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To quantify total sugar reformulation in Canadian prepackaged foods and beverages between 2013 and 2017 and identify changes in the nutritional composition of the foods and beverages reformulated to be lower in total sugar.
Longitudinal examination of foods and beverages present in both 2013 and 2017 collections of the University of Toronto’s Food Label Information Program database (n 6628 matched products). The proportion of products with changes in sugar levels was determined. Wilcoxon signed-rank test was used to examine changes in sugar levels overall for products lower or higher in sugar and changes in nutrient composition for products lower in sugar.
Largest grocery retailers by market share in Canada.
Canadian prepackaged foods and beverages.
The majority (76·6 %) of products had no change in total sugar content, 12·4 % were reformulated to be lower in sugar and 11·0 % were higher in sugar. A median sugar reduction of 19·0 % (1·6 g) was seen among products lower in sugar which was offset by a median 18·0 % (1·5 g) increase among products higher in sugar. Overall, median levels of energies and other nutrients stayed the same or decreased among products reformulated to be lower in sugar, the exception was for starch, which increased.
Limited progress was made to reformulate foods and beverages to be lower in total sugar between 2013 and 2017. Results from this study identify areas in the food supply where attention may be needed to avoid unintended consequences of sugar-focused reformulation in terms of overall nutritional composition.
Global neurosurgery has become an increasingly popular facet of global health because of striking disparities in access to neurosurgical care across the world. Regardless of the commendable efforts invested in gaining equity in this enterprise, global neurosurgical initiatives can present with various ethical challenges and opportunities for causing harm to vulnerable populations. This chapter highlights some of the concerns that arise in the planning, implementation and follow-up of international neurosurgical aid. It also explores some of the fundamental ethical principles and theories that underlie these issues and applies them to an illustrative case. While there may never be a clear cut answer to many of these ethical dilemmas, we hope that in discussing the ethics of global neurosurgery, future neurosurgeons will be able to give the most in these noble initiatives which strive for equality in global medical care.
OBJECTIVES/GOALS: Agitation has high prevalence in the emergency department (ED), but limited evidence exists regarding clinical decisions to use sedatives and physical restraint. We examined clinical factors and agitation attributes impacting thresholds for sedative and restraint use in the emergency setting. METHODS/STUDY POPULATION: We conducted a prospective cohort study of adult patients (318 yo) with acute or escalating agitation during their ED visit at an urban tertiary care referral center. Consecutive patients requiring security presence or scoring >1 on an agitation scale were enrolled during randomized 8-h blocks. We recorded patient characteristics, staff/team factors, and environmental/systems data as well as scores on 3 validated agitation scales: Agitated Behavior Scale, Overt Aggression Scale, and Severity Scale. We performed descriptive analyses, bivariable analyses, and logistic regression modeling of factors with relation to sedative/restraint use. We observed 95 agitation events on unique patients over 2 months. RESULTS/ANTICIPATED RESULTS: Median age was 42, and 62.1% were male. Most frequent chief complaints were alcohol/drug use (37.9%) and psychiatric (23.2%). Majority of events (73.7%) were associated with sedative/restraint use. Factors related to treatment course or staff interactions were the primary reasons for agitation in 56.8% of events. A logistic regression model found no association between demographics and odds of sedative/restraint use. Overt Aggression Scale scores were associated with significantly higher odds of sedative use (AOR 1.62 [1.13–2.32]), while Severity Scale scores had significantly higher odds of restraint use (AOR 1.39 [1.12–1.73]) but significantly lower odds of sedative use (AOR 0.79 [0.64–0.98]). DISCUSSION/SIGNIFICANCE OF IMPACT: External factors may be important targets for behavioral techniques in ED agitation management. Further study of the Severity Scale may allow for earlier detection of agitation and identify causal links between agitation severity and use of sedatives and restraints.
