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To explore the meanings that newly arrived refugee adolescents residing in the Southeastern USA attribute to foods.
Design:
We used methods from cognitive anthropology to assess whether adolescents from different countries share a cultural model of eating behaviours.
Setting:
A school-based study in a community in the Southeastern USA.
Participants:
Adolescents (10–17 years) who arrived in the USA on a refugee visa in the previous year.
Results:
Adolescents showed consensus in grouping items and in identifying some foods as associated with adults and others with children. There was evidence of a shared model of eating practices across age, gender and number of siblings. Adolescents who had lived in a refugee camp were significantly different in how they grouped items.
Conclusions:
Adolescents from nine countries shared a model of eating behaviours; these patterns are consistent with rapid dietary acculturation within 1 year of arrival or with shared models held from pre-arrival. Our finding that adolescents who recently arrived in the USA generally agree about how foods relate to one another holds promise for generalised nutrition and dietary interventions across diverse adolescent groups.
There are ethnic differences, including differences related to indigeneity, in the incidence of first episode psychosis (FEP) and pathways into care, but research on ethnic disparities in outcomes following FEP is limited.
Aims
In this study we examined social and health outcomes following FEP diagnosis for a cohort of Māori (Indigenous people of New Zealand) and non-Māori (non-Indigenous) young people. We have focused on understanding the opportunities for better outcomes for Māori by examining the relative advantage of non-Māori with FEP.
Method
Statistics New Zealand's Integrated Data Infrastructure was accessed to describe mental health and social service interactions and outcomes for a retrospective FEP cohort comprising 918 young Māori and 1275 non-Māori aged 13 to 25 at diagnosis. Logistic regression models were used to examine whether social outcomes including employment, benefit receipt, education and justice involvement in year 5 differed by indigeneity.
Results
Non-Māori young people were more likely than Māori to have positive outcomes in the fifth year after FEP diagnosis, including higher levels of employment and income, and lower rates of benefit receipt and criminal justice system involvement. These patterns were seen across diagnostic groups, and for both those receiving ongoing mental healthcare and those who were not.
Conclusions
Non-Māori experience relative advantage in outcomes 5 years after FEP diagnosis. Indigenous-based social disparities following FEP urgently require a response from the health, education, employment, justice and political systems to avoid perpetuating these inequities, alongside efforts to address the disadvantages faced by all young people with FEP.
Methodological approaches in social neuroscience have been rapidly evolving in recent years. Fueling these changes is the adoption of a variety of multivariate approaches that allow researchers to ask a wider and richer set of questions than was previously possible with standard univariate methods. In this chapter, we introduce several of the most popular multivariate methods and discuss how they can be used to advance our understanding of how social cognition and personality processes are represented in the brain. These methods have the potential to allow neuroscience measures to inform and advance theories in social and personality psychology more directly and are likely to become the dominant approaches in social neuroscience in the near future.
Children’s cooking programs have been linked to increased cooking frequency and positive dietary outcomes (1,2). A systematic review on children’s cooking interventions with a control group, in a variety of settings, on all age groups has not yet been conducted. Thus, we aimed to examine the effects of children’s participation in published cooking interventions on their cooking skills, food acceptance, and dietary behaviors; and the quality of the scientific evidence.
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two independent electronic searches across six databases were conducted to identify cooking-focused interventions with comparison groups among participants aged up to 18 years old, published in English, between 2017 and 2022. Studies were assessed on quality using the Academy of Nutrition and Dietetics Evidence Analysis Library quality criteria checklist.
Among 1104 articles identified, 23 met inclusion criteria and described main results for distinct interventions. Interventions varied in participant age, settings, cooking sessions and program length. Knowledge of cooking skills, self-efficacy and involvement were the most frequent positive outcomes; improvements in dietary intake were rarely achieved. Seven studies were highly rated for research quality.
Lack of assessment standardization, variability in program characteristics, and insufficient intervention description made it difficult to discern best practices for children’s cooking programs.
