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The role of conscience in healthcare decision-making is explored in this important intervention in the fields of Health Law and Ethics, Medicine, Nursing and Philosophy. It takes a broad approach to conscience, looking beyond the standard examples of conscientious objection to argue that conscience permeates healthcare decisions. However, it also shows that not all decisions of conscience are worthy of legal or societal protection and that these are interests to be weighed rather than rights. Instead, conscience should be protected only when the individual exercising conscience abides by specific responsibilities. Additionally, the book explores the important issues of complicity with healthcare decisions and institutional or organisational conscience and argues they play an oversized role in general discussions of conscience. It further claims that we ought to pay much more attention to conscientious provision. The book concludes by looking at ways to more effectively regulate claims of conscience.
We present the Evolutionary Map of the Universe (EMU) survey conducted with the Australian Square Kilometre Array Pathfinder (ASKAP). EMU aims to deliver the touchstone radio atlas of the southern hemisphere. We introduce EMU and review its science drivers and key science goals, updated and tailored to the current ASKAP five-year survey plan. The development of the survey strategy and planned sky coverage is presented, along with the operational aspects of the survey and associated data analysis, together with a selection of diagnostics demonstrating the imaging quality and data characteristics. We give a general description of the value-added data pipeline and data products before concluding with a discussion of links to other surveys and projects and an outline of EMU’s legacy value.
The scatter in global atomic hydrogen (Hi) scaling relations is partly attributed to differences in how Hi and stellar properties are measured, with Hi reservoirs typically extending beyond the inner regions of galaxies where star formation occurs. Using pilot observations from the Widefield ASKAP L-band Legacy All-sky Blind Survey (WALLABY), we present the first measurements of Hi mass enclosed within the stellar-dominated regions of galaxies for a statistical sample of 995 local gas-rich systems, investigating the factors driving its variation. We examine how global Hi scaling relations change when measurements are restricted to $R_{\text{25}}$ and $R_{\text{24}}$ – the isophotal radii at 25 and 24 mag arcsec$^{-2}$ in the i-band – and explore how the fraction of Hi mass and Hi surface density within these radii correlate with other galaxy properties. On average, 68% of the total Hi mass is enclosed within $R_{\text{25}}$ and 54% within $R_{\text{24}}$, though significant variation exists between galaxies, ranging from $\sim$20% to 100%. The fraction of Hi mass within $R_{\text{25}}$ shows a mild correlation with stellar properties, with galaxies of higher stellar mass, greater stellar surface density, or redder colours enclosing a larger fraction of their Hi reservoirs. These correlations do not significantly strengthen when considering $R_{\text{24}}$. Conversely, global Hi surface densities show no significant correlation with stellar mass or stellar surface density, but trends start emerging when these are measured within the inner regions of galaxies. The strongest correlation is observed with optical colour, with bluer galaxies having higher average Hi surface densities within $R_{\text{25}}$. This trend of the average Hi surface density with optical colour strengthens when we restrict from $R_{\text{25}}$ to $R_{\text{24}}$, suggesting a closer connection between inner Hi reservoirs and star formation. This study underscores the value of (at least marginally) resolved Hi surveys of statistical samples for advancing our understanding of the gas-star formation cycle in galaxies.
Posttraumatic stress disorder (PTSD) has been associated with advanced epigenetic age cross-sectionally, but the association between these variables over time is unclear. This study conducted meta-analyses to test whether new-onset PTSD diagnosis and changes in PTSD symptom severity over time were associated with changes in two metrics of epigenetic aging over two time points.
Methods
We conducted meta-analyses of the association between change in PTSD diagnosis and symptom severity and change in epigenetic age acceleration/deceleration (age-adjusted DNA methylation age residuals as per the Horvath and GrimAge metrics) using data from 7 military and civilian cohorts participating in the Psychiatric Genomics Consortium PTSD Epigenetics Workgroup (total N = 1,367).
Results
Meta-analysis revealed that the interaction between Time 1 (T1) Horvath age residuals and new-onset PTSD over time was significantly associated with Horvath age residuals at T2 (meta β = 0.16, meta p = 0.02, p-adj = 0.03). The interaction between T1 Horvath age residuals and changes in PTSD symptom severity over time was significantly related to Horvath age residuals at T2 (meta β = 0.24, meta p = 0.05). No associations were observed for GrimAge residuals.
