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Community advisory boards (CABs) are a promising approach for strengthening patient and partner voices in community health center (CHC) evidence-based decision-making. This paper aims to describe how CHCs used CABs during the COVID-19 pandemic to improve the reach of testing among populations experiencing health disparities and identify transferable lessons for future implementation.
Methods:
This mixed methods study integrates brief quantitative surveys of community engagement (N = 20) and one-on-one qualitative interviews (N = 13) of staff and community partners engaged in CHC CABs with a cost analysis and qualitative feedback from CHC staff participating in an online learning community (N = 17).
Results:
Community partners and staff engaged in the CHC CABs reported high ratings of engagement, with all mean ratings of community engagement principles above a 4 (“very good” or “often”) out of 5. Qualitative findings provided a more in-depth understanding of experiences serving on the CHC CAB and highlighted how engagement principles such as trust and mutual respect were reflected in CAB practices. We developed a CHC CAB toolkit with strategies for governance and prioritization, cost estimates to ensure sustainment, guidance on integrating quality improvement expertise, testimonies from community members on the benefits of joining, and template agendas and facilitator training to ensure meeting success.
Conclusion:
In alignment with the Translational Science Benefits Model, this study expands research impact through comprehensive mixed methods measurement of community engagement and by transforming findings into an action-orientated guide for CHCs to implement CABs to guide evidence-based decision-making for community and public health impact.
The authors report on ancient DNA data from two human skeletons buried within the chancel of the 1608–1616 church at the North American colonial settlement of Jamestown, Virginia. Available archaeological, osteological and documentary evidence suggest that these individuals are Sir Ferdinando Wenman and Captain William West, kinsmen of the colony's first Governor, Thomas West, Third Baron De La Warr. Genomic analyses of the skeletons identify unexpected maternal relatedness as both carried the mitochondrial haplogroup H10e. In this unusual case, aDNA prompted further historical research that led to the discovery of illegitimacy in the West family, an aspect of identity omitted, likely intentionally, from genealogical records.
To provide a bespoke development program for foundation year (FY) trainees on rotation at CNWL NHS trust.
To increase interest in foundation trainees in choosing Psychiatry as a career.
Specific: 100% self-reported satisfaction with the FY development program by April 2024.
50% increase from baseline of self-reported interest in choosing psychiatry as a specialty by April 2024.
Methods
We designed an online, 12 session teaching program for each 4 month cohort of foundation year doctors on rotation at St Charles Hospital, CNWL. We collect data at baseline, after each teaching session and at exit via online questionnaires. These are reviewed at PDSA meetings (including nominees from foundation cohort) by team quarterly. First cohort started in May 2023, we are currently in our 3rd cohort of this project. Each cohort has approximately 15 Foundation year Trainees. Our curricula integrates principles of Co-Design: 2 of the 12 teaching slot topics are voted by each cohort of foundation trainees. Co-Production: 2 of the 12 slots are always for a carer, service user or expert by experience. Bespoke: Each teacher is provided a written guide outlining the training grade of foundation trainees and highlights the needs for transferrable skills as FY trainees may not pursue psychiatry as a career. Quality Improvement: iterative learning from each cohort, with robust data collection methods (dedicated time set aside for feedback completion) and regular reviews by team. Teachers are canvassed via trust emails, trainee Whatsapp groups and patient liaison services at CNWL.
Results
Cohort 1= no data collected. Data collection methods required improvement.
Cohort 2= data collection of 3 responses (23% completion rate). Data collected insufficient. Data collection method improved.
Cohort 3= data collection of 13 responses (87% completion rate).
Self-reported satisfaction with training program: 95.3% Interest in choosing psychiatry as a specialty: 30.4% at baseline to 76.2% at time of submission.
Conclusion
This Foundation Year Development initiative provides a well-liked, bespoke and innovative approach to train foundation year doctors on placement at NHS trusts.
The majority of Foundation doctors (some surveys show 60%) are undecided on their specialty during foundation training and this is a unique opportunity to increase recruitment into psychiatry.
