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Section 106 of the National Historic Preservation Act requires US federal agencies and their applicants to consider historic properties affected by their proposed actions. Guided principally by architectural historians and archaeologists throughout the 1980s, Section 106 reviews focused on identifying discrete structures and sites and then evaluating them in terms of dominant society aesthetics, histories, and sciences. By the 1990s, Section 106 participation by consulting Tribes and other cultural resource stewards obliged federal agencies to address a broader spectrum of historic properties and values. Agencies soon began using cultural landscape studies and other research and consultation tools to “match” historic property identification and assessment processes to the scale and complexity of proposed undertakings. The Section 106 review for the SunZia interstate transmission line (2009–2024) shows that the federal government has yet to consistently meet mandates to identify and assess elements other than archaeological/architectural historic properties. Our surveys of historic preservation professionals and available cultural landscape studies underscore disconnections between practitioner preferences for and the federal agency conduct of cultural landscape studies. They also highlight standards to use in evaluating the adequacy of cultural landscape studies. We recommend six attributes as essential to all cultural landscape study designs, methods, and applications in the Section 106 process.
Cannabis use severely affects the outcome of people with psychotic disorders, yet there is a lack of treatments. To address this, in 2019 the National Health Service (NHS) Cannabis Clinic for Psychosis (CCP) was developed to support adults suffering from psychosis to reduce and/or stop their cannabis use.
Aims
Examine outcome data from the first 46 individuals to complete the CCP's intervention.
Method
The sample (N = 46) consisted of adults (aged ≥ 18) with psychosis under the care of the South London and Maudsley NHS Foundation Trust, referred to the CCP between January 2020 and February 2023, who completed their intervention by September 2023. Clinical and functional measures were collected before (T0) and after (T1) the CCP intervention (one-to-one sessions and peer group attendance). Primary outcomes were changes in the Cannabis Use Disorders Identification Test-Revised (CUDIT-R) score and pattern of cannabis use. Secondary outcomes included T0–T1 changes in measures of delusions, paranoia, depression, anxiety and functioning.
Results
A reduction in the mean CUDIT-R score was observed between T0 (mean difference = 17.10, 95% CI = 15.54–18.67) and T1, with 73.91% of participants achieving abstinence and 26.09% reducing the frequency and potency of their use. Significant improvements in all clinical and functional outcomes were observed, with 90.70% being in work or education at T1 compared with 8.70% at T0. The variance in CUDIT-R scores explained between 34 and 64% of the variance in our secondary measures.
Conclusions
The CCP intervention is a feasible strategy to support cannabis use cessation/reduction and improve clinical and functional outcomes of people with psychotic disorders.
To investigate the association between food insecurity (FI) and diet quality in private sector service workers.
Design:
Data were collected via electronic questionnaires (2019) and the national register data (2018–2019). FI was measured using the Household Food Insecurity Access Scale (HFIAS) and diet quality using an FFQ and a modified Healthy Food Intake Index (mHFII). The associations between HFIAS and mHFII were studied using ANOVA and ordinal regression analysis.
Setting:
Cross-sectional survey and register data for all municipalities in Finland in 2018–2019.
Participants:
Individuals (n 6435) belonging to the Finnish Service Union United. The members are predominantly women and work mainly in retail trade, tourism, restaurant and leisure services, property maintenance and security services.
Results:
Overall diet quality, measured by mHFII, was significantly lower in those experiencing severe FI than in those who were food secure (8·0 v. 9·1). Additionally, those with severe FI were less likely to have higher (more optimal) scores in sugar-sweetened beverages (OR: 0·67), fibre-rich grains (OR: 0·79), vegetables (OR: 0·54), fruits and berries (OR: 0·61), vegetable oil (OR: 0·80), fish (OR: 0·65), milk (OR: 0·89) and nuts and seeds (OR: 0·66) than food-secure participants. Severe FI was associated with higher odds for less frequent consumption of red and processed meat (OR: 1·15, a higher score represents less frequent consumption).
Conclusions:
Severe FI was linked to both lower overall diet quality and suboptimal consumption of several food groups. Individuals experiencing severe FI may be predisposed to accumulating dietary risk factors for chronic diseases.