Orchestration is a soft mode of governance, in which a ‘governor’ enlists the voluntary cooperation of intermediary actors to carry out governance functions that further the governor’s goals. Environmental issues figured prominently in the origin of the orchestration concept, and orchestration has since played a significant role in earth system governance research on architecture and agency. This chapter summarizes key empirical findings of this research, especially on sustainable development and climate change. It also identifies contributions of earth system governance research to orchestration theory: for example, concerning the conditions for successful orchestration, the role of orchestration platforms and orchestration’s role in institutional complexity. The chapter then engages with critiques and normative concerns, particularly relating to power, accountability and legitimacy. The chapter concludes with thoughts on an orchestration research agenda that can support the transformative goals of the new earth system governance science plan.
Schema Focused Therapy (SFT) has proven effective in outpatients with Borderline Personality Disorder (PD)(Giesen-Bloo et al., 2006). To test the effectiveness of SFT with forensic patients, we have begun a multi-center randomized clinical trial of SFT for male forensic patients with Antisocial, Borderline, Narcissistic, or Paranoid PDs.
One hundred twenty patients will be enrolled from 7 high security forensic hospitals (“TBS clinics”) in The Netherlands. Patients are randomly assigned to receive either SFT or usual forensic treatment. Patients receive 3 years of therapy, and are assessed every 6 months for changes in PD symptoms, recidivism risk, and other outcomes. Following treatment completion, patients will be followed an additional 3 years to assess actual recidivism.
Since 2007, 39 patients (mean PCL-R score = 25.0, SD = 6.6) have been enrolled in the study, 22 have completed their 12-month assessments, and 11 their 18-month assessments. Only 3 have dropped out. Recruitment is ongoing, with expected completion of the project in 2012. Pilot data on a different sample of N = 18 forensic PD inpatients treated in SFT for a mean of 1.9 years (SD = 0.8) is encouraging. Nine of the 18 patients showed reliable improvement, and only one showed reliable deterioration (mean d-score = 0.84, SD = 0.95, p < .01).
SFT appears to be a promising treatment for forensic patients with Antisocial and other Cluster B PDs.
According to recent literature, 50 to 90 percent of criminal offenders have personality disorders (PDs), with cluster B PDs being the most prevalent in forensic settings. The latter type of PD is associated with an increased risk of violence and recidivism. Among forensic patients with a cluster B diagnosis, psychopathic offenders are at particularly high risk for re-offending. Psychopaths are believed to be untreatable, but evidence for this view is weak.
The current study aims at determining the effectiveness of Schema Focused Therapy (SFT) versus ‘treatment as usual’ in male forensic patients (including psychopaths) with Antisocial, Borderline, Narcissistic, and Paranoid PDs, within a 3-year multi-center randomized clinical trial. SFT is an integrative form of psychotherapy combining cognitive, behavioral, psychodynamic object relations, and humanistic/existential approaches, and was developed as a treatment for PDs and other longstanding problems. SFT aims at changing early maladaptive schema modes, thereby producing changes on a structural, emotional level.
The goal of a second study that runs within the same project is to objectively determine the nature of the emotional deficiencies that are thought to be central to psychopathy. By administering forensic patients an extensive test battery that assesses various affective capacities (e.g., moral emotion, emotional expressive behavior, cognitive and emotional empathy), we aim at constructing an integrative picture of psychopaths’ emotional functioning. Within the SFT effectiveness study, patients are tested twice (with a one year interval), to see whether these affective capacities are subject to change in the context of therapy.
