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In this chapter we focus on the cultural diversity of genders and sexualities, and the effects of marginalisation, interpersonal and intimate partner violence and abuse on people's mental health (Afifi, 2007; Seedat et al., 2009). We describe the ways in which mental health practitioners are able to practise empathically and effectively in gender, diversity and trauma-informed care. Throughout the first part of the chapter we will be reading Riley's story to help us understand how mental health services can be more supportive and accepting of gender and sexual diversity.
Continua of sexuality and gender
The Australian (2011) and New Zealand Human Rights Commissions (2008) refer to a broad and diverse range of sexual orientations and gender identities. Many people are familiar with the idea that there exists a range of sexual orientations. One way to conceptualise gender as more than a binary of male and female is to imagine a continuum of gender identity (United Nations High Commissioner for Human Rights, 2012), with heterosexual or straight at one end and lesbian or gay at the other. Many people position themselves at either end, while others place themselves at a myriad places in between. Some people move along the continuum over the course of their lifetime. It is less commonly acknowledged that there is also a wide range of gender identities. Some terms that people might use include transgender, transsexual, intersex, gender-queer, woman or man.
‘Transgender’ is a term that encompasses a range of identities for people who do not identify with the sex they were assigned at birth. Some of these people identify as transmen (assigned female at birth, identify as male) or as transwomen (assigned male at birth, identify as female). Some people do not identify with the binary concept of male or female, and may use terms like gender-queer. Gender-queer people identify as both male and female, or as neither. This is different to intersex, which is a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that does not fit the typical biological definitions of female or male.
Outpatient interventions for adult anorexia nervosa typically have a modest impact on weight and eating disorder symptomatology. This study examined whether adding a brief online intervention focused on enhancing motivation to change and the development of a recovery identity (RecoveryMANTRA) would improve outcomes in adults with anorexia nervosa.
Participants with anorexia nervosa (n = 187) were recruited from 22 eating disorder outpatient services throughout the UK. They were randomised to receiving RecoveryMANTRA in addition to treatment as usual (TAU) (n = 99; experimental group) or TAU only (n = 88; control group). Outcomes were measured at end-of-intervention (6 weeks), 6 and 12 months.
Adherence rates to RecoveryMANTRA were 83% for the online guidance sessions and 77% for the use of self-help materials (workbook and/or short video clips). Group differences in body mass index at 6 weeks (primary outcome) were not significant. Group differences in eating disorder symptoms, psychological wellbeing and work and social adjustment (at 6 weeks and at follow-up) were not significant, except for a trend-level greater reduction in anxiety at 6 weeks in the RecoveryMANTRA group (p = 0.06). However, the RecoveryMANTRA group had significantly higher levels of confidence in own ability to change (p = 0.02) and alliance with the therapist at the outpatient service (p = 0.005) compared to the control group at 6 weeks.
Augmenting outpatient treatment for adult anorexia nervosa with a focus on recovery and motivation produced short-term reductions in anxiety and increased confidence to change and therapeutic alliance.
To explore if better diet quality scores as a measure of adherence to the Australian Dietary Guidelines (ADG) and the Mediterranean diet (MedDiet) are associated with a lower incidence of hypertension and non-fatal CVD.
Prospective analysis of the 1946–1951 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH). The Australian Recommended Foods Score (ARFS) was calculated as an indicator of adherence to the ADG; the Mediterranean Diet Score (MDS) measured adherence to the MedDiet. Outcomes included hypertension and non-fatal CVD. Generalised estimating equations estimated OR and 95 % CI across quartiles of diet quality scores.
1946–1951 cohort of the ALSWH (n 5324), without CVD, hypertension and diabetes at baseline (2001), with complete FFQ data.
There were 1342 new cases of hypertension and 629 new cases of non-fatal CVD over 15 years of follow-up. Multivariate analysis indicated that women reporting better adherence to the ARFS (≥38/74) had 15 % (95 % CI 1, 28 %; P = 0·05) lower odds of hypertension and 46 % (95 % CI 6, 66 %; P = 0·1) lower odds of non-fatal CVD. Women reporting better adherence to the MDS (≥8/17) had 27 % (95 % CI 15, 47 %; P = 0·0006) lower odds of hypertension and 30 % (95 % CI 2, 50 %; P = 0·03) lower odds of non-fatal CVD.
Better adherence to diet quality scores is associated with lower risk of hypertension and non-fatal CVD. These results support the need for updated evidenced based on the ADG as well as public health nutrition policies in Australia.
