As the population of Aotearoa New Zealand ages, informal family carers will play an increasingly important role in caring for older adults at home. Multi-generational living arrangements are a growing trend, particularly among Māori communities, where caring for older relatives within the family home is widespread. This article uses in-depth, semi-structured interviews with Māori whānau (extended family members) caring for kaumātua (older family members) at home to explore how carers experienced care coordination in the broader care collective. The findings centred on three interconnected factors that described the collective organisation of care: (1) whānau care as normal; (2) whānau care as collective coordination; and (3) whānau carer knowledge and needs as unseen. The findings show that although whānau care of kaumātua is highly valued, ‘structural holes’ within care systems contribute to challenges in care coordination. Despite extensive whānau support for kaumātua, primary carers often felt that their knowledge, preferences and self-care needs remained unseen and not translatable to those outside the everyday care situation. Rather than assuming an artificial binary difference between ‘collective’ and ‘individually oriented’ care contexts and cultures, analysing the cultural norms surrounding whānau care-giving confirms that collective care system members face similar and different challenges to carers with smaller caring capacities.

OBJECTIVES/GOALS: The primary research goal was to identify brain alterations reliably associated with obesity using coordinate-based meta-analysis. A secondary goal was to compare brain alterations in metabolically healthy (MHO) and unhealthy (MUO) obesity. METHODS/STUDY POPULATION: Source data were peer-reviewed studies reporting locations of gray-matter alterations in group-average, case-control contrasts (obese vs. non-obese) cohorts, performed in a whole-brain, voxel-wise manner. Both voxel-based morphometry and voxel-based physiology studies were included. Three coordinate-based meta-analyses were performed: Pooled (MUO + MHO), MHO, and MUO. RESULTS/ANTICIPATED RESULTS: Thirty-two studies reporting a total of 50 case-control contrasts (MHO, 23; MUO, 27) met inclusion criteria, representing 3,368 participants (obese, 1,781; non-obese, 1587). The pooled analysis yielded 8 cerebral foci (3 nuclear, 5 cortical) in regions implicated in reward-seeking, cognitive, and interoceptive behaviors. MHO yielded 7 cerebral foci (4 nuclear, 3 cortical), partially overlapping Pooled results, with similar behavioral loadings. The MUO pattern was distinct, with 3 cerebellar and 1 occipital foci. DISCUSSION/SIGNIFICANCE: Brain alterations occurred reliably in obesity. The dominant pattern (Pooled & MHO) involved cerebral reward-system circuits, evident even in metabolically healthy obesity. Cerebellar alterations occurred exclusively in metabolically unhealthy obesity, a pattern previously reported in metabolic syndrome.

Companion animals, or ‘pets’, are integral to many people's lives and to their sense of home. However, older people living with companion animals are vulnerable to separation from their animals when moving to a care home. Such separation is often a highly significant loss which, combined with other losses, may reinforce experiences of dislocation. Existing research draws attention to the importance of developing a sense of ‘home’ in a care home through reinforcing and preserving personal connections. However, there is a paucity of research examining the preservation of connections between older people resident in care homes and their animal/s. This study draws on thematic analysis of 29 qualitative interviews with older people living in care homes, relatives, care home staff and other relevant stakeholders. It highlights that retaining existing, often long-term, bonds with companion animals represent important continuities and connections which may contribute to positive adjustment to life in a care home and creating a sense of home. However, participants highlighted that supporting an older person to move into a care home with their companion animal may be challenged by real or perceived constraints such as use of shared space, concerns about the risks posed by animals and staff implications. While our study found examples of good practice of how shared residence between an older person and companion animal can be achieved in a care home, other examples highlighted that the time, complexity of planning and structures required to accommodate animals were prohibitive to merit a change of policy and practice. Our research concludes that more attention should be given to the older person–animal bond as an important source of continuity and connection.

Paromomyidae are one of several families of plesiadapiforms that flourished during the Paleocene in North America soon after the extinction of non-avian dinosaurs some 66 million years ago. Although they are often among the best-represented plesiadapiforms in mammalian faunas in both North America and Europe, the early history of paromomyids is poorly understood, and their fossil record at higher latitudes is comparatively depauperate. We report here on the discovery of two new species of paromomyids from Paleocene deposits in southwestern Alberta: Edworthia greggi new species is the second known species of the basal paromomyid Edworthia Fox, Scott, and Rankin, 2010 whereas Ignacius glenbowensis new species is among the most abundantly represented species of Ignacius Matthew and Granger, 1921. These new discoveries document, for the first time, parts of the upper dentition of Edworthia, and the new species of Ignacius represents the first new, pre-Clarkforkian species of the genus to be described in nearly 100 years. A comprehensive phylogenetic analysis of nearly all known paromomyid taxa (including the new species described herein) recovered both species of Edworthia near the base of the paromomyid tree in a polytomy with Paromomys depressidens Gidley, 1923 and a paraphyletic Ignacius. The new paromomyids from Alberta not only increase the known taxonomic diversity of Edworthia and Ignacius but also add significantly to knowledge of the dental anatomy of these poorly known genera and further add to a uniquely Canadian complement of Paleocene plesiadapiforms.