Based on the neuroinflammatory hypothesis of schizophrenia, we have quantified the numerical density of immunostained CD3+ T-lymphocytes, CD20+ B-lymphocytes, and HLA-DR+ microglial cells in the posterior hippocampus of 17 schizophrenia patients and 11 matched controls. Disease course-related immune alterations were considered by a separate analysis of residual (prevailing negative symptoms, n=7) and paranoid (prominent positive symptoms, n=10) schizophrenia cases. Higher lymphocyte densities were observed in residual schizophrenia. In contrast, HLA-DR+ microglia were increased in paranoid schizophrenia. BBB impairment and infiltration of T cells and B cells may contribute to the pathophysiology of residual schizophrenia, while microglial activation seems to play a role in paranoid schizophrenia. The identification of diverse immune endophenotypes may facilitate the development of distinct anti-inflammatory schizophrenia therapies to normalize BBB function, (auto)antibody production or microglial activity.
Aims: Although IDS is typically described as slower than adult-directed speech (ADS), potential impacts of slower speech on language development have not been examined. We explored whether IDS speech rates in 42 mother–infant dyads at four time periods predicted children's language outcomes at two years. Method: We correlated IDS speech rate with child language outcomes at two years, and contrasted outcomes in dyads displaying high/low rate profiles. Outcomes: Slower IDS rate at 7 months significantly correlated with vocabulary knowledge at two years. Slowed IDS may benefit child language learning even before children first speak.
For the past six years, the Pueblo of Pojoaque and University of Colorado Boulder have been working together to investigate ancestral sites on and adjacent to Pojoaque land. Through our partnership, we believe we have learned some important lessons about the potential of archaeology for tribal communities, how archaeologists and tribal members can work together as coinvestigators, how such partnerships improve archaeological practice, and how the incorporation of traditional knowledge leads to better archaeology in both its humanistic and scientific dimensions. In addition, we believe it is a more sustainable and ethical model to engage the cultures in which archaeologists work. In this article, we share the story of our partnership, consider how it relates to existing perspectives on archaeology and Native communities, present a few results from our work at the ancestral site of K'uuyemugeh, and offer some reflections on our efforts to put a partnership model into practice.
Gender, gender identity, and sexuality permeate interactions, institutions, and societies, including the organization of the political sphere, as well as the policies that states enact (Connell 1990, 2009; Orloff 1993; Risman 2004; Walby 2002). Expectations and norms around gender, gender identity, and sexuality vary from place to place, over time, and even within the same society, and play a central role in organizing all societies. Such cultural expectations are instantiated in the organization of the state, through its laws, policies, and institutions.
This chapter presents an overview of the importance of critical thinking, some of the reasons that people do not think critically, and some of the harmful consequences of uncritical thinking for individuals and society. It highlights the fact that psychology courses are especially appropriate venues for promoting critical thinking because they address numerous controversial, high-interest topics that are ripe for critical analysis. A set of specific demonstrations and activities illustrate some of the ways in which, through interactive lecturing, these courses can be configured to introduce a critical thinking system and incorporate systematic practice at critical thinking without fundamentally changing course content. The chapter concludes by describing a more radical approach to critical thinking in the introductory-psychology course that would, in fact, alter its content in the service of dispelling strongly held misconceptions about human behavior and mental processes.
Although immune-mediated inflammatory diseases (IMID) are associated with multiple mental health conditions, there is a paucity of literature assessing personality disorders (PDs) in these populations. We aimed to estimate and compare the incidence of any PD in IMID and matched cohorts over time, and identify sociodemographic characteristics associated with the incidence of PD.
We used population-based administrative data from Manitoba, Canada to identify persons with incident inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) using validated case definitions. Unaffected controls were matched 5:1 on sex, age and region of residence. PDs were identified using hospitalisation or physician claims. We used unadjusted and covariate-adjusted negative binomial regression to compare the incidence of PDs between the IMID and matched cohorts.