Improvements in intervention development and measurement instruments are needed.
Interventions that include hands-on cooking lessons seem promising in improving knowledge and self-efficacy, however, further exploration is needed on the factors that make cooking programs successful long-term, while considering age and gender.
The POWER study (NCT05688956) is a 12-week randomised controlled trial (ongoing) investigating the effectiveness of a novel protein-based oral nutritional supplement combined with an online resistance training programme for community-dwelling adults aged 70+ who require home care and are at risk of sarcopenia. Older adults reliant on home care are an understudied cohort acknowledged as vulnerable to sarcopenia(1) and malnutrition(2). This study aims to report the preintervention (baseline) functional status and dietary intake of older adults recruited to the POWER study.
Community-dwelling adults (≥70 y) living in Ireland receiving supportive home care and at risk of sarcopenia. Sarcopenia was screened for using the Strength, Assistance walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) questionnaire with a cut-off score of ≥1(3) (out of 10). Participants were recruited into the POWER study between July 2023 and January 2024. Data on participant demographic, nutritional status (anthropometric measures and 24-hour multiple-pass dietary recall) and muscle strength (handgrip strength (Jamar® dynamometer) and five times sit-tostand) were obtained during pre-intervention home visits. Dietary intake was analysed using NutriticsTM software (version 5.96). Intakes of protein and kilocalories were calculated as grams per kilogram body weight (g/kgBW) and as kilocalorie per kilogram body weight (kcal/kgBW) respectively. Statistical analysis was performed using RStudio (2023.06.2).
Seventeen adults aged 70+ were recruited over a 7-month period (12F, 5M; age range 71-87 years). Ten participants were receiving informal home care (i.e., from a relative) with seven receiving professional home care. All participants had a SARC-F score over 4, with a mean score of 5±1.3. Median BMI was 28.7 (range 17.1-36.2) kg/m2. One participant was underweight (BMI 17.1 kg/m2), five were overweight (BMI ≥24.9 kg/m2) and six were living with obesity (BMI ≥30 kg/m2). Using the Mini-Nutritional Assessment-Full Form (MNA-FF), nine participants were at risk of malnutrition (MNA-FF 17–23.5), and one was malnourished (MNA-FF =16.5). Mean intake of protein was 0.84±0.23 g/kgBW/day, with only two participants consuming ≥1.0 g/kgBW/day. Mean daily energy intake was 1,488 kcal or 17.0 kcal/kgBW. Time taken for five times sit-to-stand was 21±8 seconds (>15 seconds for five rises(4)) and handgrip strength was 15±6 kg (<16 kg for females(4)) and 21±12 kg (<27 for males(4)) for females and males, respectively.
Analysis of the pre-intervention data from the POWER study indicates that older adults at risk of sarcopenia are not meeting recommended daily protein intakes of 1-1.2 g/kgBW(5). Participants also demonstrated poor muscle strength. This highlights the need for a multi-component approach to support dietary intake and muscle strength in older adults reliant on home care.
This chapter focuses on causal inference in healthcare, emphasizing the need to identify causal relationships in data to answer important questions related to efficacy, mortality, productivity, and care delivery models. The authors discuss the limitations of randomized controlled trials due to ethical or pragmatic considerations and introduce quasi-experimental research designs as a scientifically coherent alternative. They divide these designs into two broad categories, independence-based designs and model-based designs, and explain the validity of assumptions necessary for each design. The chapter covers key concepts such as potential outcomes, selection bias, heterogeneous treatment effects bias, average treatment effect, average treatment effect for the treated and untreated, and local average treatment effect. Additionally, it discusses important quasi-experimental designs such as regression discontinuity, difference-in-differences, and synthetic controls. The chapter concludes by highlighting the importance of careful selection and application of these methods to estimate causal effects accurately and open the black box of healthcare.
People with psychosis experience worse cardiometabolic health than the same-aged general population. In New Zealand, Indigenous Māori experiencing psychosis have greater risk of cardiometabolic and other physical health problems.