UUID: http://zoobank.org/a2f31cfe-09b9-4168-b09f-9d0c3d0af342

Interprofessional collaboration is understood to improve efficiencies and quality of care but is associated with challenges such as professionals’ differing routines, knowledge, and identities, as well as professional hierarchies and time constraints. Given these challenges, there is limited understanding of how professionals collaborate effectively in providing patient-centred care. This study, with a convergence triangulation mixed-methods study design, explored interprofessional staffs’ perceptions of interprofessional collaboration and patient-centred care when working with hospitalized older adults. Thirty-six staff responded to a survey which included the Patient-Centred Care measure and the Modified Index of Interdisciplinary Collaboration; we also interviewed 14 nursing staff. Although all scores suggested a high value was placed on interprofessional collaboration, scores were low related to activities that facilitated team processes. We identified three themes from the data: knowing the patient/family, functional needs, and communication processes. Staff identified daily rounds with interprofessional teams as supportive of interprofessional collaboration and patient-centred-care.

Surface mass-balance and geometry data are key to quantifying the climate response of glaciers, and confidence in data synthesis and model interpretations and forecasts requires data from as wide a range of locations and glacier types as possible. This paper presents measurements of surface elevation change at the Svalbard surge-type glacier Finsterwalderbreen, by comparing a 1990 digital elevation model (DEM) with a surface GPS profile from 2003. The pattern of elevation change is consistent with that previously noted between 1970 and 1990, and reflects the continued quiescent-phase evolution of the glacier, with mass loss in the down-glacier/receiving area of up to –1.25mw.e. a–1, and mass gain in the up-glacier/reservoir area of up to 0.60 mw.e. a–1; the area-weighted, mean change for the whole glacier is 0.19mw.e. a–1. The spatial pattern of elevation increase and decrease is complex, and the boundary between thickening and thinning determined by combining GPS and DEM data does not appear to correspond with the equilibrium-line altitude determined from surface mass-balance measurements. There is no evidence yet of a decrease in the rate of reservoir area build-up driven by mass-balance change resulting from the warmer winter air temperatures, and decreased proportion of snowfall in total precipitation, noted at meteorological stations in Svalbard.

We examined caregiver report of externalizing behavior from 12 to 54 months of age in 102 children randomized to care as usual in institutions or to newly created high-quality foster care. At baseline no differences by group or genotype in externalizing were found. However, changes in externalizing from baseline to 42 months of age were moderated by the serotonin transporter linked polymorphic region genotype and intervention group, where the slope for short–short (S/S) individuals differed as a function of intervention group. The slope for individuals carrying the long allele did not significantly differ between groups. At 54 months of age, S/S children in the foster care group had the lowest levels of externalizing behavior, while children with the S/S genotype in the care as usual group demonstrated the highest rates of externalizing behavior. No intervention group differences were found in externalizing behavior among children who carried the long allele. These findings, within a randomized controlled trial of foster care compared to continued care as usual, indicate that the serotonin transporter linked polymorphic region genotype moderates the relation between early caregiving environments to predict externalizing behavior in children exposed to early institutional care in a manner most consistent with differential susceptibility.

Pain, spasticity, tremor, spasms, poor sleep quality, and bladder and bowel dysfunction, among other symptoms, contribute significantly to the disability and impaired quality of life of many patients with multiple sclerosis (MS). Motor symptoms referable to the basal ganglia, especially paroxysmal dystonia, occur rarely and contribute to the experience of distress. A substantial percentage of patients with MS report subjective benefit from what is often illicit abuse of extracts of the Cannabis sativa plant; the main cannabinoids include delta-9-tetrahydrocannabinol (Δ9-THC) and cannabidiol. Clinical trials of cannabis plant extracts and synthetic Δ9-THC provide support for therapeutic benefit on at least some patient self-report measures. An illustrative case is presented of a 52-year-old woman with MS, paroxysmal dystonia, complex vocal tics, and marijuana dependence. The patient was started on an empirical trial of dronabinol, an encapsulated form of synthetic Δ9-THC that is usually prescribed as an adjunctive medication for patients undergoing cancer chemotherapy. The patient reported a dramatic reduction of craving and illicit use; she did not experience the “high” on the prescribed medication. She also reported an improvement in the quality of her sleep with diminished awakenings during the night, decreased vocalizations, and the tension associated with their emission, decreased anxiety and a decreased frequency of paroxysmal dystonia.

This paper engages with a changing politics of male circumcision. It suggests that various shifts which have occurred in how the issue is debated challenge legal constructions of the practice as a private familial issue. Although circumcision rates have declined in those Western nations which have traditionally practised it, the procedure is now being promoted as a medicalised response to the HIV/AIDS pandemic in sub-Saharan Africa. Such initiatives propose a new biomedical rationale for the practice and have been difficult to confine to the African context or to adult bodies, prompting a resurgence of enthusiasm for neonatal male circumcision on the part of professional bodies in the USA and elsewhere. Although we have reservations about such public health policies, which we suggest downplay risks inherent in the procedure both for the individual and for the advancement of public health, we argue that such strategies have the potential to move debates about circumcision beyond the parameters of traditional ‘medical law’, with its focus on the doctor–patient nexus and the issue of who can validly consent to medical procedures. We suggest that, as with female genital cutting, male circumcision ought to be debated within a paradigm of social justice which gives adequate weighting to the interests of all affected parties (including women whose health may actually be compromised by the procedure) and which renders visible the socio-economic dimensions of the issue. In line with a social justice approach, we argue that public health initiatives must comply with international ethico-legal standards and be attentive to the emergence of an international human right to health. The shift in analytical frame that we propose has the potential not only to make us re-think our approach to the ethics and legality of male circumcision by challenging its construction as a familial decision but also to impact on the need for a broader conceptualisation of health law as rooted in social justice.