data. Results: More than 15.7 million hand hygiene events, performed by nearly 11,000 healthcare workers, were captured by the electronic monitoring system and were included in the analysis. Overall, median hand hygiene frequency was 4.1 events per hour and ranged from 2.0 events per hour to 5.6 events per hour, depending on the facility. ABHR use (median, 3.6 events per hour) was more frequent than handwashing (median, 0.4 events per hour). Hospitals included in the analysis ranged from small (<20 beds) rural facilities to large (>600 beds) academic hospitals and provided a variety of services from general medical-surgical treatment to intensive care. Interfacility differences in observed hand hygiene frequency were analyzed. Conclusions: The current analysis reinforces and builds upon previous work that examined a smaller subset of 5 hospitals located in a single geographic region. Combined, these datasets represent >20 million hand hygiene events among ∼15,000 healthcare workers from 16 unique healthcare facilities. This analysis provides detailed information about hand hygiene practices across a diverse set of healthcare facilities.
Funding: Ecolab, Inc, provided support for this study.
Disclosures: Jessica Carol Albright and Cheryl A Littau report salary from Ecolab.
The broad brush strokes of Dorothy Cottrell's paintings in the National Library of Australia mark her as a modernist artist, although not one who painted the burgeoning Sydney Harbour Bridge or bright still-life paintings of Australian flora. Rather, she captured the dun surrounds of Ularunda Station, the remote Queensland property to which she moved in 1920 after attending art school in Sydney. At Ularunda, Cottrell eloped with the bookkeeper to Dunk Island, where they stayed with nature writer E.J. Banfield, then relocated to Sydney. In 1924 they returned to Ularunda and Cottrell swapped her paintbrush for a pen, writing The Singing Gold. After advice from Mary Gilmore, whom her mother accosted in a pub, Cottrell send it to the Ladies Home Journal in America. It was snapped up immediately, optioned for a film and found a publisher in England, who described it as ‘a great Australian book, and a world book’. Gilmore added, ‘As an advertisement for Australia, it will go far — the Ladies Home Journal is read all over the world’. Cottrell herself also went far, emigrating to America, where she wrote The Silent Reefs, set in the Caribbean. Cottrell's creative, intellectual and physical peregrinations — all undertaken in a wheelchair after she contracted polio at age five — show how the local references the international, and vice versa. Through an analysis of the life and writing of this now little-known Queensland author, this essay reflects the regional and transnational elements of modernism as outlined in Neal Alexander and James Moran's Regional Modernisms, illuminating how a crack-shot with a rifle once took Queensland to the world.
Two main hypotheses have been proposed to account for the word order of negative inversion (NI) in varieties of non-canonical English (e.g. Don't nobody else care). An auxiliary inversion analysis argues that the word order is derived via movement of the auxiliary to the left periphery, whereas an existential analysis argues that the word order is an artifact of deletion of the expletive subject, paralleling there-insertion existential constructions. After reviewing these hypotheses, I provide empirical evidence that neither of these theories adequately explains the peculiarities of NI. I advance a third hypothesis, namely that NI is the result of negative movement to the specifier of NegP, and that this movement is pragmatically motivated by an existential meaning in NI constructions. Syntactically, NI is made possible through the Neg-Criterion (Haegeman & Zanuttini 1991, 1996). This analysis explains problems encountered by prior analyses, and offers a unified analysis for variation in NI across dialects. Finally, I explain cross-dialectal differences in NI by considering the relationship between subject requirements and agreement.