We published a series of papers regarding the oldest turritellids, naticids, their paleoecological interaction, and gastropod biozonation, which are of Oxfordian in age, from the Jhura pond section, Kutch, western India. Recently, an Oxfordian age was challenged by Fürsich et al. (2023) and they argued for a Cenozoic age. The authors reproduced a local geological map based on regional data where the Jhura pond section sediments were overlying the Bhuj Formation. In the original regional data, there was no Bhuj Formation and the introduction of the Bhuj Formation served to show that Jhura pond section sediments were “allochthonous”. Other lines of argument against our conclusions (e.g., identification of associated bivalve fauna, foraminiferal assemblage, and geological context) were brought forward. There were additional inconsistencies, such as the reworking of Oxfordian fossils, in their comment/opinion pieces. The only hard evidence was the report of a microfaunal assemblage, but the taxa were identified at the generic level and most of the genera appear in the Jurassic or even earlier.
Here we provide detailed and concrete evidence explaining features at the Jhura pond section, such as the subvertical nature of the beds, the ooid-bearing lithologies, the presence of various Oxfordian fossils, the difference in turritellids, naticid assemblages, and differences in the diversity curves between the present beds and the lower Miocene Chhasra Formation of Kutch. Detailed paleoecological analyses (both gastropods and bivalves) speak for two paleocommunities. We, therefore, reiterate that the present Jhura pond section sediments are Oxfordian in age and validate all the interpretations and conclusions that we have made in our previous papers.
We identify a set of essential recent advances in climate change research with high policy relevance, across natural and social sciences: (1) looming inevitability and implications of overshooting the 1.5°C warming limit, (2) urgent need for a rapid and managed fossil fuel phase-out, (3) challenges for scaling carbon dioxide removal, (4) uncertainties regarding the future contribution of natural carbon sinks, (5) intertwinedness of the crises of biodiversity loss and climate change, (6) compound events, (7) mountain glacier loss, (8) human immobility in the face of climate risks, (9) adaptation justice, and (10) just transitions in food systems.
Technical summary
The Intergovernmental Panel on Climate Change Assessment Reports provides the scientific foundation for international climate negotiations and constitutes an unmatched resource for researchers. However, the assessment cycles take multiple years. As a contribution to cross- and interdisciplinary understanding of climate change across diverse research communities, we have streamlined an annual process to identify and synthesize significant research advances. We collected input from experts on various fields using an online questionnaire and prioritized a set of 10 key research insights with high policy relevance. This year, we focus on: (1) the looming overshoot of the 1.5°C warming limit, (2) the urgency of fossil fuel phase-out, (3) challenges to scale-up carbon dioxide removal, (4) uncertainties regarding future natural carbon sinks, (5) the need for joint governance of biodiversity loss and climate change, (6) advances in understanding compound events, (7) accelerated mountain glacier loss, (8) human immobility amidst climate risks, (9) adaptation justice, and (10) just transitions in food systems. We present a succinct account of these insights, reflect on their policy implications, and offer an integrated set of policy-relevant messages. This science synthesis and science communication effort is also the basis for a policy report contributing to elevate climate science every year in time for the United Nations Climate Change Conference.
Social media summary
We highlight recent and policy-relevant advances in climate change research – with input from more than 200 experts.
Certain neuropsychiatric symptoms (NPS), namely apathy, depression and anxiety demonstrated great value in predicting dementia progression representing eventually an opportunity window for timely diagnosis and treatment. However, sensitive and objective markers of these symptoms are still missing.
Objectives
To investigate the association between automatically extracted speech features and NPS in early-stage dementia patients.
Methods
Speech of 141 patients aged 65 or older with neurocognitive disorder was recorded while performing two short narrative speech tasks. Presence of NPS was assessed by the Neuropsychiatric Inventory. Paralinguistic markers relating to prosodic, formant, source, and temporal qualities of speech were automatically extracted, correlated with NPS. Machine learning experiments were carried out to validate the diagnostic power of extracted markers.