We identified 19 572 incident cases of IMID (IBD n = 6,119, MS n = 3,514, RA n = 10 206) and 97 727 matches overall. After covariate adjustment, the IMID cohort had an increased incidence of PDs (incidence rate ratio [IRR] 1.72; 95%CI: 1.47–2.01) as compared to the matched cohort, which remained consistent over time. The incidence of PDs was similarly elevated in IBD (IRR 2.19; 95%CI: 1.69–2.84), MS (IRR 1.79; 95%CI: 1.29–2.50) and RA (IRR 1.61; 95%CI: 1.29–1.99). Lower socioeconomic status and urban residence were associated with an increased incidence of PDs, whereas mid to older adulthood (age 45–64) was associated with overall decreased incidence. In a restricted sample with 5 years of data before and after IMID diagnosis, the incidence of PDs was also elevated before IMID diagnosis among all IMID groups relative to matched controls.
IMID are associated with an increased incidence of PDs both before and after an IMID diagnosis. These results support the relevance of shared risk factors in the co-occurrence of PDs and IMID conditions.
Background: Front-of-package (FOP) nutrition labelling has become a core component of policy recommendations to address the growing burden of diet-related non-communicable disease globally. The CODEX Committee on Food Labelling is in the process of establishing standardized criteria for the definition of “high-in” for use with FOP labels highlighting excessive amounts of fats, sugars and sodium in foods. Recently, as part of Health Canada's Healthy Eating Strategy, regulations requiring the mandatory display of high-in FOP symbols have been published. The aim of this study was to investigate the extent to which these symbols would appear on foods and beverages in the Canadian prepackaged food supply, both overall and by food category.
Methods: Foods and beverages in the University of Toronto's Food Label Information Program database 2013 (n = 15,277) were assessed for the prevalence of products that would have to display a symbol based on criteria published in the draft Canadian regulations. The criteria include thresholds based on the % Daily Value (DV) for each nutrient, above which, products would be required to display a FOP symbol for that nutrient. Exemptions are provided for fruits and vegetables without added sodium, sugars, or saturated fats, non-flavoured whole or partly skimmed milk, eggs, sweetening agents (i.e. sugar, honey, syrups and molasses) and table salt.
Results: 61.7% (n = 10,251) of products would be required to display at least one symbol. Of these, 52.3% (n = 5,358) would have a sodium symbol, 41.9% (n = 4,295) a saturated fats symbol and 41.0% (n = 4,207) a sugars symbol. Overall, 37% of products would display a symbol for more than one nutrient. The highest concentration of symbols were found on processed meats (93.8%), soups (93.0%), desserts (87.2%), sugars and sweets (82.3%), dairy (76.9%) and bakery products (71.0%).
Discussion: This is the first study to evaluate the impact of proposed regulations for the mandatory display of FOP symbols on Canadian prepackaged foods. Findings identify a high concentration of symbols in categories contributing meaningfully to dietary sodium, sugars, and saturated fats intakes, but also in categories for which consumption is discouraged in national dietary guidelines (e.g. processed meats, desserts). The findings presented here will inform ongoing discussions on how best to optimize criteria underpinning the display of FOP “high-in” labels.
Metabolic syndrome and impaired insulin sensitivity may occur as side effects of atypical antipsychotic drugs. However, studies of peripheral insulin resistance using the homeostatic model assessment of insulin resistance (HOMA-IR) or oral glucose tolerance tests (OGTT) suggest that abnormal glucose metabolism is already present in drug-naive first-episode schizophrenia (DNFES). We hypothesized impairments of neuronal insulin signaling in DNFES.
To gain insight into neuronal insulin-signaling in vivo, we analyzed peripheral blood extracellular vesicles enriched for neuronal origin (nEVs). Phosphorylated insulin signal transduction serine-threonine kinases pS312-IRS-1, pY-IRS-1, pS473-AKT, pS9-GSK3β, pS2448-mTOR, pT389-p70S6K and respective total protein levels were determined in plasma nEVs from 48 DNFES patients and healthy matched controls after overnight fasting.