Conclusions
Results indicated that individuals who developed new-onset PTSD or showed increased PTSD symptom severity over time evidenced greater epigenetic age acceleration at follow-up than would be expected based on baseline age acceleration. This suggests that PTSD may accelerate biological aging over time and highlights the need for intervention studies to determine if PTSD treatment has a beneficial effect on the aging methylome.
The Lower Mekong Basin (LMB) denotes the geographical area that drains into the Mekong River and its tributaries within the Lao PDR, Thailand, Cambodia and Viet Nam. Hydropower development of the LMB’s water resources is proceeding at a rapid pace (Friend, Arthur, & Keskinen, 2009). In addition to 124 hydropower projects at various stages of development, up to twelve mainstream dams are planned for the LMB (ICEM, 2010; MRC, 2010). This large- scale hydro-development involves countless trade-offs of interests, creating clear winners and losers. One of the most significant tradeoffs is that between the ‘traditional’ and ‘modern’ sectors.
In the first issue of this journal, Mr R. E. McGarvie, Q.C., examined, ‘from a lawyer's viewpoint the way in which Commonwealth industrial arbitration is operating sixty years after the commencement …’ of the Commonwealth Conciliation and Arbitration Act. Limiting himself ‘to an examination of the working of the Commission in the exercise of its arbitral powers’ he nevertheless acknowledged that the system, the tribunal and the concept of Commonwealth industrial arbitration have been subject to a variety of criticisms.
Objectives/Goals: This study aim to identify cervical cancer prevention barriers and facilitators, assess the associations between social determinants of health factors and cervical cancer prevention, and examine the association between levels of health literacy and willingness to undertake HPV vaccine and cervical cancer screening among Black and Hispanic women. Methods/Study Population: To achieve Aim 1, we will conduct a quantitative survey on barriers and facilitators to cancer prevention among non-Hispanic Black and Hispanic women. For Aim 2, we will assess the relationship between Social Determinants of Health and HPV vaccination/cervical cancer screening using the AHC Health-Related Social Needs Screening Tool. For Aim 3, health literacy will be measured using the SAHL–S&E test and its association with willingness to vaccinate or cervical cancer screening. We will analyze the results using chi-square and logistic regression models. Participants will be recruited through multiple methods. We will recruit 250 individuals who were assigned female at birth and identify as non-Hispanic Black or Hispanic, aged 18–26 years, from Caddo and Bossier Parishes. Results/Anticipated Results: We expect to identify several barriers and facilitators to cervical cancer prevention among non-Hispanic Black and Hispanic women, including factors like access to care, cultural beliefs, and knowledge gaps. Social determinants of health (SDOH), such as income, education, and healthcare access, will likely show a strong association with lower HPV vaccination, Pap smear, and HPV screening rates. Additionally, we anticipate that lower health literacy will correlate with reduced willingness to vaccinate or screen for HPV. These findings can bridge the gap between research and practical health applications by guiding the design of community-based behavioral interventions that enhance cervical cancer prevention among minority populations. Discussion/Significance of Impact: This research is the first to assess how SDOH factors impact cervical cancer prevention among Blacks and Hispanic women in North Louisianawhile also exploring the role of health literacy in HPV vaccination and screening. Findings will drive practical interventions to reduce disparities and improve outcomes.