We conducted a systematic review of the medical, nursing, forensic, and social science literature describing events and processes associated with what happens after a traumatic death in the socio-cultural context of largely Western and high-income societies. These include death notification, why survivors choose to view or not view the body, forensic practices affecting viewing the body, alternatives to viewing, and social and cultural practices following the death. We also describe how elements of these processes may act to increase or lessen some of the negative cognitive and emotional consequences for both survivors and providers. The information presented is applicable to those who may be faced with traumatic deaths, including those who work in medicine, nursing, and law enforcement, as well as first responders, forensic investigators, funeral directors, and the families of the deceased.
Society of Thoracic Surgeons Congenital Heart Surgery Database is the largest congenital heart surgery database worldwide but does not provide information beyond primary episode of care. Linkage to hospital electronic health records would capture complications and comorbidities along with long-term outcomes for patients with CHD surgeries. The current study explores linkage success between Society of Thoracic Surgeons Congenital Heart Surgery Database and electronic health record data in North Carolina and Georgia.
Methods:
The Society of Thoracic Surgeons Congenital Heart Surgery Database was linked to hospital electronic health records from four North Carolina congenital heart surgery using indirect identifiers like date of birth, sex, admission, and discharge dates, from 2008 to 2013. Indirect linkage was performed at the admissions level and compared to two other linkages using a “direct identifier,” medical record number: (1) linkage between Society of Thoracic Surgeons Congenital Heart Surgery Database and electronic health records from a subset of patients from one North Carolina institution and (2) linkage between Society of Thoracic Surgeons data from two Georgia facilities and Georgia’s CHD repository, which also uses direct identifiers for linkage.
Results:
Indirect identifiers successfully linked 79% (3692/4685) of Society of Thoracic Surgeons Congenital Heart Surgery Database admissions across four North Carolina hospitals. Direct linkage techniques successfully matched Society of Thoracic Surgeons Congenital Heart Surgery Database to 90.2% of electronic health records from the North Carolina subsample. Linkage between Society of Thoracic Surgeons and Georgia’s CHD repository was 99.5% (7,544/7,585).
Conclusions:
Linkage methodology was successfully demonstrated between surgical data and hospital-based electronic health records in North Carolina and Georgia, uniting granular procedural details with clinical, developmental, and economic data. Indirect identifiers linked most patients, consistent with similar linkages in adult populations. Future directions include applying these linkage techniques with other data sources and exploring long-term outcomes in linked populations.
Private practice is the fastest growing employment sector for dietitians in Australia, including for new graduates(1). There is an anecdotal concern that current graduate cohorts are not adequately prepared for private practice. The present study aims to assess the existing literature relevant to workforce development specific to private practice dietetics, including areas such as workforce size, distribution, competency, practices and global challenges. The secondary aim is to identify gaps in the literature to inform future priority areas and to inform private practice dietetics workforce development research. Five databases were systematically searched from inception to August 2023 and grey-literature was searched using the Google search engine using key search terms to identify studies for inclusion. Of the 2361 peer-reviewed publications and 1800 grey literature, eighty were included. Directed content analysis and qualitative constant comparison technique were used to deductively extract data from eligible private practice literature. Intelligence sources covering the following themes proved to be limited: workforce size, distribution, attributes, demography, supply/preparation, competencies, continued professional development and challenges. However, clear structural issues present workforce challenges for private practice dietitians. There is an overwhelming paucity of comprehensive literature on the private practice dietetics workforce across the world. Private practice dietetics workforce development research is warranted to address current research gaps in a coordinated, collaborative approach to ensure this rapidly expanding workforce is well supported.