Results
Different speech variables seem to be associated with specific neuropsychiatric symptoms of dementia; apathy correlates with temporal aspects, anxiety with voice quality and this was mostly consistent between male and female after correction for cognitive impairment. Machine learning regressors are able to extract information from speech features and perform above baseline in predicting anxiety, apathy and depression scores.
Conclusions
Different NPS seem to be characterized by distinct speech features which in turn were easily extractable automatically from short vocal tasks. These findings support the use of speech analysis for detecting subtypes of NPS. This could have great implications for future clinical trials.
Campeche, one of the Spanish Empire's main Mexican ports, was a place where previously distinct cultures and populations intermingled during the colonial era (AD 1540–1680). Investigation of the town's central plaza revealed a Hispanic cemetery of multi-ethnic burials. The authors combine previous analyses with newly generated genome-wide data from 10 individuals to trace detailed life histories of the mostly young, local Indigenous Americans and first-generation European and African immigrants, none of whom show evidence of genetic admixture. These results provide insights into the individual lives and social divides of the town's founder communities and demonstrate how ancient DNA analyses can contribute to understanding early colonial encounters.
Closing the material loop is fundamental to circular economy (CE). However, significant quantities of resources are currently landfilled. Today, companies realise the importance of take-back for CE but face several barriers in implementing it, lack of knowledge, being one such barrier. To address this, a proposal is presented for the design of a configurator to support companies evaluate different approaches, as well as opportunities and challenges for designing and implementing take-back. The paper presents a conceptual framework for the configurator, based on a systematic literature review.
Retraction pockets are collapsed segments of the tympanic membrane. Their formation is associated with a disruption in middle-ear ventilation pathways, leading to the loss of organised collagen of the tympanic membrane. There are several approaches in treating retraction pockets, which aim either to improve ventilation or repair the retraction pockets themselves.
Methods
A review of the literature regarding the classification and associated management of retraction pockets was conducted, using Medline and Cochrane Library databases, with the addition of our institution's experience in undertaking novel techniques.
Results
All the current classification systems fail to guide treatment or prognosticate the disease. Commonly, an initial conservative approach is suggested for early stages, with no clear indication regarding when a surgical solution should be offered. There are conflicting data concerning the effectiveness of these treatments in terms of disease prevention, recurrence and hearing outcomes.
Conclusion
Minimally invasive approaches utilising novel techniques may be key to reducing peri-operative morbidity and improving the overall patient experience.
In her detailed retelling of three iconic movements in India, Professor Emerita Krishna Mallick, PhD, gives hope to grassroots activists working toward environmental justice. Each movement deals with a different crisis and affected population: Chipko, famed for tree-hugging women in the Himalayan forest; Narmada, for villagers displaced by a massive dam; and Navdanya, for hundreds of thousands of farmers whose livelihoods were lost to a compact made by the Indian government and neoliberal purveyors of genetically modified organisms (GMOs). Relentlessly researched, the book presents these movements in a framework that explores Hindu Vedic wisdom, as well as Development Ethics, Global Environment Ethics, Feminist Care Ethics, and the Capability Approach.
At a moment when the climate threatens populations who live closest to nature - and depend upon its fodder for heat, its water for life, and its seeds for food - Mallick shows how nonviolent action can give poor people an effective voice.
Certain neuropsychiatric symptoms (NPS), namely apathy, depression, and anxiety demonstrated great value in predicting dementia progression, representing eventually an opportunity window for timely diagnosis and treatment. However, sensitive and objective markers of these symptoms are still missing. Therefore, the present study aims to investigate the association between automatically extracted speech features and NPS in patients with mild neurocognitive disorders.
Methods
Speech of 141 patients aged 65 or older with neurocognitive disorder was recorded while performing two short narrative speech tasks. NPS were assessed by the neuropsychiatric inventory. Paralinguistic markers relating to prosodic, formant, source, and temporal qualities of speech were automatically extracted, correlated with NPS. Machine learning experiments were carried out to validate the diagnostic power of extracted markers.