Aims
To identify a cohort of adults accessing secondary mental health and addiction services in New Zealand, with a previous psychosis diagnosis as of 1 January 2018, and compare odds of hospital admission outcomes, mortality and receipt of cardiometabolic blood screening between Māori and non-Māori in the following 2 years.
Method
Crude and adjusted logistic regression models compared odds of hospital admission outcomes, mortality and receipt of cardiometabolic blood screening (lipids and haemoglobin A1c) between Māori and non-Māori, occurring between 1 January 2018 and 31 December 2019.
Results
A cohort (N = 21 214) of Māori (n = 7274) and non-Māori (n = 13 940) was identified. Māori had higher adjusted risk of mortality (odds ratio 1.26, 95% CI 1.03–1.54), and hospital admission with diabetes (odds ratio 1.64, 95% CI 1.43–1.87), cardiovascular disease (odds ratio 1.54, 95% CI 1.25–1.88) and any physical health condition (odds ratio 1.07, 95% CI 1.00–1.15) than non-Māori. Around a third of people did not receive recommended cardiometabolic blood screening, with no difference between Māori and non-Māori after covariate adjustment.
Conclusions
Māori experiencing psychosis are more likely to die and be admitted to hospital with cardiovascular disease or diabetes than non-Māori. Because of the higher cardiometabolic risk borne by Māori, it is suggested that cardiometabolic screening shortfalls will lead to worsening physical health inequities for Māori experiencing psychosis.
Background: Central venous catheter (CVC) utilization and central-line associated bloodstream infection (CLABSI) have increased nationwide. Busy providers can easily overlook the recommended practice of daily assessment of the ongoing indication for CVC. Prospective audit and feedback (PAF) is widely used and the gold standard for antibiotic stewardship programs (ASP), but reports involving PAF for device use are scarce. Therefore, we decided to evaluate the usefulness and feasibility of PAF for reducing device utilization and ultimately CLABSI rates at our 528-bed tertiary care hospital. Methods: A PAF-based Central Line Stewardship (CLS) initiative was launched in February 2023, with a team of hospitalists, infectious diseases physicians, health informatics, vascular access nurses, and infection preventionists. On business days, CVC line-lists were exported from the electronic medical record (EMR), into a REDCap (Research Electronic Data Capture) database for team members to evaluate, in real-time, all non-ICU CVCs in place for more >72 hours (Figures 1 and 2). For CVCs eligible for stewardship, CLS members placed Legal-approved note into the patient’s EMR, advising CVC removal or alternative IV access (Figure 3). CVCs continued to be audited until removal or patient discharge. Recommendation outcomes were tracked over the subsequent 72 hours for acceptance. Standardized Utilization Rates (SUR) and Infection Rates (SIR) were calculated and compared using the National Healthcare Safety Network. Results: Between February and August 2023, the CLS team reviewed 861 CVCs, representing 581 unique patient encounters, and made 622 recommendations. Recommendations to remove or replace the CVC represented 23.5% (146) of reviews, and 57% of these CVCs were removed within 3 days. 95% of removed lines had no adverse outcomes and did not require reinsertion. Hospital-wide CVC utilization decreased 18.7% from a SUR of 1.006 in the previous year, to 0.818 during the 7-month pilot period (p < 0 .001). In the 4 months following the pilot period, decreased CVC utilization was sustained with an SUR of 0.797. Non-ICU CLABSI SIR decreased from 1.282 in 2022 to 1.024 in 2023 (p=0.36). Average time physician required for CLS review approximated a 0.4 full-time equivalent a week. The intervention was well received, with requests for expansion to urinary catheters. Conclusion: CLS safely and significantly reduced device-utilization; directly via documentation and recommendation, and indirectly through increased awareness and the Hawthorne Effect. Examples of the “art” of CLS include when to leave a discoverable note and how to determine ongoing need for CVC in a fragile patient.
