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Involving stakeholders has been acknowledged as a way to improve quality and relevance in health research. The mechanisms that support effective research engagement with stakeholders have not been studied in the area of concussion. Concussion is a large public health concern worldwide with billions of dollars spent on health care services and research with improvements in care and service delivery not moving forward as quickly as desired. Enabling effective stakeholder engagement could improve concussion research and care.
The aim of the study was to identify potential benefits, challenges, and motivators to engaging in research by gathering the perspectives of adults with lived experience of concussion.
A thematic analysis of qualitative responses collected from a convenience sample attending a provincial brain injury conference (n = 60) was undertaken using open coding followed by axial coding.
Four themes regarding benefits to engagement emerged: first-hand account, meaningful recovery, research relevance, and better understanding of gaps. Three forces inhibited engagement: environmental barriers, injury-related constraints, and personal deterrents. Four enablers supported engagement: focus on positive impact, build connections, create a supportive environment, and provide financial assistance.
Understanding stakeholder’s perspectives on research engagement is an important issue that may serve to improve research quality. There may be unique nuances at play with injury-specific stakeholders that require researchers to consider a balance between reducing inhibitors while supporting enablers. These findings are preliminary and limited. Nevertheless, they provide needed insight and guidance for ongoing investigation regarding improvement of stakeholder engagement in concussion research.
Junk-food marketing contributes significantly to childhood obesity, which in turn imposes major health and economic burdens. Despite this, political priority for addressing junk-food marketing has been weak in many countries. Competing interests, worldviews and beliefs of stakeholders involved with the issue contribute to this political inertia. An integral group of actors for driving policy change are parliamentarians, who champion policy and enact legislation. However, how parliamentarians interpret and portray (i.e. frame) the causes and solutions of public health nutrition problems is poorly understood. The present study aimed to understand how Australian parliamentarians from different political parties frame the problem of junk-food marketing.
Framing analysis of transcripts from the Australian Government’s Parliamentary Hansard, involving development of a theoretical framework, data collection, coding transcripts and thematic synthesis of results.
Parliamentarian framing generally reflected political party ideology. Liberal parliamentarians called for minimal government regulation and greater personal responsibility, reflecting the party’s core values of liberalism and neoliberalism. Greens parliamentarians framed the issue as systemic, highlighting the need for government intervention and reflecting the core party value of social justice. Labor parliamentarians used both frames at varying times.
Parliamentarians’ framing was generally consistent with their party ideology, though subject to changes over time. This project provides insights into the role of framing and ideology in shaping public health policy responses and may inform communication strategies for nutrition advocates. Advocates might consider using frames that resonate with the ideologies of different political parties and adapting these over time.
The boll weevil spread across the South from 1892 to 1922 with devastating effect on cotton cultivation. The resulting shift away from this child labor–intensive crop lowered the opportunity cost of school attendance. We investigate the insect’s long-run effect on educational attainment using a sample of adults from the 1940 census linked back to their childhood census records. Both white and black children who were young (ages 4 to 9) when the weevil arrived saw increased educational attainment by 0.24 to 0.36 years. Our results demonstrate the potential for conflict between child labor in agriculture and educational attainment.
Christian preaching and the genre of the sermon developed both inside and outside the cloister, evolving as they circulated between secular and religious audiences. Whereas few monks (beyond the ones who became bishops) were ordained in the early centuries of Western monasticism, the difference between monks and secular clergy moved gradually to sharper definition in the eighth century, as more and more monks were being ordained. Debates intensified in the late eleventh and early twelfth centuries over the duty and authorization for preaching by monks, particularly outside the monastery. While Jerome (347–420) had asserted that the duty of monks is “not to teach, but to weep,” Rupert of Deutz (c. 1075–1129), addressing his extensive biblical commentaries to prelates and monk-priests, argued forcefully that preaching stood first among their responsibilities. For Rupert, the impetus toward renewal and reform in the twelfth century rested upon correct and authorized preaching. Bernard of Clairvaux (1090–1153), alarmed over unauthorized preaching of monks and lay persons, stated that “it is not expedient for a monk to preach in public, nor is it seemly for a novice, nor proper for anyone unless he is expressly sent.” The temptation to preach publicly is thus a fox, evil disguised as good. Nonetheless, Gratian’s (d. 1144/5) Decretum recognized that “monks chosen by the people, consecrated by the bishop with the consent of the abbot, have the right to the legitimate exercise of their power.” Within traditional communities that followed the RB, and Cistercian and Carthusian monasteries, abbots and designated representatives preached to their monastic congregations. Female superiors, such as Hildegard of Bingen (1098–1179), addressed their religious communities, presumably with permission of the abbot or superior. The statutes of the double monastery at Admont explain that a sister could preach to her community when the abbot or his representative could not be present. Abbots, some monks, and Hildegard herself preached outside their monasteries as well.