Upstream pS312-IRS-1 was reduced at trend level (p = 0.071; this condition may amplify IRS-1 signaling). Exploratory omnibus analysis of downstream serine-threonine kinases (AKT, GSK3β, mTOR, p70S6K) revealed lower phosphorylated/total protein ratios in DNFES vs. controls (p = 0.013), confirming decreased pathway activation. Post-hoc-tests indicated in particular a reduced phosphorylation ratio of mTOR (p = 0.027). Phosphorylation ratios of p70S6K (p = 0.029), GSK3β (p = 0.039), and at trend level AKT (p = 0.061), showed diagnosis-dependent statistical interactions with insulin blood levels. The phosphorylation ratio of AKT correlated inversely with PANSS-G and PANSS-total scores, and other ratios showed similar trends.
These findings support the hypothesis of neuronal insulin resistance in DNFES, small sample sizes notwithstanding. The counterintuitive trend towards reduced pS312-IRS-1 in DNFES may result from adaptive feedback mechanisms. The observed changes in insulin signaling could be clinically meaningful as suggested by their association with higher PANSS scores.
David Lewis’s metaphysics of causation set the stage for many contemporary approaches to the topic and laid the groundwork for debates on related dependent philosophical concepts, including interventionist theories of causation, causal modeling, grounding, and the role of laws in metaphysics. This chapter will give an overview of Lewis’s work on causation, and trace the influence of his approach through recent developments in the metaphysics of causation. First I will give a summary of Lewis’s views on causation, as well as various well-known challenges they faced. Next I will summarize the attempts to respond to these problems that dominated the causation literature for many years after his early work. Then I will give an overview of the myriad and widespread topics that share an ancestor in Lewis’s theories of causation. Finally, I will examine the influence of his approach on present-day “hot topics” in metaphysics.
The present study examined the extent to which social support (SS) availability and satisfaction could predict the extent of caregiver burden (CB) among mothers of children with Acute Lymphocytic Leukemia (ALL).
The study was a cross-sectional, descriptive-correlative study. It was conducted on a sample of 117 mothers whose children were undergoing treatment in a public hospital in Bam, Iran. The Norbeck Social Support Scale and the Caregiver Burden Scale were used to measuring study variables. The data were analyzed using Pearson's correlations, t-tests, ANOVAs, and linear regressions.
Significant correlations were observed between CB and SS availability (r = −0.499, p < 0.001), SS satisfaction (r = −0.543, p < 0.001), the age of the child with cancer (r = −0.22, p = 0.01), and duration of treatment (r = 0.336, p < 0.001). Married mothers experienced less CB than those that were widowed or divorced. Within the regression equation, SS satisfaction, SS availability, marital status, and duration of treatment were the predictors of CB.
Significance of results
Based on the results of the current study, mothers who have less SS, especially those who are single mothers, with younger children, and who have taken care of their child for an extended duration should be given special attention. Furthermore, it appears that there are distinct cultural variations amongst Iranian mothers which suggest that culture may impact upon SS availability. Results also suggest a need for interventions that enhance nurses' ability to provide support to caregivers and the broader family unit as a whole. Nurses in cancer care need to have psychological competencies to help family members of cancer patients especially mothers and more so those that are single mothers. As integral members of the patient care experience, nurses may be uniquely positioned to provide this needed psychosocial support.
Scholars and politicians have sometimes presented bureaucracy as inherently conflicting with democracy. But bureaucrats themselves are rarely consulted about that relationship. In contrast, I draw on interviews and participant observation to illuminate how government administrators understand their own place in the government of Taiwan, one of the few successful third wave democracies. The administrators I work with root their own legitimacy not in separated powers or autonomous expertise, but in their ongoing collaboration with legislators and publics. They define their own accountability not just as executing legislative mandates but as producing them in the first place, and they figure bureaucracy as a key site for political participation. I put these views into historical context to elucidate how bureaucracy can compete for democratic bona fides with common democratic indicators like constitutions and elections. This article contributes to scholarship on the ethnography of bureaucracy, administrative accountability networks, and the internal law of administration. In particular, I stress the importance of administrative culture as a central aspect of political legitimation.