Results
Different speech variables are associated with specific NPS; apathy correlates with temporal aspects, and anxiety with voice quality—and this was mostly consistent between male and female after correction for cognitive impairment. Machine learning regressors are able to extract information from speech features and perform above baseline in predicting anxiety, apathy, and depression scores.
Conclusions
Different NPS seem to be characterized by distinct speech features, which are easily extractable automatically from short vocal tasks. These findings support the use of speech analysis for detecting subtypes of NPS in patients with cognitive impairment. This could have great implications for the design of future clinical trials as this cost-effective method could allow more continuous and even remote monitoring of symptoms.
Three Indian environmental movements are analyzed – the Chipko movement of the 1970s against deforestation, Narmada Bachao Andolan in the 1980s against dam-building, and Navdanya, the contemporary movement against genetically modified organisms (GMOs) – from three dimensions: nonviolence, feminism, and environmentalism. Each of these movements has accomplished its goals, with Chipko achieving a 15-year ban on tree-cutting, NBA succeeding in slowing down the building of dams on the Narmada river through litigation with the help of the World Bank and still fighting for the resettlement and rehabilitation of the displaced people, and Navdanya promoting local organic seeds for small farmers in India whose rights have been violated by multinational corporations monopolizing GM crops. The three movements followed three principles: environmental justice, intergenerational equality, and respect for nature.
Keywords: environmental justice, intergenerational equality, respect for nature, globalization from below, globalization from above
Many people believe, and rightly so, that the main source of environmental destruction in the world is the demand for natural resources caused by consumption by the rich, whether nations, individuals, or groups. The positive message of this book is that poor communities have the power to accomplish economically and environmentally sound goals. In various parts of India over the last five decades, several social justice and environmental movements have been formed and continue to emerge. Environmental sustainability has been the primary goal of many of these movements, and my aim in this book is to provide detailed accounts of three such movements that had both a local and a global impact.
The Chipko movement, with its focus on preventing deforestation; Narmada Bachao Andolan (NBA), which fought for the rights of villagers displaced by a dam; and the Navdanya movement, a seed repository of native varieties, together constitute a special triad in terms of the magnitude of their impact, their membership constituencies, and their lack of political affiliation. This book honours their contributions toward an ethics of ‘globalization from below’ as opposed to ‘globalization from above’. In simple terms, globalization from below is the struggle against social exclusion that involves coming up with new initiatives that have both local and global impacts. By contrast, globalization from above – neoliberalism – helps to maximize capitalist efficiency and economic growth through free markets and policies that promote multinational companies’ (deleterious) involvement in the resources of other countries.
The conclusion reiterates the three main messages of this book: that the human and the environmental world are interrelated; that economic and ecological development are not mutually exclusive; and that there is a relationship between the local and the global. Global activism is valuable, as it helps to bring to the forefront the voices of the disadvantaged. From a moral point of view, the well-being of all humans – both the advantaged and the disadvantaged – are equally important. The Chipko, NBA, and Navdanya movements have made a global impact by taking the discourse on economic development to a new level that includes the voices of the powerless and the centrality of environmental sustainability. In order to make progress towards global environmental sustainability, a paradigm shift must be made in democratic societies.
Keywords: global environmental theory, feminist care ethics, ethics of Nonviolence
As India goes through a sweeping process of economic transformation, environmental sustainability concerns must be at the forefront of its development discourse. India's food grain production has increased considerably from the 1960s to the 1980s, and its economy has developed significantly in the 1990s and 2000s. One might think that, with its robust economic development and self-sufficient food production, all segments of the Indian population have benefited and all issues related to food sovereignty have been resolved. That is not the case today.
The chapters of this book have presented perspectives on the economic development discourse as they took shape within the Chipko movement (1970s), the Narmada Bachao Andolan (1980s and 1990s), and the contemporary Navdanya movement. Social justice is at the core of each of these three movements. Social equity is an important component of social justice. In an equitable society, there should not be any discrimination that prevents people from functioning socially, politically, and economically. Unfortunately, this is not the case in the real world.