Objectives/Goals: Personalized cancer therapy based on genomic testing is advancing patient care. Genomic alterations in fibroblast growth factor receptor (FGFR) predict response to FGFR inhibitors; however, the role of RNA expression and protein activation is not known. We propose to examine the phospho-proteomic signature in FGFR-altered cancers to identify new candidates for FGFR-targeted therapies. Methods/Study Population: In our preliminary study, we have curated a cohort of FGFR2 mutants (13 FGFR2-fusions and 4 FGFR2 point mutations) with known clinical outcomes to FGFR inhibitors and 8 FGFR2 wild-type (WT) cholangiocarcinoma tumor samples to investigate the phospho-proteomic fingerprint using a clinical grade reverse phase protein array (RPPA). RPPAs are high throughput quantitative antibody-based proteomics assays that can quantify hundreds of proteins in thousands of patient tissues providing a high degree of sensitivity through laser tumor microdissection (LCM). We have selected proteins in the FGFR signaling pathway including FGFR2, AKT, ERK1.2, STAT1/3, FRS2, and PLCg to define the range of phospho-proteomic signal between FGFR2 WT and mutant cancers. All samples will undergo evaluation with RNASeq for gene expression. Results/Anticipated Results: Our initial analysis defined the range of RNA expression of FGFR2 and pFGFR2 protein signal (Y653/654 and Y769) between FGFR2 WT and FGFR2 mutant samples. On average, the FGFR2 mutant cohort displayed higher FGFR2 RNA expression compared to the FGFR2 WT cohort. There is no apparent correlation between RNA expression and clinical response to FGFR-targeted therapy. However, in this small cohort, there is no significant difference in FGFR2 phosphorylation between FGFR2 WT and mutant cancers. RPPA analysis of FGFR downstream signaling proteins reveals a wide range of phosphorylation, but no significant difference between FGFR2 WT and mutant cancers. Discussion/Significance of Impact: These findings illustrate the complexities of FGFR signaling between FGFR2 WT and mutant cancers. These data suggest that tumors with genomically WT FGFR may display increased pFGFR2 and downstream signaling phospho-proteins. We propose a larger study of cholangiocarcinoma to evaluate evidence of FGFR pathway activation in WT tumors.
Objectives/Goals: To reduce cervical cancer in the USA, it is essential to identify the reasons underlying the low HPV vaccination rates. This study aims to identify knowledge and beliefs about HPV vaccination among women in rural areas. The knowledge gained from this study will directly lead to developing an education tool tailored specifically for women in rural areas. Methods/Study Population: We conducted a cross-sectional study from November 2022 to July 2023. We recruited women (n = 141) who visited a mobile health unit in rural North Louisiana. The inclusion criteria were women aged 25–64 years who spoke English, had not undergone a total hysterectomy, and had no history of cervical cancer. Data collected included sociodemographic characteristics, sexual history, awareness and knowledge of HPV infection, cervical cancer, genital warts, and HPV vaccination, the perceived risk of acquiring genital HPV infection and developing cervical cancer, and the willingness to receive an HPV vaccine. Descriptive statistics were used to evaluate participant responses. Written informed consent was obtained before completing the self-administered questionnaire. Results/Anticipated Results: Our findings showed significant gaps in HPV vaccine knowledge and uptake. Approximately 40% of the participants were unaware of the HPV vaccine, 96.5% had never received it, and 91.4% had never been offered it. However, 42% indicated a willingness to consider vaccination if it were offered. Factors influencing their decision to vaccinate against HPV included a family history of cervical cancer (44.7%), having multiple sexual partners (48%), and engaging in unprotected sex (61.7%). Furthermore, there was significant uncertainty surrounding the vaccine, with 65.2% of participants unsure about its safety, 66% unaware of potential health risks, and 47.5% uncertain about its effectiveness in preventing HPV. Discussion/Significance of Impact: Our research emphasizes the need for tailored behavioral interventions to address knowledge gaps about the HPV vaccine. Low HPV vaccination rates in rural areas contribute to health disparities in cervical cancer. Implementing educational interventions in healthcare settings can enhance vaccination rates and mitigate the risk of cervical cancer.
For almost eight decades, productivity in the United States agricultural sector has substantially increased, in large extent due to the adoption of technological innovations. Despite the increased utilization of technology, questions remain regarding which producers are more likely to adopt a greater number of technological innovations. This research seeks to understand how commodity diversification strategies, farm characteristics, producer perceptions of risk, conservation, information sources, climate adaptation, and producer demographic characteristics are associated with technology adoption among beef cattle producers in the Southeast United States. Utilizing data from an online survey and an Ordered Probit model, we show that beef cattle producers who also produce fruit have an increased probability of adopting a greater number of technologies. The opposite effect is found for other commodities such as vegetables, row crops, and other livestock. Policy recommendations are also discussed.
