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To assess public health nutrition practice within the public health system in Ontario, Canada to identify provincial-wide needs for scientific and technical support.
A qualitative descriptive study was conducted to identify activities, strengths, challenges and opportunities in public health nutrition practice using semi-structured key informant interviews (n 21) and focus groups (n 10). Recorded notes were analysed concurrently with data generation using content analysis. System needs were prioritised through a survey.
Public health units.
Eighty-nine practitioners, managers, directors, medical officers of health, researchers and other stakeholders were purposively recruited through snowball and extreme case sampling.
Five themes were generated: (i) current public health nutrition practice was broad, complex, in transition and collaborative; (ii) data/evidence/research relevant to public health needs were insufficiently available and accessible; (iii) the amount and specificity of guidance/leadership was perceived to be mismatched with strong evidence that diet is a risk factor for poor health; (iv) resources/capacity were varied but insufficient and (v) understanding of nutrition expertise in public health among colleagues, leadership and other organisations can be improved. Top ranked needs were increased understanding, visibility and prioritisation of healthy eating and food environments; improved access to data and evidence; improved collaboration and coordination; and increased alignment of activities and goals.
Collective capacity in the public health nutrition can be improved through strategic system-wide capacity-building interventions. Research is needed to explore how improvements in data, evidence and local contexts can bridge research and practice to effectively and efficiently improve population diets and health.
Test the efficacy and perceived effectiveness of nutrition labels on children’s menus from a full-service chain restaurant in an online study.
Using a between-groups experiment, parents were randomised to view children’s menus displaying one of five children’s nutrition labelling conditions: (i) No Nutrition Information (control); (ii) Calories Only; (iii) Calories + Contextual Statement (CS); (iv) Calories, Sodium + CS; or (v) Calories and Sodium in Traffic Lights + CS. Parents hypothetically ordered up to one entrée, side, beverage and dessert for their child, then rated and ranked all five labelling conditions on the level of perceived effectiveness.
998 parents with a 3–12 year old child.
Parents exposed to menus displaying ‘Calories, Sodium + CS’ selected significantly fewer calories ‘overall’ (entrées + side + dessert + beverage) compared to parents exposed to the control condition (−53·1 calories, P < 0·05). Parents selected ‘entrees’ with significantly fewer calories and lower sodium when exposed to menus with ‘Calories + CS’ (−24·3 calories, P < 0·05); ‘Calories, Sodium + CS’ (−25·4 calories, −56·1 mg sodium, P < 0·05 for both); and ‘Calories and Sodium in Traffic Lights + CS’ (−29·1 calories, −58·6 mg sodium, P < 0·05 for both). Parents exposed to menus with ‘Calories, Sodium + CS’ and ‘Calories and Sodium in Traffic Lights + CS’ were more likely to notice and understand nutrition information compared to other nuntrition labelling conditions. Parents perceived the menu with ‘Calories and Sodium in Traffic Lights + CS’ as most effective (P < 0·05).
Menus disclosing calories, sodium and a contextual statement increased the proportion of parents who noticed and understood nutrition information, and resulted in parents selecting lower calorie and sodium entrées for their children in the hypothetical purchase task.
A growing body of literature examines how direct or vicarious contact with forms of state surveillance affects political behavior and perceptions of government legitimacy. We develop a new method, Portals, to collect conversations between black residents from highly policed areas in five different U.S. cities between 2016 and 2018. While existing research emphasizes how interactions with the carceral state are alienating and demobilizing, our analysis of these conversations identifies productive ways in which citizens respond to oppressive encounters with police. The political discourses used by Portals participants, we argue, are centered on a logic of “collective autonomy”—given police ignorance, abuses of police authority, and the little political power that residents of highly policed communities have to demand change, many conclude that power is best achieved by strategically distancing from state institutions in the short term while building community power in the long term. Crucially, articulations of collective autonomy transcend the ideological positions of participants and track closely with an ideological tradition in black politics that persists across generations and contexts of state oppression.
