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The Developmental Origins of Health and Disease (DOHaD) framework aims to understand how environmental exposures in early life shape lifecycle health. Our understanding and the ability to prevent poor health outcomes and enrich for resiliency remain limited, in part, because exposure–outcome relationships are complex and poorly defined. We, therefore, aimed to determine the major DOHaD risk and resilience factors. A systematic approach with a 3-level screening process was used to conduct our Rapid Evidence Review following the established guidelines. Scientific databases using DOHaD-related keywords were searched to capture articles between January 1, 2009 and April 19, 2019. A final total of 56 systematic reviews/meta-analyses were obtained. Studies were categorized into domains based on primary exposures and outcomes investigated. Primary summary statistics and extracted data from the studies are presented in Graphical Overview for Evidence Reviews diagrams. There was substantial heterogeneity within and between studies. While global trends showed an increase in DOHaD publications over the last decade, the majority of data reported were from high-income countries. Articles were categorized under six exposure domains: Early Life Nutrition, Maternal/Paternal Health, Maternal/Paternal Psychological Exposure, Toxicants/Environment, Social Determinants, and Others. Studies examining social determinants of health and paternal influences were underrepresented. Only 23% of the articles explored resiliency factors. We synthesized major evidence on relationships between early life exposures and developmental and health outcomes, identifying risk and resiliency factors that influence later life health. Our findings provide insight into important trends and gaps in knowledge within many exposures and outcome domains.
Introduction: Les erreurs médicales sont causées par des failles de système plutôt qu'un seul individu. Dans ce contexte, de multiples designs pédagogiques de formation interprofessionnelle (FIP) ont été proposés pour développer une meilleure collaboration interprofessionnelle. L'une des initiatives pédagogiques proposées en médecine de désastre est la simulation de table (TTX). La TTX consiste à simuler une situation de code orange dans un environnement informel où les participants doivent discuter de la suite logique des actions à prendre. Le protocole d'arrêt cardiaque intra-hospitalier chez le nourrisson de moins de 30 jours (code rose) ayant été mis à jour au Centre hospitalier de l'Université de Montréal (CHUM), cela a généré un besoin de FIP au sein des équipes. Ainsi, nous avons développé une FIP innovante en utilisant la TTX pour enseigner un nouveau protocole de code rose. L'objectif primaire de la présente étude est d'évaluer la perception des apprenants à propos de cette FIP. Methods: La présente étude rétrospective de cohorte s'est déroulée en mars 2019 au centre de simulation du Centre hospitalier de l'Université de Montréal. Un groupe interprofessionnel (médecins, infirmières, inhalothérapeutes, préposés aux bénéficiaires, etc.) a été recruté. Un sondage de satisfaction des participants leur a été remis immédiatement après la TTX. Des statistiques descriptives (n, %) ont été réalisées. Les commentaires recueillis lors du débreffage ont permis de nuancer les résultats et d'apporter des changements à la nouvelle procédure de code rose. Results: Un total de 13 participants ont participé à la TTX, dont 10 ont répondu au sondage (10/13 : 77%). 3 observateurs ont participé à la TTX et ont tous répondu à certaines questions du sondage (3/3 : 100%). Suite à la TTX, 80% (n = 8) des participants ont eu l'impression de mieux comprendre leur propre rôle et 90% (n = 9) des participants ont eu l'impression de mieux comprendre le rôle des autres professionnels. Tous (100%, n = 13) ont apprécié la TTX et ont affirmé qu'il était probable ou très probable qu'ils participent à nouveau à une telle activité de FIP s'ils y étaient invités et qu'ils recommanderaient à un collègue d'y participer. Conclusion: Il est possible de réaliser une TTX pour une autre procédure d'urgence que le code orange, c'est-à-dire pour le code rose et cela est apprécié des participants. Ces derniers se sont sentis plus confiants dans leur rôle et dans leur connaissance du rôle des autres professionnels.