This article discusses how and why disorientation is used as an aesthetic strategy in breakdown sections of festival-house tracks and performances. Breakdowns in electronic dance music (EDM) have many sound layers removed from the mix. For house music at EDM festivals, this usually includes drums, therefore in many breakdowns it is easy for listeners to lose their metric entrainment. Breakdowns also often introduce a new sound layer, use metrical dissonance, and feature prominent ‘effects’. Through analyses and interviews, the article argues that festival-house breakdowns can be disorienting both physically and psychologically, but that this fulfils multiple purposes for performers, such as providing contrast that makes musical climaxes more exciting and allowing an opportunity for dancers to physically rest. Breakdowns also encourage visual interaction between performers and dancers and allow performers to communicate a narrative. The analyses in the article make interpretations about the meaning of tracks as communicated primarily in breakdown sections.
Accurate diagnosis of bipolar disorder (BPD) is difficult in clinical practice, with an average delay between symptom onset and diagnosis of about 7 years. A depressive episode often precedes the first manic episode, making it difficult to distinguish BPD from unipolar major depressive disorder (MDD).
Aims
We use genome-wide association analyses (GWAS) to identify differential genetic factors and to develop predictors based on polygenic risk scores (PRS) that may aid early differential diagnosis.
Method
Based on individual genotypes from case–control cohorts of BPD and MDD shared through the Psychiatric Genomics Consortium, we compile case–case–control cohorts, applying a careful quality control procedure. In a resulting cohort of 51 149 individuals (15 532 BPD patients, 12 920 MDD patients and 22 697 controls), we perform a variety of GWAS and PRS analyses.
Results
Although our GWAS is not well powered to identify genome-wide significant loci, we find significant chip heritability and demonstrate the ability of the resulting PRS to distinguish BPD from MDD, including BPD cases with depressive onset (BPD-D). We replicate our PRS findings in an independent Danish cohort (iPSYCH 2015, N = 25 966). We observe strong genetic correlation between our case–case GWAS and that of case–control BPD.
Conclusions
We find that MDD and BPD, including BPD-D are genetically distinct. Our findings support that controls, MDD and BPD patients primarily lie on a continuum of genetic risk. Future studies with larger and richer samples will likely yield a better understanding of these findings and enable the development of better genetic predictors distinguishing BPD and, importantly, BPD-D from MDD.
The association structure between manifest variables arising from the single-factor model is investigated using partial correlations. The additional insights to the practitioner provided by partial correlations for detecting a single-factor model are discussed. The parameter space for the partial correlations is presented, as are the patterns of signs in a matrix containing the partial correlations that are not compatible with a single-factor model.
History of prior mental disorder, particularly post-traumatic stress disorder (PTSD), increases risk for PTSD following subsequent trauma exposure. However, limited research has examined differences associated with specific prior mental disorders among people with PTSD.
Aims
The current study examined whether different prior mental disorders were associated with meaningful differences among individuals presenting to a specialist service for severe earthquake-related distress following the Canterbury earthquakes (N = 177).
Method
Two sets of comparisons were made: between participants with no history of prior disorder and participants with history of any prior disorder; and between participants with history of prior PTSD and those with history of other prior disorders. Comparisons were made in relation to sociodemographic factors, earthquake exposure, peri-traumatic distress, life events and current psychological functioning.
Results
Participants with any prior mental disorder had more current disorders than those with no prior disorder. Among participants with history of any prior disorder, those with prior PTSD reported more life events in the past 5 years than those with other prior disorders.
Conclusions
Findings suggest a history of any prior mental disorder contributes to increased clinical complexity, but not increased PTSD severity, among people with PTSD seeking treatment. Although post-disaster screening efforts should include those with prior mental disorders, it should also be recognised that those with no prior disorders are also at risk of developing equally severe PTSD.
Evidence-based insertion and maintenance bundles are effective in reducing the incidence of central line-associated bloodstream infections (CLABSI) in intensive care unit (ICU) settings. We studied the adoption and compliance of CLABSI prevention bundle programs and CLABSI rates in ICUs in a large network of acute care hospitals across Canada.