The estimated global preterm birth rate in 20201 was more than 10% of livebirths or 13.4 million infants. Nutrition in the neonatal period is a key factor to optimise growth, neurodevelopment, and later metabolic disease risk2. There is no consensus on optimal nutrition for preterm infants, leading to substantial practice variation3. We aimed to assess the quality of nutritional guidelines for preterm infants, the consistency of recommendations, and the gaps in these recommendations. This review is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 checklist. The study protocol was registered with PROSPERO (CRD42022327248). We searched six databases and 44 websites for nutritional guidelines for preterm infants before first hospital discharge, which were endorsed, prepared, or authorised by a regional, national, or international body, written in English, and published between 2012-2023. Two reviewers independently screened articles and extracted relevant data including nutritional recommendations (ranges or descriptions), the quality of recommendations (certainty of evidence and strength of recommendation), and gaps in recommendations, defined as those identified by the guidelines or when recommendations were based on very low certainty evidence. Disagreements were resolved by discussion or a third reviewer. Four reviewers appraised the included guidelines using AGREE II. We identified 7051 records, 27 guidelines were included in the review, 26% of which were of high quality. Most guidelines lacked stakeholder involvement and rigour of development. Twelve guidelines had recommendations for macronutrient intake, 18 for micronutrient intake, 12 for feeding, eight for fortification, and 14 for monitoring of nutritional adequacy. Only two guidelines provided recommendations for all five of these aspects. We found considerable variation in recommendations, many of which lacked details of certainty of evidence and strength of recommendation. Recommendations for feeding types and breastmilk fortification were consistent among high quality guidelines, but recommendations varied for intakes of almost all nutrients and monitoring of nutritional adequacy. Different guidelines gave different certainty of evidence for the same recommendations. Most gaps in recommendations were due to a very low certainty of evidence. Future development of nutritional guidelines for preterm infants should follow the standard guideline development method and ensure rigorous process including stakeholders’ involvement to improve the reporting of strength of recommendation, certainty of evidence, and gaps in recommendation. Evidence is needed to support recommendations about macro and micronutrient intakes, breastmilk fortification, and markers on adequacy of intake of different nutrients.
The teenage years represent a crucial period of physical and cognitive growth and development with sufficient micronutrient intakes necessary to meet high nutritional requirements. This review examines current micronutrient intakes in teenagers in the Western world in the context of public health implications including the prevalence of inadequate intakes and risk of excessive intakes. Intakes of vitamins A, D, E and C, folate, calcium, iron, magnesium, zinc and potassium in teenagers are low when compared to generally accepted recommendations, while there is little risk of excessive micronutrient intakes based on current dietary patterns. Therefore, strategies should focus on increasing micronutrient intakes in order to decrease the risk of negative impacts resulting from these low intakes. These strategies should be mindful of guidance towards an environmentally sustainable diet whilst ensuring that nutrient intakes in teenagers are not further negatively impacted. In order to identify, implement and monitor the effectiveness of such strategies, intakes of micronutrients should be continually monitored in nationally representative samples of the population for all age groups including this vulnerable cohort of teenagers.
Milk production declines as dairy cows enter late lactation, resulting in reduced milk quality and negatively impacting milk processability, such as rennet coagulation time (RCT), milk pH and ethanol stability (ES), leading to seasonality issues for milk processors. Multispecies forages, containing grass, legume and herb species, require lower N inputs and are of interest to dairy farmers. However, little is known about the effect of grazing multispecies forages on milk processability characteristics in late lactation dairy cows. Forty-five autumn-calving dairy cows in late lactation were allocated to 1 of 3 grazing forages; perennial ryegrass (PRG; Lolium perenne), perennial ryegrass and white clover (Trifolium pratense) (PRGWC), and a 6 – species multispecies forage (MULTI) containing perennial ryegrass, timothy (Phleum pratense), white clover, red clover (Trifolium repens), chicory (Cichorium intybus) and plantain (Plantago lanceolata). Cows were allocated 12 kg DM grazed forage and supplemented with a grass – silage TMR and concentrate. Forage DMI was significantly lower for cows grazing PRG. Milk yield increased when cows grazed PRGWC (18.07 kg/d) and MULTI (17.84 kg/d) compared to PRG (16.08 kg/d). Milk RCT (mins) and ES (%) were unaffected by treatment. However, offering cows PRGWC and MULTI increased the concentration of C18:2 cis – 9, 12 and C18:3 cis – 9, 12, 15 in milk compared to PRG. Compared to PRG, grazing forages containing clover and herb species improved milk yield and beneficially altered milk fatty acid profile in late lactation dairy cows without negatively impacting milk processability.
This study aimed to evaluate the proportion of Irish medical students exposed to ‘badmouthing’ of different specialities and to ascertain: the degree of criticism of specialities based on the seniority of clinical or academic members of staff; if ‘badmouthing’ influenced student career choice in psychiatry; and attitudes of medical students towards psychiatry as a speciality and career choice.
Methods:
Medical students in three Irish universities were invited to complete an online survey to determine the frequency and effect of non-constructive criticism on choice of medical specialty. The online questionnaire was distributed to Royal College of Surgeons in Ireland (RCSI), University of Galway (UoG) and University College Dublin (UCD) in the academic year 2020–2021.