Few studies have examined the genetic population structure of vector-borne microparasites in wildlife, making it unclear how much these systems can reveal about the movement of their associated hosts. This study examined the complex host–vector–microbe interactions in a system of bats, wingless ectoparasitic bat flies (Nycteribiidae), vector-borne microparasitic bacteria (Bartonella) and bacterial endosymbionts of flies (Enterobacterales) across an island chain in the Gulf of Guinea, West Africa. Limited population structure was found in bat flies and Enterobacterales symbionts compared to that of their hosts. Significant isolation by distance was observed in the dissimilarity of Bartonella communities detected in flies from sampled populations of Eidolon helvum bats. These patterns indicate that, while genetic dispersal of bats between islands is limited, some non-reproductive movements may lead to the dispersal of ectoparasites and associated microbes. This study deepens our knowledge of the phylogeography of African fruit bats, their ectoparasites and associated bacteria. The results presented could inform models of pathogen transmission in these bat populations and increase our theoretical understanding of community ecology in host–microbe systems.
This conversation article brings together six of the original contributors to the 1993 Getting the Big Picture special issue of the British Journal for the History of Science. The contributors introduce their personal memories of the 1991 conference panel which formed the basis of that special issue. They also discuss the wider intellectual, institutional and political contexts of writing the history of science during the 1980s and 1990s, before concluding with reflections on the future of the discipline. The conversation was held live online via Microsoft Teams in March 2023. A professional transcript was produced by Sarah King. The transcript was then edited by James Poskett for length and clarity, before final edits were made by the contributors.
Antimicrobials are frequently used for palliation during end-of-life care, but adverse effects, such as antimicrobial resistance, are a concern. Shared decision-making is beneficial in end-of-life care conversations to help align antimicrobial-prescribing with patient preferences. However, there is limited data regarding optimal incorporation of antimicrobial-prescribing discussions into shared decision-making conversations. We explored healthcare provider, patient, and support caregiver (eg, family member/friend) perceptions of barriers and facilitators to discussing antimicrobial-prescribing during the end-of-life period.
Design:
Qualitative study.
Participants:
Healthcare providers; palliative care/hospice care patients/caregivers.
Methods:
We conducted semi-structured interviews on shared attitudes/beliefs about antimicrobial-prescribing during end-of-life patient care at one acute-care and one long-term-care facility. Interviews were analyzed for thematic content.
Results:
Fifteen providers and 13 patients/caregivers completed interviews. Providers recognized the potential benefit of leveraging shared decision-making to guide antimicrobial-prescribing decisions. Barriers included limited face-to-face time with the patient and uncertainty of end-of-life prognosis. Patients/caregivers cited trust, comprehension, and feeling heard as important characteristics which act as facilitators in fostering effective shared decision-making around antimicrobial use. Communication in which providers ensure patients are involved in shared decision-making discussions could be increased to ensure patients and their providers develop a mutually agreeable care plan.
Conclusions:
Shared decision-making is a practice that can guide antimicrobial-prescribing decisions during end-of-life care, thus potentially minimizing antimicrobial-related adverse effects. Our findings highlight opportunities for increased shared decision-making around antimicrobial use during end-of-life care. Interventions designed to address the identified barriers to shared decision-making have the potential to improve antimicrobial-prescribing practices at end-of-life.
It is widely known that those in the helping professions are mandated to report suspected incidences of child maltreatment. However, few are aware of the historical resistance to mandated reporting that helping professionals demonstrated before the passing of the Child Abuse Prevention and Treatment Act (CAPTA) of 1974 and the associated federal mandates that compelled helping professionals to engage in mandated reporting, oftentimes against their will. By analysing historical policy documents through a grounded theory approach, the authors identified three themes that describe the rationale for the passage of CAPTA: (1) identifying national evidence of child abuse; (2) resistance to intrusion of the helping professional-client relationship; and (3) the necessity of immunity waivers for those who reported instances of child abuse and misdemeanor punishment for those who failed to report such instances. In light of conversations around abolishing or reforming child protective services, it is important to understand how the first federal child protective services policy in the United States originated and how these regulations embedded social control into the foundation of the helping professional-client relationship, thus turning helping professionals into unwilling agents of the state. Implications of mandated reporting, including introducing a penal aspect to the helping professional-client relationship, are also explored.