Greenhouse and outdoor container experiments were conducted to determine garden spurge and large crabgrass emergence when seeds were placed either on top of or below three different mulch materials [pine bark (PB), hardwood (HW), or pine straw (PS)] applied at five depths (0, 1.3, 2.5, 5.1, and 10.2 cm). To elucidate mulch characteristics that contributed to weed control, photosynthetic active radiation (PAR) was recorded underneath each mulch layer, moisture retention was monitored for 24 h following irrigation, and particle size was determined using standard soil sieves. HW reduced PAR (97%) more than did PB (90%) or PS (92%) at 1.3 cm, but few or no differences were noted between mulches at greater mulch depths. HW also contained the highest percentage of small particles and consequently retained more water (29%), than PB (14%) or PS (22%) 24 h following a simulated irrigation event. Emergence of large crabgrass and garden spurge was consistently greater when seeds were placed on top of the mulch, compared to seeds placed below. Emergence of both species also tended to respond to increasing depth in a quadratic manner, indicating that once a critical level of mulch was applied (2.5 to 5 cm), further reductions in weed emergence would not be observed, at least over the short term (12 wk). PB and PS tended to provide a greater reduction in emergence of both species compared to HW. This research also indicates that larger particle materials such as PB or PS would be advantageous because of their ability to suppress weed emergence regardless of seed position.
Field studies were conducted on organic soils in Belle Glade, FL in 2016 to 2017 to evaluate sugarcane tolerance and fall panicum control with topramezone applied alone or in combination with triazine herbicides (atrazine, metribuzin, ametryn). Treatments included topramezone (25 and 50 g ai ha-1) applied alone or in combination with atrazine (2,240 g ai ha-1), metribuzin (2,240 g ai ha-1), and ametryn (440 g ha-1) on four plant cane varieties to evaluate tolerance, and on second ratoon fields to determine efficacy on fall panicum control. Topramezone applied alone had no effect on sugarcane chlorophyll fluorescence (Fv/Fm), total chlorophyll, and carotenoid 7 to 28 days after treatment (DAT) suggesting sugarcane tolerance. Significant reduction of these parameters occured 7 to 14 DAT when topramezone (50 g ai ha-1) was applied with ametryn or metribuzin; however, reductions were not detected thereafter indicating recovery. Sugarcane yield was not affected by topramezone applied alone or in combination with the triazine herbicides. Topramezone (50 g ai ha-1) plus metribuzin resulted in acceptable control of fall panicum (84%) with limited to no regrowth of meristematic tissue at sugarcane canopy closure, equivalent to 56 to 70 DAT. These results indicate that when sequential applications of topramezone applied alone or in combination with these triazine herbicides is required for efficacious weed control, topramezone applications alone can be made after 7 days while the combinations can be made after 14 or 21 days depending on sugarcane sensitivity.
With regionalized trauma care, medical transport times can be prolonged, requiring paramedics to manage patient care and symptoms. Our objective was to evaluate pain management during air transport of trauma patients.
We conducted a 12-month review of electronic paramedic records from a provincial critical care transport agency. Patients were included if they were ≥18 years old and underwent air transport to a trauma centre, and excluded if they were Glasgow Coma Scale score <14, intubated, or accompanied by a physician or nurse. Demographics, injury description, and transportation parameters were recorded. Outcomes included pain assessment via 11-point numerical rating scale, patterns of analgesia administration, and analgesia-related adverse events. Results were reported as mean ± standard deviation, [range], (percentage).
We included 372 patients: 47.0 years old; 262 males; 361 blunt injuries. Transport duration was 82.4 ± 46.3 minutes. In 232 (62.4%) patients who received analgesia, baseline numerical rating scale was 5.9 ± 2.5. Fentanyl was most commonly administered at 44.3 [25–60] mcg. Numerical rating scale after first analgesia dose decreased by 1.1 [-2–7]. Thereafter, 171 (73.7%) patients received 2.4 [1-18] additional doses. While 44 (23.4%) patients had no change in numerical rating scale after first analgesia dose, subsequent doses resulted in no change in numerical rating scale in over 65% of patients. There were 43 adverse events recorded, with nausea the most commonly reported (39.5%).
Initial and subsequent dose(s) of analgesic had minimal effect on pain as assessed via numerical rating scale, likely due in part to inadequate dosing. Future research is required to determine and address the barriers to proper analgesia.
