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Women are still underrepresented as public-sector organizational leaders, despite comprising half of the United States public-sector workforce. To explore the factors driving gender imbalance, this Element employs a problem-driven approach to examine gender imbalance in local government management. We use multiple methods, inductive and deductive research, and different theoretical frames for exploring why so few women are city or county managers. Our interviews, resume analysis and secondary data analysis suggesting that women in local government management face a complex puzzle of gendered experiences, career paths and appointment circumstances that lend insights into gender imbalanced leadership in this domain.
Commercialization of crops resistant to application of dicamba is a cause of major concern for sweetpotato producers regarding potential negative impacts due to herbicide drift or sprayer contamination events. A field study was initiated in 2014 and repeated in 2015 to assess impacts of reduced rates of BAPMA or DGA salt of dicamba, glyphosate, or a combination of these individually in separate trials with glyphosate on sweetpotato. Reduced rates of 1/10, 1/100, 1/250, 1/500, 1/750, and 1/1000 of the 1x use rate of each dicamba formulation at 0.56 kg ha-1, glyphosate at 1.12 kg ha-1, and the combination of the two at aforementioned rates were applied to ‘Beauregard’ sweetpotato at storage root formation (10 d after transplanting) in one trial or storage root development (30 d after transplanting) in a separate trial. Injury with each salt of dicamba (BAPMA or DGA) applied alone or with glyphosate was generally equal or greater than glyphosate applied alone at equivalent rates, indicating that injury is most attributable to the dicamba in the combination. There was a quadratic increase in crop injury and quadratic decrease in crop yield (with respect to most yield grades) observed with increase herbicide rate of dicamba applied alone or in combination with glyphosate applied at storage root development. However, this relationship as well as the significance of herbicide rate was not observed on crop injury or sweetpotato yield when herbicide application occurred at storage root formation stage with a few exceptions. In general, crop injury and yield reduction was greatest at the highest rate (1/10x) of either salt of dicamba applied alone or in combination with glyphosate, although injury observed at lower rates would be cause for concern after initial observation by sweetpotato producers. However, in some cases yield reduction of no.1 and marketable grades was observed following 1/250, 1/100, or 1/10x application rate of dicamba alone or with glyphosate when applied at storage root development.
Innovation Concept: Research training programs for students, especially in emergency medicine (EM), may be difficult to initiate due to lack of protected time, resources, and mentors (Chang Y, Ramnanan CJ. Academic Medicine 2015). We developed a ten-week summer program for medical students aimed at cultivating research skills through mentorship, clinical enrichment, and immersion in EM research culture through shadowing and project support. Methods: Five second year Ontario medical students were recruited to participate in the Summer Training and Research in Emergency Medicine (STAR-EM) program at University Health Network, Toronto, from June - Aug, 2019. Program design followed review of existing summer research programs and literature regarding challenges to EM research (McRae, Perry, Brehaut et al. CJEM 2018). The program had broad emergency physician (EP) engagement, with five EP research project mentors, and over ten EPs delivering academic sessions. Curriculum development was collaborative and iterative. All projects were approved by the hospital Research Ethics Board (REB). Curriculum, Tool or Material: Each weekly academic morning comprised small group teaching (topics including research methodology, manuscript preparation, health equity, quality improvement, and wellness), followed by EP-led group progress review of each student's project. Each student spent one half day per week in the emergency department (ED), shadowing an EP and identifying patients for recruitment for ongoing mentor-initiated ED research projects. Remaining time was spent on independent student project work. Presentation to faculty and program evaluation occurred in week 10. Scholarly output included one abstract submitted for publication per student. Program evaluation by students reflected a uniform impression that course material and mentorship were each excellent (100%, n = 5). Interest in pursuing academic EM as a career was identified by all students. Faculty researchers rated the program as very effective (80%, n = 4) or somewhat effective (20%, n = 1) in terms of enhancing productivity and scholarly output. Conclusion: The STAR-EM program provides a transferable model for other academic departments seeking to foster the development of future clinician investigators and enhance ED research culture. Program challenges included delays in REB approval for student projects and engaging recalcitrant staff to participate in research.
