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Interstage monitoring programs for single ventricle disease have been developed to reduce morbidity and mortality. There is increased use of telemedicine and mobile application monitoring. It is unknown if there are disparities in use based on patient socio-demographic factors.
Methods:
We conducted a retrospective cohort study of patients enrolled in the single ventricle monitoring program and KidsHeart application at a single centre from 4/21/2021 to 12/31/2023. We investigated the association of socio-demographic factors with telemedicine usage, mobile application enrollment and usage. We assessed resource utilisation and weight changes by program era.
Results:
There were 94 children in the cohort. Patients with Norwood and ductal stent had higher mean telemedicine visits per month (1.8 visits, p = 0.004), without differences based on socio-demographic factors. There were differences in application enrollment with more Black patients enrolled compared to White patients (p = 0.016). There were less Hispanic patients enrolled than Non-Hispanic patients (p = 0.034). There were no Spaish speaking patient’s enrolled (p = 0.0015). There were no patients with maternal education of less than high school enrolled and all those with maternal education of advanced degree were enrolled (p = 0.0016). There was decreased mobile application use in those from neighbourhoods in the lowest income quartile. There were decreased emergency department visits with mobile application monitoring. Mean weight-for-age z-scores had increased from start to completion of the program in all eras.
Discussion:
Differences were seen in mobile application enrollment and usage based on socio-demographic factors. Further work is needed to ensure that all patients have access to mobile application usage.
In its early decades, Antiquity regularly featured the subject of linear earthworks that criss-cross the British landscape. Subsequently, however, discussion has been largely relegated to period-specific and local journals. As a result, interpretations of these imposing but often poorly dated earthworks have been drawn in the contrasting research traditions of later prehistory and the early medieval period. Here, the authors propose a comparative dialogue as a means for reinterpreting these landscape features, and as a lens through which to explore social complexity. Combined with advances in archaeometrical dating, this new approach promises to reinvigorate the study of some of Britain's largest archaeological monuments.
In a book on African paleoecology and human evolution, it is important to define several key themes, including biomes, vegetation formations and associations, as well as plant physiognomy. We first define these terms, before examining the sources of data employed in paleoenvironmental reconstructions. Finally, we provide an overview of the approaches used to understand past habitats, which underpin the chapters on the specific sites which make use of these approaches to refine our understanding of African paleoenvironments and the place of hominins within them.
We created a COVID-19 Research Patient and Community Advisory Board (PCAB) to provide patient and community input into clinical and translational research studies. The purpose of this article is to describe the PCAB creation, implementation, and evaluation.
Methods:
We identified PCAB members who had participated in previous stakeholder engaged activities at our institution and invited their participation. We created a systematic consultation process where researchers could submit plain language research summaries and questions for the PCAB. A facilitated 1-hour virtual consultation was then held where PCAB members provided feedback. We assessed satisfaction of PCAB members and researchers who received consultations using surveys. We also reviewed video recordings of PCAB consultations and reflections from team meetings to identify key lessons learned.
Results:
Twenty-seven PCAB members took part in 23 consultation sessions. Twenty-two completed an evaluation survey (81% response rate). Most members agreed or strongly agreed their opinions were valued (86%), it was a productive use of time (86%) and were satisfied (86%). Nineteen researchers completed an evaluation survey (83% response rate). Researchers reported positive experiences of working with the PCAB. Additional insights include limited funding in COVID-19 research for equitable community engagement, deficiencies in researcher communication skills, and a lack of cultural humility incorporated into study activities.
Conclusions:
PCAB members provided recommendations that maximized the patient-centeredness and health equity focus of COVID-19 research. The detailed description of the process of developing, implementing, and evaluating our PCAB can be used as a template for others wishing to replicate this engagement model.
What is the significance of science’s reliance on metaphor? Does the fact that much of the language of science is non-literal undermine its status as objective knowledge of reality or its ability to help us solve practical problems concerning the world and our health? What should readers keep in mind when they hear or read scientists employing metaphorical language?
Scientific language, especially that which is metaphorical, should be regarded as similar to provisional hypotheses that may require revision or ultimate rejection depending upon what the evidence suggests. We should also be aware that the metaphors scientists use may have quite positive effects for them in their original narrow application, allowing them to think about, understand, and possibly to manipulate some very specific and limited aspect of the world, but that the metaphor may be less adequate when applied to the broader system as a whole.
This chapter deals with the thorniest and most tangled thicket of metaphors, and there is probably no other area in the life sciences whose language has received so much critical attention. A great deal has been written about the metaphors used in genetics and genomics research, and I will attempt to provide only a summary here, with few original contributions of my own.
Classical genetics (that which preceded the “molecular revolution” of the mid-twentieth century) dealt with the phenomenon of biological inheritance, where evident species- and family-level similarities between parent and offspring attest that something is transmitted from one generation to the next (hence the metaphor of inheritance). Dogs give birth to dogs, corn plants produce more corn plants, and children tend to look like their parents and close relations.
While genes are said to provide the instructions, blueprints, programs, or recipes for protein synthesis, proteins themselves (which play structural and functional roles in the physiological activities of the cell), are commonly described as machines, motors, pumps, receptors, switches, messengers, recruiters, and cooperators that work together to carry out all the functions required of a living cell. Scientists employ these anthropomorphic and technomorphic metaphors to help themselves understand what proteins do and how they do it. As with the language of molecular genetics, there is often healthy debate among molecular biologists about the strengths and weaknesses of these metaphors for protein structure and function.
Medicine, as the old saying goes, is as much an art as a science. Its chief objective is the treatment and prevention of illness and disease. Biomedicine combines the traditional and practical objectives of medicine with modern scientific understanding of normal and pathological function in humans and other living organisms, but especially from the perspectives of molecular and cellular biology.
As earlier chapters explained, the experimental and molecular turn in biology of the twentieth century involved the adoption of an engineering perspective in two senses: (1) the goal is not simply to achieve an understanding of how living things function through passive observation, but rather to determine by intervention and manipulation of their component parts (cells and their own components) how they behave in different environments and conditions; and (2) this approach is guided by engineering metaphors that portray organisms and cells as machines that can be disassembled and rearranged in order to learn how the parts and whole function.
While other scientific-technological developments may have had greater material impacts on how we live (for instance, the unleashing of fossil fuels to drive the industrial revolution, atomic energy, or the creation of digital computers), none has had a greater impact on how we understand what it means to be human and our place in the universe than the Darwinian theory of evolution. Darwin was not the first to propose that humans and other species have not always existed in their present forms, and that they have gradually developed or emerged from earlier forms of life. Theories about the “transmutation” or “transformation” of species were proposed in Europe by members of his grandfather’s generation, including Lamarck, Geoffroy Saint-Hilaire, and Darwin’s own paternal grandfather Erasmus. In his own time, people like Robert Chambers and Herbert Spencer wrote popular and philosophical essays espousing what was frequently called the hypothesis or principle of development.
Given the wide range of possibilities to draw from, one might expect the metaphors being used in the life sciences to come from a wide variety of source domains. After all, if you’re trying to describe an organism and understand how it works, for instance, you could in theory compare it to anything. But as a matter of fact, the metaphors one tends to find in the life sciences fall into three broad categories: agents, machines, and information. I will refer to these broad categories as background metaphors. All three involve teleological thinking – that is, the assumption that things are (or that it is at least a helpful heuristic to suppose they are) either designed to fulfill certain functions or have plans of their own they are attempting to achieve. We will also look at a smaller number of metaphors drawing on natural objects as the source domain, but the majority to be covered in this book will fall into the three chief background metaphor categories of agents, machines, and information.