Background: Ciliary mutations cause multi-system disorders, often involving the CNS. We set to evaluate the prevalence of ciliary dysfunction in children with isolated neuroanatomical defects, by measuring nasal nitric oxide (nNO), a screening test for Primary Ciliary Dyskinesia (PCD). Study design: We measured nNO levels of 26 children with congenital midline CNS defects. We evaluated the effect of age, gender, and anomaly (brain, spinal cord, or combined) on measurements. We compared our results to the previously established normal range (153.6-509.9 nL/min), and to the cutoff for PCD (77 nL/min). Results: The range for nNO in our cohort was 56.5-334.7 nL/min, with age, gender, and anomaly not having a significant effect. The overall mean, 217.7 nL/min, was significantly lower than that of normal children, 314.51 nL/min (p<0.01). Four subjects (15.4%) had nNO levels below the lower end of normal, with two (7.7%) having values fitting the cutoff for PCD. Conclusions: We report an association between ciliary dysfunction and isolated midline neuroanatomical defects, not in context of any known syndrome. This suggests that genes causing isolated CNS defects, may be implied in the function of cilia. Longitudinal studies are required to investigate whether children with abnormal measurements suffer from any respiratory sequelae.
Cerumen impaction is a common problem, and aural microsuction is a technique frequently employed for its management. This study aimed to quantify the patient perception, safety and efficacy of this procedure.
Patients were asked to complete a questionnaire following cerumen clearance by microsuction. The perceived severity of pain, noise-related discomfort and vertigo was scored on a scale of 1 to 10. Patients with mastoid cavities and those who had used a cerumenolytic agent in the preceding week were analysed separately.
A total of 159 questionnaires were returned. Mean scores (95 per cent confidence intervals) were: pain, 2.34 (2.06–2.62); noise discomfort, 3.03 (2.71–3.35); and vertigo, 1.95 (1.66–2.25). There was successful clearance (i.e. sufficient to view the tympanic membrane) in 91 per cent of cases. Patients who had used cerumenolytics reported significantly less pain and vertigo (p = 0.008 and p < 0.001, respectively) compared with those who had not, whilst patients with mastoid cavities reported greater levels of vertigo (p < 0.001) than those without.
Aural microsuction is well tolerated. Side effects are mild, and the prior use of cerumenolytics appears to further reduce their severity.
The search for a primary malignancy in patients with a metastatic cervical lymph node is challenging yet ultimately of utmost clinical importance. This study evaluated the efficacy of positron emission tomography computed tomography in detecting the occult primary, within the context of a tertiary referral centre head and neck cancer multidisciplinary team tumour board meeting.
Thirty-two patients (23 men and 9 women; mean and median age, 61 years) with a metastatic cervical lymph node of unknown primary origin, after clinical examination and magnetic resonance imaging, underwent positron emission tomography computed tomography.
The primary tumour detection rate was 50 per cent (16/32). Positron emission tomography computed tomography had a sensitivity of 94 per cent (16/17) and a specificity of 67 per cent (10/15). Combining these results with those of 10 earlier studies of similar patients gave an overall detection rate of 37 per cent.
Positron emission tomography computed tomography has become an important imaging modality. To date, it has the highest primary tumour detection rate, for head and neck cancer patients presenting with cervical lymph node metastases from an unknown primary.
For most doctors, Gustav Killian is best known for his eponymous pharyngeal dehiscence. Otorhinolaryngologists may also be familiar with his contributions to rhinology by way of his well-known incision and speculum. Few, however, will be aware of the true significance of his contributions to medicine. Killian was at the forefront of advances in ENT surgery at the turn of the twentieth century. From his early years to his revolutionary work on bronchoscopy and a narrowly missed Nobel Prize, this paper reviews the life and works of a most prolific and often overlooked surgical innovator.
We describe a rare case of spontaneous temporomandibular joint herniation into the external auditory canal, and we also review the presentation, aetiology and management of such cases.
An 87-year-old woman presented with a four-month history of left-sided otorrhoea and otalgia. Examination revealed a soft, polypoid mass in the left ear canal. When the patient opened her mouth the lesion disappeared. Subsequent computed tomographic imaging of the patient's temporal bones confirmed an 8.6 mm defect in the antero-inferior portion of the left ear canal, with herniation of retrodiscal soft tissues.
The external auditory canal is intimately related to the temporomandibular joint, separated only by its bony anterior wall. Neoplasm, trauma or inflammation in this area can result in displacement of the temporomandibular joint into the ear canal; however, spontaneous herniation is rare. Persistence of the primitive foramen of Huschke can result in dehiscence of the anterior canal wall, allowing articular tissue to prolapse into the ear canal. Surgical closure of these defects is known to be effective in ameliorating symptomatic cases.