Background: In patients with acute hip fracture, a fascia iliaca compartment block (FICB) has been shown to provide effective non-opioid analgesia, reduce the incidence of pneumonia, and potentially decrease the rate of delirium . However, this procedure was infrequently used in the St. Michael's Hospital (SMH) emergency department (ED). Aim Statement: Our aim was to increase the proportion of patients with hip fracture receiving FICB in the ED to 50% in six months. Measures & Design: We completed two Plan-Do-Study-Act (PDSA) cycles, measuring rates of FICB before and after each cycle. The first was a departmental rounds presentation with information about the process and benefits of FICB, addressing barriers identified by surveying the group. The second cycle included a bundle of interventions comprising of an “instruction card” with the steps required to do the procedure, access to a video tutorial, and a list of experienced physicians willing to help less experienced providers perform FICB. Evaluation/Results: In the three months prior to the project, the rate of FICB in the ED was 12.5% (3/24). For the three months after the first PDSA cycle, the rate increased to 22.2% (8/36). Then, the second cycle was performed. In the following two months the rate further increased to 36.8% (7/19). Discussion/Impact: Despite the clear increase in FICB rate, these changes were not statistically significant (p = 0.063). Our methodology was shown to be safe and effective, and our model can be applied to other ED groups looking to increase their rates of FICB.
A major challenge in linking conservation science and policy is deciding how, and when, to offer relevant science to decision-makers to have the greatest impact on decisions. This chapter argues it is a question of alignment – of selecting the right knowledge to address the needs of decision-makers, ensuring that knowledge is accessible to them, and articulating it within their decision-making processes. The chapter describes three mechanisms to enhance this alignment: decision support tools; active knowledge exchange mechanisms; and large-scale scientific assessments. For each, we provide examples and draw out guidelines regarding circumstances in which the mechanism is likely to be most effective. No single mechanism is consistently best at aligning evidence with policy and practice. Each has strengths and weaknesses, and can be applied in different circumstances and at different scales. The chapter ends with a call for these mechanisms that link synthesised evidence with policy and practice decisions to be funded sufficiently, alongside environmental research, to enable adherence to core values of salience, legitimacy, credibility and transparency.
Attention-deficit hyperactivity disorder (ADHD) is associated with later depression and there is considerable genetic overlap between them. This study investigated if ADHD and ADHD genetic liability are causally related to depression using two different methods.
First, a longitudinal population cohort design was used to assess the association between childhood ADHD (age 7 years) and recurrent depression in young-adulthood (age 18–25 years) in N = 8310 individuals in the Avon Longitudinal Study of Parents and Children (ALSPAC). Second, two-sample Mendelian randomization (MR) analyses examined relationships between genetic liability for ADHD and depression utilising published Genome-Wide Association Study (GWAS) data.
Childhood ADHD was associated with an increased risk of recurrent depression in young-adulthood (OR 1.35, 95% CI 1.05–1.73). MR analyses suggested a causal effect of ADHD genetic liability on major depression (OR 1.21, 95% CI 1.12–1.31). MR findings using a broader definition of depression differed, showing a weak influence on depression (OR 1.07, 95% CI 1.02–1.13).
Our findings suggest that ADHD increases the risk of depression later in life and are consistent with a causal effect of ADHD genetic liability on subsequent major depression. However, findings were different for more broadly defined depression.
Research on bullying, mostly focusing on children of school age, has been active since the 1970s. Paralleling earlier work on aggression, bullying has often been described as maladaptive and dysfunctional behavior, and this has informed some intervention efforts. However, and again as for aggression generally, this view has been challenged in the 2000s (Ellis et al., 2012; Hawley, Little, & Rodkin, 2007; Kolbert & Crothers, 2003; Volk et al., 2012). It has been argued that bullying behavior is universal (historically and culturally, as well as in contemporary urban societies); that it is heritable, perhaps in part via temperament; and that it can have advantages for those who bully. The advantages would ultimately be for reproductive success, but via physical resources and social status, as well as attractiveness to the opposite sex.