Excluding all animal-sourced foods may be associated with increased risks of nutrient deficiencies. As indispensable amino acids (IAAs) cannot be stored or endogenously produced, consistent protein consumption throughout the day is important to improve protein quality for optimal metabolic function(1). Assessment of protein adequacy needs to be undertaken at the meal rather than daily intake level because food combinations within each meal can be complementary and influence the overall amino acid profile of the meal(2).
Outcomes of our previous review found that among plant-sourced foods, soy, legumes, nuts and seeds provide greater protein content and quality(3). We hypothesise that variation in protein intake will exist both between vegan individuals and between observation days for the same individuals. Previous investigations of the relationship between meals and nutrient intake based on specified time windows for eating may have been subject to researcher bias in the definition of these windows. The main outcome of this study is to utilise time series clustering to determine the impact of dietary patterns on protein distribution, across the day.
Intake data was obtained using a four-day food diary from a cross-sectional survey of 193 New Zealand vegans (Ethical approval: HDEC 2022 EXP 12312). The inclusion criteria required participants to have followed an exclusive vegan diet for at least two years. A kernel density contour estimation was used to visualise protein distribution across eating occasions for all participants over four days. Dynamic Time Warping (DTW) was then used to align two temporal sequences (time series) to compute an output of distance(4) which was used for hierarchical clustering using the Ward.D2 method. An optimal cluster of 3 was identified using silhouette coefficient and domain knowledge.
Participants had a mean age of 39.4 years (SD=12.3), with 90.1% having attained a tertiary-level education or higher. Overall, mean protein intake was 1.11 g/kg/d (SD=0.39), with 8.29% of participants below the Estimated Average Requirements (EAR) and 24.3% of participants below the Recommended Dietary Allowance (RDA) for adults. The mean Acceptable Macronutrient Distribution Range (AMDR) for protein is 15.5% (SD=4.16), with 96.9% of participants within the recommended AMDR range (10-35%). Peak protein consumption was observed at 1230 and 1900. Sequential colour scale representing density found higher distribution of data points representing protein intake of less than 10g per eating occasion. Time series similar in shape and amplitude were assigned to the same cluster. Preliminary findings identified three different protein intake profiles across the day.
A small percentage of participants has protein intake below the daily requirements for adults. More occasions with lower protein intake per eating moment was observed. This approach classifies dietary patterns objectively for analysis of daily protein and IAA intake.
Migraine and post-traumatic stress disorder (PTSD) are both twice as common in women as men. Cross-sectional studies have shown associations between migraine and several psychiatric conditions, including PTSD. PTSD is disproportionally common among patients in headache clinics, and individuals with migraine and PTSD report greater disability from migraines and more frequent medication use. To further clarify the nature of the relationship between PTSD and migraine, we conducted bidirectional analyses of the association between (1) migraine and incident PTSD and (2) PTSD and incident migraine.
Methods
We used longitudinal data from 1989–2020 among the 33,327 Nurses’ Health Study II respondents to the 2018 stress questionnaire. We used log-binomial models to estimate the relative risk of developing PTSD among women with migraine and the relative risk of developing migraine among individuals with PTSD, trauma-exposed individuals without PTSD, and individuals unexposed to trauma, adjusting for race, education, marital status, high blood pressure, high cholesterol, alcohol intake, smoking, and body mass index.
Results
Overall, 48% of respondents reported ever experiencing migraine, 82% reported experiencing trauma and 9% met the Diagnostic and Statistical Manual of Mental Disorders-5 criteria for PTSD. Of those reporting migraine and trauma, 67% reported trauma before migraine onset, 2% reported trauma and migraine onset in the same year and 31% reported trauma after migraine onset. We found that migraine was associated with incident PTSD (adjusted relative risk [RR]: 1.26, 95% confidence interval [CI]: 1.14–1.39). PTSD, but not trauma without PTSD, was associated with incident migraine (adjusted RR: 1.20, 95% CI: 1.14–1.27). Findings were consistently stronger in both directions among those experiencing migraine with aura.
Conclusions
Our study provides further evidence that migraine and PTSD are strongly comorbid and found associations of similar magnitude between migraine and incident PTSD and PTSD and incident migraine.