Research into global uses of English, and particularly ELF (English as a Lingua Franca), has highlighted the diversity and fluidity of communicative practices in intercultural and transcultural communication through English. Successful intercultural/transcultural communication involves the ability to make use of and negotiate multilingual/plurilingual linguistic resources, a variety of communicative practices and strategies, and movement between global, national, local, and emergent frames of reference. This is a very different conception of competence to that typically utilised in English language teaching (ELT) with its pre-determined ‘code’ consisting of a restricted range of grammatical, lexical, and phonological forms and minimal concern with the sociocultural dimension of communication. The need for a reconceptualisation of language in applied linguistics and more recently ELT has begun to receive serious scholarly attention. However, this needs to be accompanied by a focus on the wider intercultural and transcultural communicative practices in which language is embedded and enmeshed. This entails recognition of the central place of intercultural competence and the awareness that is necessary to manage such complexity, variation, and fluidity in communication. As such, this chapter addresses Hall and Wicaksono’s (this volume) call to interrogate and be “explicit about what we, as applied linguists, think English is – our ontologies of English – and how these ontologies underpin our educational ideologies and professional practices”, with a particular focus on the intercultural and transcultural dimensions to both English use and education policy and practice.
The reported incidence of Clostridoides difficile infection (CDI) has increased in recent years, partly due to broadening adoption of nucleic acid amplification tests (NAATs) replacing enzyme immunoassay (EIA) methods. Our aim was to quantify the impact of this switch on reported CDI rates using a large, multihospital, empirical dataset.
We analyzed 9 years of retrospective CDI data (2009–2017) from 47 hospitals in the southeastern United States; 37 hospitals switched to NAAT during this period, including 24 with sufficient pre- and post-switch data for statistical analyses. Poisson regression was used to quantify the NAAT-over-EIA incidence rate ratio (IRR) at hospital and network levels while controlling for longitudinal trends, the proportion of intensive care unit patient days, changes in surveillance methodology, and previously detected infection cluster periods. We additionally used change-point detection methods to identify shifts in the mean and/or slope of hospital-level CDI rates, and we compared results to recorded switch dates.
For hospitals that transitioned to NAAT, average unadjusted CDI rates increased substantially after the test switch from 10.9 to 23.9 per 10,000 patient days. Individual hospital IRRs ranged from 0.75 to 5.47, with a network-wide IRR of 1.75 (95% confidence interval, 1.62–1.89). Reported CDI rates significantly changed 1.6 months on average after switching to NAAT testing (standard deviation, 1.9 months).
Hospitals that switched from EIA to NAAT testing experienced an average postswitch increase of 75% in reported CDI rates after adjusting for other factors, and this increase was often gradual or delayed.
Modern humans evolved in Africa approximately 200,000 years ago (Campbell and Tishkoff 2010). As groups migrated out of Africa they underwent bottlenecks leading to sharp reductions in population size and genetic diversity (Amos and Hoffman 2010; Harpending and Rogers 2000; Ramachandran et al. 2005). To this day, African populations retain the most genetic diversity globally (Auton et al. 2015). In order to survive both within and out of Africa, early human populations had to adapt to their novel environments, including new food resources, colder climates, higher altitudes, and, especially, infectious diseases (Balaresque et al. 2007; Fumagalli et al. 2011). These adaptive requirements, facilitated by natural selection, led to an increased frequency of alleles that were beneficial in that environment. Due to the fact that these adaptive requirements were driven by local environmental pressures, some of these evolutionarily advantageous alleles display geographic and ancestral specificity, as observed in the genomes of present-day humans (Fumagalli et al. 2011).