The Lagrangian-mean motion of fluid particles induced by horizontally localized small-amplitude wavepackets of vertically trapped inertia–gravity waves is computed analytically, at second order in wave amplitude, and the results are supported by direct nonlinear numerical simulations. The leading-order motion is assumed to be inertia–gravity waves, which is applicable to oceanic mesoscale flows in regions where wave activity is as strong as or stronger than the balanced flow. The analytical computation is based on time-dependent asymptotic wave–mean interaction theory, and the numerical simulation uses a Galerkin-truncated
-plane nonlinear hydrostatic Boussinesq model that retains the barotropic mode and two baroclinic modes (vertical wavenumbers 0,
), this being the minimal set on which consistent wave–mean interactions can take place. Two novel dynamical effects are revealed: First, we find that the barotropic component robustly dominates the Lagrangian-mean flow response, which is contrary to earlier findings for the same problem. Second, we discovered a new wavepacket regime in which the baroclinic mean-flow response consists of the persistent radiation of resonantly forced secondary internal waves. The latter effect occurs in an oceanically accessible parameter regime.
Over half of individuals with eating disorders experience suicidal ideation at some point in their lives, yet few longitudinal studies have examined predictors of ideation in this at-risk group. Moreover, prospective research has focused on relatively distal or trait-level factors that are informative for distinguishing who is most at risk but not when. Little is known about more proximal or state-level risk factors that fluctuate within an individual, which is critical for determining when a person is most likely to engage in suicidal behaviors.
Women (N = 97) receiving treatment for their eating disorder completed questionnaires weekly to assess suicidal ideation and interpersonal constructs (i.e. perceived burdensomeness, thwarted belongingness) theorized to be proximal predictors of suicidal desire. Longitudinal multilevel models were conducted to examine both within- and between-person predictors of suicidal ideation across 12 weeks of treatment.
Statistically significant within-person effects for burdensomeness (β = 0.06; p < 0.001) indicate that when individuals have greater feelings of burdensomeness compared to their own average, they also experience higher suicidal ideation. We did not find any significant influence of thwarted belongingness or the interaction between burdensomeness and belongingness on suicidal ideation.
This study was the first to examine dynamic associations between interpersonal constructs and suicidal ideation in individuals with eating disorders. Results are only partially consistent with the Interpersonal Theory of Suicide and suggest that short-term changes in burdensomeness may impact suicidal behavior in individuals with eating disorders.
To examine associations of tree nut snack (TNS) consumption with diet quality and cardiovascular disease (CVD) risk in UK adults from National Diet and Nutrition Survey (NDNS) 2008–2014.
Cross-sectional analysis using data from 4-d food diaries, blood samples and physical measurements for CVD risk markers. To estimate diet quality, modified Mediterranean Diet Score (MDS) and modified Healthy Diet Score (HDS) were applied. Associations of TNS consumption with diet quality and markers of CVD risk were investigated using survey-adjusted multivariable linear regression adjusted for sex, age, ethnicity, socio-economic and smoking status, region of residency and total energy and alcohol intake.
UK free-living population.
4738 adults (≥19 years).
TNS consumers had higher modified MDS and HDS relative to non-consumers. TNS consumers also had lower BMI, WC, SBP and DBP and higher HDL compared to non-consumers, although a dose-related fully adjusted significant association between increasing nut intake (g per 4184 kJ/1000 kcal energy intake) and lower marker of CVD risk was only observed for SBP. TNS consumption was also associated with higher intake of total fat, mono-, n-3 and n-6 polyunsaturated fatty acids, fibre, vitamin A, thiamin, folate, vitamin C, vitamin E, potassium, magnesium, phosphorus, selenium and iron; and lower intake of saturated fatty acids, trans fatty acids, total carbohydrate, starch, free sugar, sodium and chloride.