Results:
General practice (69%), surgery (65%) and psychiatry (50%) were the most criticised specialties. Criticism was most likely to be heard from medical students. 46% of students reported reconsidering a career in psychiatry due to criticism from junior doctors. There was a positive perception of psychiatry with 27% of respondents considering psychiatry as a first-choice specialty.
Conclusions:
Criticism of psychiatry by doctors, academics and student peers negatively influences students’ career choice, which could be contributing to recruitment difficulties in psychiatry.
In this chapter, these four co-authors emphasise the importance of sustainability for the future of people and planet, given that the case for all human and non-human inhabitants has never been clearer. Through an account of Mia’s doctoral study, they challenge readers to provide young children with meaningful opportunities to participate in conversations about the Earth’s future. More importantly, they argue for children’s concerns to be heard and their ideas acted upon. To this end, the chapter offers research-based strategies for early years educators, especially in the first years of schooling, given that the research was conducted with children aged from 6 to 8 years. They developed the 4C Pedagogical Framework for transformational early childhood education for sustainability as a valuable tool for this purpose.
State Medical Boards (SMBs) can take severe disciplinary actions (e.g., license revocation or suspension) against physicians who commit egregious wrongdoing in order to protect the public. However, there is noteworthy variability in the extent to which SMBs impose severe disciplinary action. In this manuscript, we present and synthesize a subset of 11 recommendations based on findings from our team’s larger consensus-building project that identified a list of 56 policies and legal provisions SMBs can use to better protect patients from egregious wrongdoing by physicians.
This study investigated sex differences in Fe status, and associations between Fe status and endurance and musculoskeletal outcomes, in military training. In total, 2277 British Army trainees (581 women) participated. Fe markers and endurance performance (2·4 km run) were measured at the start (week 1) and end (week 13) of training. Whole-body areal body mineral density (aBMD) and markers of bone metabolism were measured at week 1. Injuries during training were recorded. Training decreased Hb in men and women (mean change (–0·1 (95 % CI –0·2, –0·0) and –0·7 (95 % CI –0·9, –0·6) g/dl, both P < 0·001) but more so in women (P < 0·001). Ferritin decreased in men and women (–27 (95 % CI –28, –23) and –5 (95 % CI –8, –1) µg/l, both P ≤ 0·001) but more so in men (P < 0·001). Soluble transferrin receptor increased in men and women (2·9 (95 % CI 2·3, 3·6) and 3·8 (95 % CI 2·7, 4·9) nmol/l, both P < 0·001), with no difference between sexes (P = 0·872). Erythrocyte distribution width increased in men (0·3 (95 % CI 0·2, 0·4)%, P < 0·001) but not in women (0·1 (95 % CI –0·1, 0·2)%, P = 0·956). Mean corpuscular volume decreased in men (–1·5 (95 % CI –1·8, –1·1) fL, P < 0·001) but not in women (0·4 (95 % CI –0·4, 1·3) fL, P = 0·087). Lower ferritin was associated with slower 2·4 km run time (P = 0·018), sustaining a lower limb overuse injury (P = 0·048), lower aBMD (P = 0·021) and higher beta C-telopeptide cross-links of type 1 collagen and procollagen type 1 N-terminal propeptide (both P < 0·001) controlling for sex. Improving Fe stores before training may protect Hb in women and improve endurance and protect against injury.
This mixed-methods complementarity study explored family members’, friends’, and health care providers’ perspectives of acceptability of group leisure activities as an intervention for loneliness experienced by older adults living with dementia. A sample of 25 family members, friends, and health care providers of people living with dementia in ON rated the acceptability of group leisure activities (adapted Treatment Perception and Preference questionnaire) and discussed their ratings in an interview. Quantitative (descriptive statistics) and qualitative (conventional content analysis) results were integrated to understand acceptability. Participants viewed group leisure activities as effective, logical, and suitable for use with people living with dementia. Participants described the need for flexible programs, careful facilitation, and attention to activity selection. Group leisure activities were seen as low risk, but stigmas related to dementia could prevent participation. The findings inform the design of acceptable group leisure activities, promoting their use to address loneliness in people living with dementia.
Given the many statistical analysis options used for randomized controlled trials (RCTs) of behavioral interventions and the lack of clear guidance for analysis selection, the present study aimed to characterize the predominate statistical analyses utilized in RCTs in palliative care and behavioral research and to highlight the relative strengths and weaknesses of each of these methods as guidance for future researchers and reform.