Whole grain cereal breakfast consumption has been associated with beneficial effects on glucose and insulin metabolism as well as satiety. Pearl millet is a popular ancient grain variety that can be grown in hot, dry regions. However, little is known about its health effects. This study investigated the effect of a pearl millet porridge (PMP) compared with a well-known Scottish oats porridge (SOP) on glycaemic, gastrointestinal, hormonal and appetitive responses. In a randomized, two way crossover trial, 26 healthy participants consumed two iso-energetic/volumetric PMP or SOP breakfast meals, served with a drink of water. Blood samples for glucose, insulin, GLP-1, GIP and PYY, gastric volumes and appetite ratings were collected for two hours postprandially, followed by an ad libitum meal and food intake records for the remainder of the day. The incremental area under the curve (iAUC2h) for blood glucose was not significantly different between the porridges (p ˃ 0.05). The iAUC2h gastric volume was larger for PMP compared with SOP (p = 0.045). The iAUC2h GIP concentration was significantly lower for PMP compared with SOP (p = 0.001). Other hormones and appetite responses were similar between meals. In conclusion, this study reports, for the first time, data on glycaemic and physiological responses to a pearl millet breakfast, showing that this ancient grain could represent a sustainable, alternative, with health-promoting characteristics comparable to oats. GIP is an incretin hormone linked to triacylglycerol absorption in adipose tissue, therefore the lower GIP response for PMP may be an added health benefit.
Our objective was to determine emergency department (ED) patient adherence to outpatient specialized geriatric services (SGS) following ED evaluation by the geriatric emergency management (GEM) nurse, and identify barriers and facilitators to attendance.
We conducted a prospective cohort study at two academic EDs between July and December 2016, enrolling a convenience sample of patients ≥ 65 years, seen by a GEM nurse, referred to outpatient SGS, and consented to study participation. We completed a chart review and a structured telephone follow-up at 6 weeks. Descriptive statistics were used.
We enrolled 103/285 eligible patients (86 eligible but not enrolled, 86 declined specialized geriatric referrals, and 10 declined study participation). Patients were mean age of 83.1 years, 59.2% female, and 73.2% cognitively impaired. Reasons for referral included mobility (86.4%), cognition (56.3%), pain (38.8%), mood (35.0%), medications (33.0%), and nutrition (31.1%). Referrals were to Geriatric Day Hospital (GDH) programs (50.5%), geriatric outreach (26.2%), falls clinic (12.6%), and geriatric psychiatry (8.7%). Adherence with follow-up was 59.2%. Barriers to attendance included patient did not feel SGS were needed (52.1%), inability to recall GEM consultation (53.4%), and dependence on family for transportation (72.6%). Home-based assessments had the highest adherence (81.5%).
Adherence of older ED patients referred by the GEM team to SGS is suboptimal, and a large proportion of patients decline these referrals in the ED. Future work should examine the efficacy of home-based assessments in a larger confirmatory setting and focus on interventions to increase referral acceptance and address barriers to attendance.
It is clear that the sugars component of the diet has potentially deleterious effects on health. In the past, the dietary sugars were collectively referred to as non-milk extrinsic sugars (UK) or added sugars. The WHO first proposed a new term, free sugars, which is rather broader than added sugars, and also includes the sugars in fruit juices and purees, as well as honey and syrups. This review considers the potential problems that free sugars represent in relation to health risks, and the recent proposals that free sugars are a more appropriate focus than added or total as far as public health initiatives are concerned. This will require major activities in relation to measurement, labelling and communication to the consumer if attempts to reduce dietary free sugars content are to be successful.
The wearable products market is growing rapidly. Engaging users on an emotional level may be the key to long-term use and attracting new customers. While researchers have proposed various design approaches to realize design qualities for wearable devices, emotional needs are overlooked in the design process. To bridge this gap, we developed an approach with an online tool that uses a two-axis interactive collage for users to compare and evaluate wearable products with targeted emotion-related descriptive words. This approach enabled us to explore how users perceive products and identify types of emotions that were associated with their preferences for and perceptions of the product's form and visible characteristics. The study demonstrated this design approach to reveal insights into the relationships between product characteristics and design goals, such as user comfort, user delight, and perceived product usefulness. The results showed that products that resemble clothes were perceived as more delightful and comfortable. This study suggests that the approach can be further used to explore other design concepts or goals.