TNS consumers report better dietary quality and consumption was associated with lower CVD risk factors. Encouraging replacement of less healthy snacks with TNS should be encouraged as part of general dietary guidelines.
Italian ryegrass is one of the most troublesome weeds worldwide because of the rapid evolution of herbicide resistance in this species. Oregon tall fescue seed production requires high seed purity, demanding good control of Italian ryegrass. The necessity to control herbicide-resistant Italian ryegrass and maintain tall fescue seed purity created interest in new chemical management options. The objectives of this study were to assess the effects of synthetic auxin herbicides on seed viability of Italian ryegrass biotypes and the feasibility of this management strategy for use in tall fescue seed production. Eight treatments of synthetic auxin herbicides were applied to Italian ryegrass and tall fescue at two growth stages (boot and anthesis): dicamba (1.0 and 2.2 kg ae ha−1), 2,4-D (1.1 and 2.2 kg ae ha−1), aminopyralid (0.5 kg ae ha−1), dicamba + 2.4-D (0.8 + 1.1 kg ae ha−1), 2.4-D + clopyralid (1.1 + 0.3 kg ae ha−1), and halauxifen-methyl + florasulam (0.4 kg ae ha−1 + 0.4 kg ai ha−1). Aminopyralid applied at boot and anthesis stages of Italian ryegrass reduced seed viability. Aminopyralid treatments reduced seed viability and weight of Italian ryegrass more than 50% compared to the control. Four biotypes from different locations in western Oregon with different types of herbicide resistance were sprayed, and differences in aminopyralid effect among Italian ryegrass biotypes were documented. Aminopyralid reduced the speed of germination by 1 to 2 d. Aminopyralid treatments had a greater effect when applied at the anthesis stage and had a greater negative impact on tall fescue. Tall fescue plants were more susceptible to aminopyralid, so this management practice is not feasible for tall fescue seed production. Future studies are needed to understand the physiological mechanisms involved in the reduced seed viability and to define an optimum aminopyralid rate for different Italian ryegrass biotypes.
Topical nasal decongestants are frequently used as part of the medical management of symptoms related to Eustachian tube dysfunction.
This study aimed to assess the effect of topical xylometazoline hydrochloride sprayed in the anterior part of the nose on Eustachian tube active and passive opening in healthy ears.
Active and passive Eustachian tube function was assessed in healthy subjects before and after intranasal administration of xylometazoline spray, using tympanometry, video otoscopy, sonotubometry, tubo-tympano-aerodynamic-graphy and tubomanometry.
Resting middle-ear pressures were not significantly different following decongestant application. Eustachian tube opening rate was not significantly different following the intervention, as measured by all function tests used. Sonotubometry data showed a significant increase in the duration of Eustachian tube opening following decongestant application.
There remains little or no evidence that topical nasal decongestants improve Eustachian tube function. Sonotubometry findings do suggest that further investigation with an obstructive Eustachian tube dysfunction patient cohort is warranted.
An outbreak of 18 cases of hepatitis A virus infection across five Canadian provinces was investigated. Case onsets occurred between October 2017 and May 2018. A retrospective matched case-control study was conducted to identify the likely source of the outbreak. Three matched controls were recruited for each case using a previously established control bank, supplemented by landline and cell phone call lists. Univariate and multivariate matched analyses were conducted to identify a potential outbreak source. Seventy-two per cent of controls were recruited through the control bank, and required on average 25.5 calls per recruited control; 20% of controls were recruited through a landline sample and 8% of controls were recruited through a cell phone sample, requiring an average of 847.3 and 331.7 calls per recruited control, respectively. Results of the analysis pointed to shrimp/prawns (odds ratio (OR) 15.75, p = 0.01) and blackberries (OR 7.21, p = 0.02) as foods of interest, however, an outbreak source could not be confirmed. The control bank proved to be a more efficient method for control recruitment than random call lists. Expanding the control bank size and using alternative methods, such as online surveys, may prove beneficial for increasing the timeliness of a case-control study during an outbreak investigation.