Microwave plasma chemical vapor deposition (MPCVD) was used to diffuse boron into tantalum using plasma initiated from a feedgas mixture containing hydrogen and diborane. The role of substrate temperature and substrate bias in influencing surface chemical structure and hardness was investigated. X-ray diffraction shows that increased temperature results in increased TaB2 formation (relative to TaB) along with increased strain in the tantalum body-centered cubic lattice. Once the strained tantalum becomes locally supersaturated with boron, TaB and TaB2 precipitate. Additional boron remains in a solid solution within the tantalum. The combination of precipitation and solid solution hardening along with boron-induced lattice strain may help explain the 40 GPa average hardness measured by nanoindentation. Application of negative substrate bias did not further increase the hardness, possibly due to etching from increased ion bombardment. These results show that MPCVD is a viable method for synthesis of superhard borides based on plasma-assisted diffusion.
The dystopian scenario of an ‘artificial intelligence takeover’ imagines artificial intelligence (AI) becoming the dominant form of intelligence on Earth, rendering humans redundant. As a society we have become increasingly familiar with AI and robots replacing humans in many tasks, certain jobs and even some areas of medicine, but surely this is not the fate of psychiatry?
Here a computational neuroscientist (Janaina Mourão-Miranda) and psychiatrist (Justin Taylor Baker) suggest that psychiatry as a profession is relatively safe, whereas psychiatrists Christian Brown and Giles William Story predict that robots will be taking over the asylum.
The past decade has seen a surge of reports and investigations into cases of autoimmune-mediated encephalitis. The increasing recognition of these disorders is especially of relevance to the fields of neurology and psychiatry. Autoimmune encephalitis involves antibodies against synaptic receptors, neuronal cell surface proteins and intracellular targets. These disorders feature prominent symptoms of cognitive impairment and behavioural changes, often associated with the presence of seizures. Early in the clinical course, autoimmune encephalitis may manifest as psychiatric symptoms of psychosis and involve psychiatry as an initial point of contact. Although commonly associated with malignancy, these disorders can present in the absence of an inciting neoplasm. The identification of autoimmune encephalitis is of clinical importance as a large proportion of individuals experience a response to immunotherapy. This review focuses on the current state of knowledge on n-methyl-d-aspartate (NMDA) receptor-associated encephalitis and limbic encephalitis, the latter predominantly involving antibodies against the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor, the γ-aminobutyric acid (GABA)B receptor and leucine-rich glioma-inactivated 1 (LGI1) protein. In addition, we briefly describe anti-dopamine D2 receptor encephalitis. A summary of the literature will focus on common clinical presentations and course, diagnostic approaches and response to treatment. Since a substantial proportion of patients with autoimmune encephalitis exhibit symptoms of psychosis, the relevance of this disorder to theories of psychosis and schizophrenia will also be discussed.
This article argues that, despite the protestations to the contrary of William Camden (1551–1623), the antiquarian methods of his “Britannia” are indebted to the “Origines Antwerpianae” of Johannes Goropius Becanus (1519–73). Both Goropius and Camden posited the contemporary existence of an unchanged primeval language (Dutch for Goropius and Welsh for Camden) wherein etymologies could be used to trace the origins and migrations of ancient peoples. Even as humanist philology underscored the mutability of language, Goropius and Camden selectively ignored this mutability in order to have a basis other than myth or legend for reconstructing antiquity. Their efforts, however, created new myths about language and its ability to bridge present and distant past.