Introduction: The Brain Injury Guidelines (BIG) stratifies complicated mild traumatic brain injury (mTBI) patients into 3 groups to guide hospitalization, neurosurgical consultation and repeat head-CT. BIG-1 patients could be managed safely without neurosurgical consultation or transfer. Systematic transfer to neurotrauma centers provide few benefits to this subgroup leading to overtriage. Similarly, unnecessary clinical and radiological follow-ups utilize significant health-care resources. Objective: to validate the safety and efficacy of the BIG for complicated mTBIs. Methods: We performed a multicenter historical cohort study in 3 level-1 trauma centers in Quebec. Patients ≥16 years old assessed in the Emergency Department (ED) with complicated mTBI between 2014 and 2017 were included. Patients with penetrating trauma, cerebral aneurysm or tumor were excluded. Clinical, demographic and radiological data, BIG variables, TBI-related death and neurosurgical intervention were collected using a standardized form. A second reviewer assessed all ambiguous files. Descriptive statistics, over- and under-triage were calculated. Results: A total of 342 patients’ records were assessed. Mean age was 63 ± 20,7 and 236 (69 %) were male. Thirty-five patients were classified under BIG-1 (10.2%), 110 under BIG-2 (32.2%) and 197 under BIG-3 (57.6%). Twenty-six patients (7%) required neurosurgical intervention, all were BIG-3. 90% of TBI-related deaths occurred in BIG-3 and none were classified BIG-1. Among the 192 transfers (51%), 14 were classified under BIG-1 (7.3%) and should not have been transferred according to the guidelines and 50 under BIG-2 (26%). In addition, 40% of BIG-1 received a repeat head computed tomography, although not indicated. Similarly, 7 % of all patients had a neurosurgical consult even if not required. Projected implementation of BIG would lead to 47% of overtriage and 0.3% of undertriage. Conclusion: Our results suggest that the Brain Injury Guidelines could safely identify patients with negative outcomes and could lead to a safe and effective management of complicated mTBI. Applying these guidelines to our cohort could have resulted in significantly fewer repeat head CTs, neurosurgical consults and transfers to level 1 neurotrauma centers.
Shelley repeatedly described himself as an atheist, and yet in his poetry he frequently explored the possibility of god-like transcendent powers, divine inspiration, and prophecy. In many of his greatest poetic works (such as Mont Blanc, Ode to the West Wind, and Prometheus Unbound), Shelley frequently invokes biblical imagery to articulate essentially Christian values (hope, charity, love) while developing his own master themes of enlightened defiance, political liberty and the struggle toward self-control. In Prometheus Unbound, Shelley's Greek Titan is metaphorically “crucified” for his sacrifice to help humanity. His liberation follows a personal transformation that recalls aspects of St. Paul’s writing on self-mastery. It is unclear if Prometheus’ liberation is causally linked to his own imaginative renewal, or whether there are other forces (God, Necessity, inscrutable Powers) that are instrumental. The repeated inclination to invoke both classical and biblical writing while developing themes of personal autonomy and enlightenment is one of the most interesting aspects of Shelley's work, and one of the most representative qualities of Romantic writing more generally.
First, I discuss cross-cultural evidence showing that a good deal of enculturation takes place outside of thinking through other minds. Second, I review evidence challenging the claim that humans seek to minimize entropy. Finally, I argue that optimality claims should be avoided, and that descriptive Bayesianism offers a more promising avenue for the development of a Bayesian theory of culture.
Several thousand new civil society organisations were legally established in Tunisia following the 2010–11 uprising that forced the long-serving dictator, Zine al-Abidine Ben Ali, from office. These organisations had different visions for a new Tunisia, and divisive issues such as the status of women, homosexuality, and human rights became highly contested. For some actors, the transition from authoritarian rule allowed them to have a strong voice that was previously muted under the former regimes. For others, the conflicts that emerged between the different groups brought new repressions and exclusions – this time not from the regime, but from 'civil society'. Vulnerable populations and the organisations working with them soon found themselves operating on uncertain terrain, where providing support to marginalised and routinely criminalised communities brought unexpected challenges. Here, Edwige Fortier explores this remarkable period of transformation and the effects of opening up public space in this way.