Meal timing may influence food choices, neurobiology and psychological states. Our exploratory study examined if time-of-day eating patterns were associated with mood disorders among adults.
During 2004–2006 (age 26–36 years) and 2009–2011 (follow-up, age 31–41 years), N = 1304 participants reported 24-h food and beverage intake. Time-of-day eating patterns were derived by principal components analysis. At follow-up, the Composite International Diagnostic Interview measured lifetime mood disorder. Log binomial and adjacent categories log-link regression were used to examine bidirectional associations between eating patterns and mood disorder. Covariates included sex, age, marital status, social support, education, work schedule, body mass index and smoking.
Three patterns were derived at each time-point: Grazing (intake spread across the day), Traditional (highest intakes reflected breakfast, lunch and dinner), and Late (skipped/delayed breakfast with higher evening intakes). Compared to those in the lowest third of the respective pattern at baseline and follow-up, during the 5-year follow-up, those in the highest third of the Late pattern at both time-points had a higher prevalence of mood disorder [prevalence ratio (PR) = 2.04; 95% confidence interval (CI) 1.20–3.48], and those in the highest third of the Traditional pattern at both time-points had a lower prevalence of first onset mood disorder (PR = 0.31; 95% CI 0.11–0.87). Participants who experienced a mood disorder during follow-up had a 1.07 higher relative risk of being in a higher Late pattern score category at follow-up than those without mood disorder (95% CI 1.00–1.14).
Non-traditional eating patterns, particularly skipped or delayed breakfast, may be associated with mood disorders.
In patients with β-lactam allergies, administration of non–β-lactam surgical prophylaxis is associated with increased risk of infection. Although many patients self-report β-lactam allergies, most are unconfirmed or mislabeled. A quality improvement process, utilizing a structured β-lactam allergy tool, was implemented to improve the utilization of preferred β-lactam surgical prophylaxis.
There is growing concern over a future shortfall in provision of UK otolaryngology consultants. There is a declining rate of applications to otolaryngology specialty training in the UK.
This study aimed to systematically review the literature to establish what factors influence medical students’ and junior doctors’ decision to pursue a career in otolaryngology.
Medline, Embase and PubMed databases were searched in January 2019. Additional manual reference checks of identified literature were performed.
Eleven articles were included in the review. Common factors that positively influenced the decision to pursue a career in otolaryngology were exposure to the specialty, positive role models and a good work-life balance. Lack of exposure was a consistent deterrent from pursuing a career in otolaryngology.
This review reiterates the need for greater exposure to otolaryngology in the undergraduate curriculum. In addition, mentorship for students with an interest in otolaryngology should be a priority.
Cybermentoring refers to virtual peer support in which young people themselves are trained as cybermentors and interact with those needing help and advice (cybermentees) online. This article describes the training in, and implementation of, a cross-national cybermentoring scheme, Beatbullying Europe, developed in the United Kingdom. It involved train-the-trainer workshops for partners and life mentors in six European countries (Italy, Spain, Portugal, Romania, Poland and the Czech Republic) in 2013–2014, followed by training sessions for pupil cybermentors aged 11–16 years. Although BeatBullying went into liquidation in November 2014, the project was largely completed. We (1) report an evaluation of the training of the life mentors and mentors, via questionnaire survey; and (2) discuss findings about the implementation of the scheme and its potential at a cross-national level, via partner interviews during and at the end of the project. The training was found to be highly rated in all respects, and in all six countries involved. The overall consensus from the data available is that there was a positive impact for the schools and professionals involved; some challenges encountered are discussed. The BeatBullying Europe project, despite being unfinished, was promising, and a similar approach deserves further support and evaluation in the future.