Glucose intolerance during pregnancy – a major driver of gestational diabetes mellitus (GDM) – has significant short- and long-term health consequences for both the mother and child. As GDM prevalence continues to escalate, there is growing need for preventative strategies. There is limited but suggestive evidence that myo-inositol (MI) and probiotics (PB) could improve glucose tolerance during pregnancy. The present study tested the hypothesis that MI and/or PB supplementation would reduce the risk of glucose intolerance during pregnancy. Female C57BL/6 mice were randomised to receive either no treatment, MI, PB (Lactobacillus rhamnosus and Bifidobacterium lactis) or both (MIPB) for 5 weeks. They were then provided with a high-fat diet for 1 week before mating commenced and throughout mating/gestation, while remaining on their respective treatments. An oral glucose tolerance test occurred at gestational day (GD) 16·5 and tissue collection at GD 18·5. Neither MI nor PB, separately or combined, improved glucose tolerance. However, MI and PB both independently increased adipose tissue expression of Ir, Irs1, Akt2 and Pck1, and PB also increased Pparγ. MI was associated with reduced gestational weight gain, whilst PB was associated with increased maternal fasting glucose, total cholesterol and pancreas weight. These results suggest that MI and PB may improve insulin intracellular signalling in adipose tissue but this did not translate to meaningful differences in glucose tolerance. The absence of fasting hyperglycaemia or insulin resistance suggests this is a very mild model of GDM, which may have affected our ability to assess the impact of these nutrients.
It is important for the pediatric airway clinician to maintain oxygenation and avoid trauma when managing a child with a difficult airway. While these two objectives are compatible, it is also known that oxygen therapy can lead to significant harm. This chapter will include a discussion of various forms of oxygenation techniques during pediatric airway management, with an emphasis on avoiding hypoxia during all phases of the perioperative process. Included in this discussion will be mention of the deleterious effects of hypoxemia and hyperoxia, and the potential dangers of some oxygenation techniques.
The geomagnetic field extending outward beyond Earth’s solid surface encounters a strong, highly variable flow of hot ionized gas from the Sun called the solar wind. This compresses and shapes the dayside of Earth’s magnetic field. On the night (anti-sunward) side of the Earth, the magnetic field gets drawn out into a long, comet-like tail. Present evidence is that this magnetotail region extends to hundreds or thousands of Earth radii. Research over the past six decades has revealed much about the various current systems that shape the Earth’s "magnetosphere". This chapter is devoted to providing a broad overview of the individual current systems that, acting together, generate the complex and fascinating geomagnetic field.
Papillon treatment is a form of contact X-ray brachytherapy (CXB) which is used as an alternative to surgery for rectal cancer. This study aimed to audit patients who were referred for and treated with CXB over a 6-year period against guidelines derived from a critical review of the evidence base.
Materials and methods:
Patient demographics, tumour characteristics and outcome data were gathered for 31 patients referred for CXB. A critical review of the evidence identified consensus referral criteria and outcome data against which to audit patients.
Referral criteria were derived from six published studies. These applied to patients unfit for surgery or stoma-averse. All referred patients had a visible tumour or scar with a tumour size under 3 cm and sited less than 12 cm from the anal verge. Nodal status varied from N0 to N2, but there was no metastatic disease present. The audited cohort demonstrated demographic equivalence, while the initial clinical complete response and recurrence rates were also comparable.
This audit confirmed the validity of referral and treatment protocols and should guide future referrals until evidence from ongoing studies becomes available. These findings should contribute to the development of robust national guidelines.
This paper examines ex-ante impacts of two policy interventions that improve productivity of local-breed cows through artificial insemination (AI) and producers’ access to distant markets through a dairy market hub. The majority of cattle in Kilosa district in Tanzania are local low productivity breeds kept by smallholders and agro-pastoralists. Milk production is seasonal, which constrains producers’ access to distant urban markets, constrains producers’ incomes and restricts profitability in dairy processing. We developed and evaluated an integrated system dynamics (SD) simulation model that captures many relevant feedbacks between the biological dynamics of dairy cattle production, the economics of milk market access, and the impacts of rainfall as an environmental factor. Our analysis indicated that in the short (1 year) and medium (5-year) term, policy interventions have a negative effect on producers’ income due to high AI costs. However, in the long term (5+ years), producers’ income from dairy cattle activities markedly increases (by, on average, 7% per year). The results show the potential for upgrading the smallholder dairy value chain in Kilosa, but achievement of this result may require financial support to producers in the initial stages (first 5 years) of the interventions, particularly to offset AI costs, as well as additional consideration of post-farm value chain costs. Furthermore, institutional aspects of dairy market hub have substantial effects on trade-offs amongst performance measures (e.g. higher profit vs. milk consumption at producer's household) with gain in cumulative profit coming at the expense of a proportional and substantial reduction in home milk consumption.