Different types of biological adhesion can be categorized according to the
length scales, structures, and materials involved. The setal adhesion system
of the gekkonid lizards occupies a hierarchy of scales from the toes (~ 1
cm) to the terminal spatular pads on the setal branches (~ 100 nm). This
unique combination of scale and foot-hair morphology allow the animal
robust, controllable, and near-universal adhesion via van der Waals
attraction, but it is also apparent that the mechanical behavior of the
β-keratin plays an important role in an animal’s climbing ability.
Experimental results show a four-fold increase in the viscoelastic loss
tangent of β-keratin, alongside a substantial increase in adhesion of setal
arrays, over a range of relative humidity from 10 to 80%. A model of
single-spatular deformation predicts that the elastic energy stored in the
setal branches, energy which is not completely recovered on detachment, is
strongly influenced by these properties changes. The enhanced dissipation
characteristics of the system explain the effects of environmental humidity
on the clinging ability of geckos.
This chapter assesses the origins of the food price rises in the context of the international trade-distorting policies (including through food aid), global food markets and food price developments and trends. Recognising that the policy response to higher food prices requires both a short and longer term perspective, this chapter looks at both the efficacy of immediate mechanisms (notably food aid both in kind and in cash, including the impact on domestic production incentives) and at medium to longer term support of agricultural development and trade.
The short-term policy dimension needs to be set in the context of the ‘right to food for the truly needy’. Although the issue of food security arguably lies outside the remit of the WTO and the scope of regional trade arrangements, it is unsurprising that, without reliable and effective support mechanisms, countries will look to trade policy instruments to address food and livelihood concerns. This chapter reviews the adequacy of existing food aid instruments and trade policy rules and measures. It recognises that support to a global system, which progressively seeks to liberalise trade in agriculture, is severely compromised by the lack of a credible and predictable system of support.
The author proposes and recommends a serious reflection on and assessment of the need for a stand-alone emergency mechanism that is cash based and determined ex ante by criteria reflective of global prices of staple foods and malnutrition and famine indicators and therefore not linked to (i.e. decoupled from) trade liberalisation in agriculture (unlike the ‘Marrakesh Decision’).
Smallholders now grow most of Malawi's main export crop – burley tobacco. Based on nineteen months' fieldwork in the Central Region, this article offers a sociological interpretation of why some smallholder growers spend a proportion of burley income on conspicuous consumption in rural towns and trading centres. This practice can be seen as a form of inculcated behaviour whereby smallholders reproduce elements of one model of success in this region: that of the Malawian tobacco bwana (boss/master). The article discusses implications from this form of potlatch behaviour by describing the contrasting fortunes of two non-farm rural enterprises, examining data on how tobacco production and ‘cooling off’ is viewed by wives, and comparing the crop preferences of husbands and wives. It concludes by suggesting that the concept of conspicuous consumption may provide an alternative prism to the instrumental lens of neo-patrimonialism through which to view apparently unintelligible investment decisions in African economies.
Rebecca Cardigan, Head of Components Development, NHS Blood and Transplant Cambridge, Cambridge, UK,
Chris Prowse, Research Director, National Science Laboratory, Scottish National Blood Transfusion Service, Edinburgh, UK,
Lorna M. Williamson, Reader in Transfusion Medicine, University of Cambridge; Medical Director, NHS Blood and Transplant, Cambridge, UK
Although donor selection and donation screening remain the critical elements of protection from transfusion-transmitted pathogens, there is increasing interest in achieving further safety enhancements by component modification. In the last five years, leucocyte depletion has moved from being a bedside procedure for specific patients to a universal and integral part of component processing. In this context, its potential for removal of leucocyte-associated viruses has been the subject of considerable debate. Over the same time period, techniques for pathogen reduction of fresh frozen plasma and platelets have been developed and, in some cases, licensed for routine use. Pathogen reduction for red cells is proving a more challenging prospect, but in time the current difficulties may be overcome. Such techniques present policy-makers with interesting decisions which must take into account cost-effectiveness, loss of functionality of components, potential toxicity, and the potential impact on current donor selection and screening policies.
Leucocyte depletion (LD)
Many countries now undertake universal LD of all components in blood centres within 1–2 days of collection. The reasons for this practice vary from country to country, but perceived benefits include reduced immunomodulation, fewer febrile reactions, and reduction of cytomegalovirus risk (reviewed in Williamson, 2000). In the UK, the main reason for implementation of universal LD was as a precaution against transmission of variant Creutzfeld-Jacob disease. Leucocyte depletion is achieved either by filtration of either whole blood or processed components, or by centrifugation/elutriation during platelet apheresis.