Methods
All RCTs published between 2015 and 2021 were systematically extracted from 4 behavioral medicine journals and analyzed based on prespecified inclusion criteria. Two independent raters classified each of the manuscripts into 1 of 5 RCT analysis strategies.
Results
There was wide variation in the methods used. The 2 most prevalent analyses for RCTs were longitudinal modeling and analysis of covariance. Application of method varied significantly by sample size.
Significance of results
Each statistical analysis presents its own unique strengths and weaknesses. The information resulting from this research may prove helpful for researchers in palliative care and behavioral medicine in navigating the variety of statistical methods available. Future discussion around best practices in RCT analyses is warranted to compare the relative impact of interventions in a more standardized way.
Laser-plasma instabilities (LPI) play a detrimental role in energy coupling to the target in inertial confinement fusion (ICF). The recent development of applied strong magnetic fields for use in ICF and laboratory astrophysics experiments has opened opportunities to investigate the role of external magnetic fields on LPIs. Recent numerical studies have shown that stimulated Raman scattering (SRS) can be mitigated by external magnetic fields in the kinetic regime of the instability and warrant systematic experimental studies to validate modelling. To this end, we design experiments at the OMEGA-EP laser facility to investigate the effect of an external perpendicular $B$-field of 5–30 T on the backscattered light spectrum from a gas-jet target. We present measurements from a proof-of-principle experiment, where the backward-SRS (BSRS) is in the kinetic regime, for which the magnetization is expected to produce the greatest effects on instability growth. New simulations motivated by this experiment are used to inform the proposal of an upgraded experimental design. Our simulation predictions show that the new design is suited to experimentally demonstrating BSRS mitigation by an external magnetic field, despite the magnetization effects on the hydrodynamics, as well as the inherent temporal and spatial variations in plasma conditions.
The investigators conducted a psychosocial needs assessment of mesothelioma patients through self-report measures of quality of life (QOL), coping, depression, and social support.
Methods
Patients with malignant pleural mesothelioma (MPM) (N = 67) completed a battery of assessments at a single timepoint after being approached during routine medical oncology clinic appointments or by letter.
Results
Participants were predominately male (70.0%; n = 47) and ranged in age from 35 to 83 years old (M = 65.61, SD = 9.71). Most participants were white (88.0%; n = 59), and 10.0% (n = 7) were identified as Hispanic. The majority were married or living with a partner (93.0%; n = 62) and had some college or more education (64.0%; n = 43). Fourteen percent of participants (n = 11) endorsed significantly elevated depression symptoms. No significant demographic or clinical differences in depressed compared to nondepressed participants were observed, with a trend toward those identifying as Hispanic and those who were divorced as being more likely to be depressed. For the total sample, the most frequently endorsed coping strategies were active coping, emotional support, and acceptance.
Significance of results
The present study did not identify any clear correlates of depression or QOL among patients with MPM. This research contributes to the small literature on psychosocial functioning in patients with MPM and provides putative directions for future larger studies and the development of interventions to provide appropriate support to diverse patients with MPM.
The past 50 yr of advances in weed recognition technologies have poised site-specific weed control (SSWC) on the cusp of requisite performance for large-scale production systems. The technology offers improved management of diverse weed morphology over highly variable background environments. SSWC enables the use of nonselective weed control options, such as lasers and electrical weeding, as feasible in-crop selective alternatives to herbicides by targeting individual weeds. This review looks at the progress made over this half-century of research and its implications for future weed recognition and control efforts; summarizing advances in computer vision techniques and the most recent deep convolutional neural network (CNN) approaches to weed recognition. The first use of CNNs for plant identification in 2015 began an era of rapid improvement in algorithm performance on larger and more diverse datasets. These performance gains and subsequent research have shown that the variability of large-scale cropping systems is best managed by deep learning for in-crop weed recognition. The benefits of deep learning and improved accessibility to open-source software and hardware tools has been evident in the adoption of these tools by weed researchers and the increased popularity of CNN-based weed recognition research. The field of machine learning holds substantial promise for weed control, especially the implementation of truly integrated weed management strategies. Whereas previous approaches sought to reduce environmental variability or manage it with advanced algorithms, research in deep learning architectures suggests that large-scale, multi-modal approaches are the future for weed recognition.