By social justice, we generally mean how both the good and bad aspects of life are distributed among the members of a society. Social justice is related to ‘distributive justice’, meaning how the goods and services of a society are distributed. Some of the themes of social justice involve equity, human rights, environmental justice, sustainability, and globalization.
After tracing the history of dam-building, specifically the Sardar Sarovar Project in the Narmada river which traverses the three states of Gujarat, Maharashtra, and Madhya Pradesh, this chapter analyzes the Narmada Bachao Andolan protest movement which started in the 1980s and was led by Medha Patkar and others following the Gandhian method of satyagraha. The NBA took the SSP to the Indian Supreme Court with the help of the World Bank, leading to the suspension of the project for a short time. The NBA is continuing its efforts to obtain a proper rehabilitation policy for the indigenous population (adivasi) displaced by the SSP, as the government has infringed on the right to survival of the people living around the dams. The NBA has made a global impact by launching a dialogue about biodiversity and sustainability.
The Narmada Bachao Andolan (NBA) or ‘Save the Narmada’ movement originated in the 1980s as a protest against the building of dams in the Narmada River, a major waterway flowing across the Indian states of Madhya Pradesh, Maharashtra, and Gujarat. The movement was led by a woman, Medha Patkar, and was embraced by poor indigenous people who were displaced due to the dam-building. Whereas the Chipko movement a decade earlier had focused attention on preserving access to forest resources by local people, the NBA insisted that those people whose rights to local resources cannot be protected due to development – of a dam, for example – should be compensated as well as resettled. In this way, economic justice is served. Dam-building, like forest clear-cutting, has a long colonial and postcolonial history in India. By 1999, India had become the world's third largest dambuilder, trailing only China and the United States.
The specific target of the NBA's protests was the development of the Sardar Sarovar Project (SSP), the second largest of 30 very massive dams that were part of a larger plan for 3,000 dams in India. Today, the SSP has one of the largest canal networks in the world. The primary rationale for building the dam was to provide irrigation and drinking water, but as a multipurpose dam and canal system, it also produces electrical power.
This chapter addresses the issue of sustainable agriculture by relating it to food sovereignty and food security and the contribution that Navdanya is making by promoting seed satyagraha, or civil disobedience against seed control by large corporations. The founder of Navdanya, Vandana Shiva, is highly critical of GM crops and chemically based industrial agriculture, which are monopolized by multinational companies in India. Shiva's philosophy of Earth Democracy is based on the premise of the interconnectedness of everything. Agroecology must be transformed based on sustainable agriculture, which is possible only by promoting local farmers who use organic seeds from community seed banks such as those started by Navdanya and can protect their livelihood and communities as well as the natural resources.
Keywords: GMOs (genetically modified organisms), Earth Democracy, Vandana Shiva, food sovereignty, sustainable agriculture, La Via Campesina
In the 1960s and 1970s, the Green Revolution in India provided food security for a nation whose population had more than doubled since independence in 1947. Agricultural productivity was achieved through heavy reliance on fertilizers and pesticides as well a few high-yield seed varieties, sown in the agricultural practice of monocropping – growing a single crop repeatedly on the same land to increase efficiency – which in turn reduces agricultural diversity. Decades of monocropping have led to soil salinization and degradation, along with major increases in water consumption through public subsidies and abusive practices (Vyas, 2003) as well as accelerated groundwater depletion even in such rain-fed states as Andhra Pradesh, Karnataka, Rajasthan, Madhya Pradesh, Chhattisgarh, and Gujarat (Virmani & Lepineux, 2015).
The Navdanya movement is a struggle for freedom against large transnational corporations and their partnered states for the most fundamental survival needs: food and water. In this movement, independent and indigenous farmers practiced civil disobedience by refusing to follow laws constructed and enforced by the very states charged with protecting their fundamental human rights (Armaline & Glasberg, 2009). Agricultural biotechnology is at the forefront of the international development discourse. The debate around genetically modified (GM) crops has widened to include the future of agriculture and small-scale farmers, corporate control, property rights, and the rules of global trade (Scoones, 2008).