Zoysia germplasm exhibit different levels of sensitivity to fluazifop-P-butyl, but the genetic factors responsible for such differences are unknown. Segregation patterns of the fluazifop-P-butyl tolerance trait were studied under greenhouse conditions. In total, 244 F1 lines were generated from multiple crosses between the tolerant line 5337-2 (non–target site tolerance) and three more-sensitive lines (123, 252, and 5330-23). Progeny segregation showed that fluazifop-P-butyl tolerance within zoysiagrass (Zoysia spp.) is expressed as a quantitative trait with a wide range of intermediate phenotypes between parental phenotypes. Transgressive segregation was extensive and largely favored susceptibility in most families, but was especially evident for 5337-2 × 123 and 5337-2 × 5330-23. The segregation patterns for biomass reduction and percent injury were different within reciprocal crosses and among three different family crosses. Reciprocal effects were observed in growth reduction for 5337-2 × 5330-23, in percent injury at 3 wk after the treatment (WAT), and for 5337-2 × 252 at 6 WAT. This indicated that fluazifop-P-butyl tolerance was not completely controlled by nuclear genetic factors in 5337-2 and maternal/cytoplasmic inheritance was also partially responsible. These results suggested that fluazifop-P-butyl tolerance may be attributed to multiple genetic mechanisms, which could present a challenge for future breeding efforts because of the difficulty of fixing multiple traits within a breeding population.
Social-media companies make extensive use of artificial
intelligence in their efforts to remove and block
terrorist content from their platforms. This paper
begins by arguing that, since such efforts amount to
an attempt to channel human conduct, they should be
regarded as a form of regulation that is subject to
rule-of-law principles. The paper then discusses
three sets of rule-of-law issues. The first set
concerns enforceability. Here, the paper highlights
the displacement effects that have resulted from the
automated removal and blocking of terrorist content
and argues that regard must be had to the whole
social-media ecology, as well as to jihadist groups
other than the so-called Islamic State and other
forms of violent extremism. Since rule
by law is only a necessary, and not
a sufficient, condition for compliance with
rule-of-law values, the paper
then goes on to examine two further sets of issues:
the clarity with which social-media companies define
terrorist content and the adequacy of the processes
by which a user may appeal against an account
suspension or the blocking or removal of content.
The paper concludes by identifying a range of
research questions that emerge from the discussion
and that together form a promising and timely
research agenda to which legal scholarship has much
Background: Gross total resection of pediatric posterior fossa tumors is paramount towards improving progression-free survival.
Fluorescein accumulates in tumoral tissue, where the blood-brain barrier is disrupted. It can therefore potentially aid in differentiating tumoral versus normal tissue. We aimed to evaluate the efficacy of fluorescent-guidance (using fluorescein) towards the resection of a pediatric cerebellar tumor, as the index case at our institution using this technique. Methods: 5 mg/kg of IV fluorescein sodium was injected upon induction of general anesthesia. During tumor resection, a yellow 560-nm filter (Kinevo microscope, Zeiss) was employed for fluorescent-guidance. The extent of resection was assessed via post-operative MRI. Results: There were no adverse side effects experienced by the patient. Tumoral material was clearly visualized under the yellow 560-nm filter, allowing for satisfactory gross total resection of the lesion (confirmed on post-operative MRI). Preliminary pathology was consistent with medulloblastoma. Conclusions: Fluorescent-guided resection of pediatric posterior fossa tumors appears to be a safe and useful adjunct for gross total resection of these lesions. To the best of our knowledge, this is the first reported case in Canada wherein IV fluorescein was used under a yellow 560-nm filter for resection of a posterior fossa medulloblastoma in a child.
Anthropogenic habitat alteration and invasive species are threatening carnivores globally. Understanding the impact of these factors is critical for creating localized, effective conservation programmes. Madagascar's Eupleridae have been described as the least studied and most threatened group of carnivores. We investigated the effects of habitat degradation and the presence of people and exotic species on the modelled occupancy of the endemic fosa Cryptoprocta ferox, conducting camera-trap surveys in two western deciduous forests, Ankarafantsika National Park and Andranomena Special Reserve. Our results indicated no clear patterns between habitat degradation and fosa occupancy but a strong negative association between cats Felis sp. and fosas. Cat occupancy was negatively associated with birds and positively associated with contiguous forest and narrow trails. In contrast, dog Canis lupus familiaris occupancy was best predicted by wide trails, degraded forest and exotic civets. Our results suggest fosas are capable of traversing degraded landscapes and, in the short term, are resilient to contiguous forest disturbance. However, high occupancy of cats and dogs in the landscape leads to resource competition through prey exploitation and interference, increasing the risk of transmission of potentially fatal diseases. Management strategies for exotic carnivores should be considered, to reduce the widespread predation of endemic species and the transmission of disease.
Sports victory constitutes an important part of propaganda in authoritarian states. The heavy state investment in sports industries and sports culture in China illustrates the political importance of sports. However, few studies have systematically examined the exact impact of sports propaganda on public opinion. Using a survey experiment conducted in two Chinese cities, this article finds that broadcast highlighting national sports achievements has significant positive effects on general satisfaction and compliance with the local governments. These results expand on the small, but growing, literature on the effects of sports on political opinions and help detail the specific ways in which sports can affect political attitudes.