It is uncontroversial that something goes wrong with the blaming practices of hypocrites. However, it is more difficult to pinpoint exactly what is objectionable about their blaming practices. I contend that, just as epistemologists have recently done with blame, we can constructively treat hypocrisy as admitting of an epistemic species. This paper has two objectives: first, to identify the epistemic fault in epistemically hypocritical blame, and second, to explain why epistemically hypocritical blamers lose their standing to epistemically blame. I tackle the first problem by appealing to an epistemic norm of consistency. I address the second by arguing that the epistemically hypocritical blamer commits to an opting-out of the set of shared epistemic standards that importantly underlies our standing to epistemically blame. I argue further that being epistemically hypocritical undermines a blamer's standing even to judge epistemically blameworthy.
Wildlife conservation on private land is an important approach that is increasingly utilized to protect biodiversity and can help contribute to the 30 by 30 target of the Global Biodiversity Framework. In 2018, a Chilean non-profit conservation organization launched a land conservation programme aiming to build long-term partnerships with private landowners to protect critical habitat for threatened amphibians in Chilean Patagonia. Here we describe a new locality record of the micro-endemic, Endangered Barrio's frog Insuetophrynus acarpicus found at a site that joined the programme in 2020. Barrio's frog is ranked 11th in the list of Evolutionarily Distinct and Globally Endangered amphibians. Our systematic literature search showed that most aspects of the natural history and ecology of this species are unknown, limiting our ability to provide actionable science to inform its conservation. The newly described Barrio's frog population is the eighth known locality of this species and one of only three occurring within a protected area. Habitat quality assessments indicated optimal conditions for most of the measured habitat parameters in the high-gradient stream where the species occurs. This case study illustrates that long-term partnerships between private landowners and conservationists can be used as an effective tool to protect the habitat of highly threatened amphibians.
In 2013, international news coverage started to emerge about a new Russian law that prohibited the positive depiction of non- traditional (meaning nonheteronormative) relations, lifestyles, and ideas. My first encounter with Russian state homophobia1 was a news article that reported the passing of the so- called ‘gay propaganda law’. The article was accompanied by a headline photograph of four individuals huddled together, one with blood streaming down their face, surrounded by police officers. I remember the moment I saw this photograph quite distinctly because it shocked me, left me feeling uncomfortable, and that image has stuck with me ever since.
Figure 4.1 is strikingly similar to the photographs accompanying those news articles. The moment I saw that photograph and read reports about the gay propaganda law, it wasn't immediately clear to me what its passing really boiled down to: arbitrary moralizing about the types of sex, bodily pleasures, and erotic desires one is allowed to have and legitimately pursue. I did not have the vocabulary to articulate what Russia's new law meant in terms of sex. I hadn't really considered that there might be a politics of sex. Nor was I able to put words around international dimensions of Russia's politicization of sex beyond pointing to ‘the international community’s’ obligation to do something. That sex and homophobia might be part of a broader geopolitical strategy— what I have since conceptualized as ‘heteronormative internationalism’ (Cooper- Cunningham, 2021: 11, 46; Gifkins et al, 2022: 11)— was surprising when I first encountered that image and long after.
That is the power that an image holds. Power to inspire thought, exploration, reflection, inquisitiveness, and theoretical play. Seeing that image in 2013, I failed to think through the politics or the power of visual representation, which is ironic given that it was a photograph of homophobic violence that provoked me; or to use Roland Barthes’ terminology, it possessed the amorphous ‘punctum’, that which ‘pricks me (but also bruises me, is poignant to me)’ (1981: 27). An image can have an immediate affective and vividly experienced effect on an individual, but it can also take time for the political to surface and become clear. In my case, this happened over several years. Those years involved finding the tools, vocabulary, and knowledge of queer and visual politics to enable me to grasp what was going on in a meaningful way.
This eighteenth-century study of the life and writings of the medieval English bishop Robert Grosseteste was too scandalous to be published in its author's lifetime. It is now available in print for the first time, showing how Grosseteste's reputation continued to be contested five centuries after his death.
Pediatric traumatic brain injury (TBI) is the leading cause of disability in children under the age of 15, often resulting in executive function deficits and poor behavioral outcomes. Damage to white matter tracts may be a driving force behind these difficulties. We examined if whether 1) greater TBI severity was associated with worse neurobehavioral outcome, 2) greater TBI severity was associated with tract-based white matter microstructure, and 3) worse neurobehavioral outcome was associated with white matter microstructure.
Participants and Methods:
Twelve children with complicated-mild TBI (cmTBI; Mage=12.59, nmale=9), 17 with moderate-to-severe TBI (msTBI; Mage =11.50, nmale=11), and 21 with orthopedic injury (OI; Mage =11.60, nmale=16), 3.94 years post injury on average, were recruited from a large midwestern children’s hospital with a Level 1 Trauma Center. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and Child Behavior Checklist (CBCL) while children completed 64-direction diffusion tensor imaging in a Siemens 3T scanner. White matter microstructure was quantified with FMRIB’s Diffusion Toolbox (FSLv6.0.4). Tract-Based Spatial Statistics computed fractional anisotropy (FA) and mean diffusivity (MD) for the cingulum bundle (CB), inferior fronto-occipital fasciculus (IFOF), superior longitudinal fasciculus (SLF), and uncinate fasciculus (UF), bilaterally.
Results:
Group differences were assessed using one-way ANOVA. Children with msTBI were rated as having worse Sluggish Cognitive Tempo on the CBCL than children with cmTBI and OI (p=.02, eta2=.143); no other parent-rated differences reached significance. Group differences were found in left SLF FA (p=.031; msTBI<cmTBI=OI) and approached significance in left UF FA (p=.062, eta2=.114; msTBI<OI). Group differences were also found in right IFOF MD (p=.048; msTBI>OI) and left SLF MD (p=.013; msTBI>cmTBI=OI). Bivariate correlations assessed cross-domain associations. Higher left IFOF FA was associated with better BRIEF Metacognitive Skills (r=-.301, p=.030) and CBCL School Competence (r=.280; p=.049). Higher left SLF FA was associated with better BRIEF Behavioral Regulation and Metacognitive Skills (r=-.331, p=.017 and r=-.291, p=.036, respectively), and CBCL School Competence and Attention Problems (r=.398, p=.004 and r=-.435, p=.001, respectively). Similarly, higher right UF FA was broadly associated with better neurobehavioral outcomes, including Behavioral Regulation and Metacognitive Skills (r=-.324, p=.019 and r=-.359, p=.009, respectively), and School Competence, Attention Problems, and Sluggish Cognitive Tempo (r=.328, p=.020, r=-.398, p=.003, and r=-.356, p=.010, respectively). Higher right CB MD was associated with worse Behavioral Regulation (r=.327, p=.018) and more Attention Problems (r=.278, p=.046); higher left and right SLF MD was associated with Sluggish Cognitive Tempo (r=.363, p=.008, r=.408, p=.003, respectively).
Conclusions:
Children with TBI, particularly msTBI, were rated as having cognitive slowing; while other anticipated group differences in neurobehavioral outcomes were not found, this appears driven by milder difficulties in cmTBI and OI groups. In fact, across CBCL and BRIEF subscales, children with msTBI were rated as approaching or exceeding a full standard deviation deficit based on normative data. TBI severity was also associated with white matter microstructure and cross-domain associations linked microstructure with observable neurobehavioral morbidities, suggesting a possible mechanism post-injury. Future longitudinal studies would be useful to examine the temporal evolution of deficits.