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Prevailing political and ethical approaches that have been used to both critique and propose alternatives to the existing food system are lacking. Although food security, food sovereignty, food justice, and food democracy all offer something important to our reflection on the global food system, none is adequate as an alternative to the status quo. This article analyses each in order to identify the prerequisites for such an alternative approach to food governance. These include a focus on goods like nutrition and health, equitable distribution, supporting livelihoods, environmental sustainability, and social justice. However, other goods, like the interests of non-human animals, are not presently represented. Moreover, incorporating all of these goods is incredibly demanding, and some are in tension. This raises the question of how each can be appropriately accommodated and balanced. The article proposes that this ought to be done through deliberative democratic processes that incorporate the interests of all relevant parties at the local, national, regional, and global levels. In other words, the article calls for a deliberative approach to the democratisation of food. It also proposes that one promising potential for incorporating the interests of all affected parties and addressing power imbalances lies in organising the scope and remit of deliberation around food type.
Introduction: Opioid overdoses (OODs) have become a public health emergency, yet little is known about their long-term outcomes following an OD. We determined the one-year all-cause mortality and associated risk factors in a cohort of patients treated in an urban emergency department (ED) for an OOD. Methods: We reviewed records of all patients who visited St. Paul's Hospital ED from January 2013 to August 2017 and had a discharge diagnosis of OOD or had received naloxone in the ED as per pharmacy records. Patients with a suspected OOD were identified on structured chart review. A patient's first visit for an OOD during the study period was used as the index visit, with subsequent visits excluded. The primary outcome was mortality during the year after the index visit. Mortality was assessed by linking patient electronic medical records with Vital Statistics data. Deaths that occurred in the ED on the index visit were excluded. Patients admitted to hospital following ED treatment were included in this study. We described patient characteristics, calculated mortality rates, and used Cox regression to identify risk factors. Results: A total of 2239 patients visited the ED for an OOD during the study period, with a median patient age of 37 years (IQR 29, 49). Males comprised 73% of patients, while 28% had no fixed address, and 21% received take-home naloxone at the index visit. In total, 137 patients (6.1%) died within 1 year of the index visit. Eighty-one deaths (3.6%) occurred within 6 months, including 24 deaths (1.1%) that occurred within 1 month. The highest mortality rate occurred in 2017, with 8.0% of patients entering the cohort that year dying within 1 year. Gender did not significantly impact mortality risk. A Cox regression analysis controlled for gender, housing status, and whether take-home naloxone was provided at the index visit indicated that advancing age (adjusted hazards ratio [AHR] 1.03; 95%CI: 1.01-1.04 for each year increase in age) and the index visit calendar year (AHR 1.30; 95%CI: 1.10-1.54 for each yearly increase in the study period) were significant factors for mortality within 1 year. Conclusion: The mortality rate following an opioid OD treated in the ED is high, with over 6% of patients in our study dying within 1 year. The rising mortality risk with increasing calendar year may reflect the growing harms of fentanyl-related OODs. Patients visiting the ED for an OOD should be considered high risk and offered preventative treatment and referrals prior to discharge.
A variety of paediatric tracheostomy tubes are available. This article reviews the tubes in current use at Great Ormond Street Hospital for Children and Evelina London Children's Hospital.
This paper outlines our current preferences, and the particular indications for different tracheostomy tubes, speaking valves and other attachments.
Our preferred types of tubes have undergone significant design changes. This paper also reports further experience with certain tubes that may be useful in particular circumstances. An updated sizing chart is included for reference purposes.
The choice of a paediatric tracheostomy tube remains largely determined by individual clinical requirements. Although we still favour a small range of tubes for use in the majority of our patients, there are circumstances in which other varieties are indicated.
Soil samples representing a time series from forest before clearing to land in cultivation for 20 yr were taken near Delta Junction, AK, to determine the changes that occur in the soil seed bank following clearing and agricultural use. The total number of seed was initially low in the forested sites but increased after 3 to 5 yr in cultivation due to seed production by native colonizers and by introduced weeds such as common lambsquarters (Chenopodium album L. ♯3 CHEAL). Viability of seed of several mature forest species was low. There was a shift from a seed bank dominated by native species in the forest and newly cleared sites to a seed bank dominated by introduced colonizers in the older fields. Although seed of introduced species increased in importance over time, native species, especially native colonizers, continued to be an important component of the seed bank throughout the 20-yr period represented.
Advances in fetal diagnostic techniques have opened many areas to prenatal anatomical scrutiny. Intrauterine hydrocephalus and ventriculomegaly are conditions which are readily diagnosed. Fetal intervention has been undertaken in humans in order to minimize the craniofacial disfigurement and to maximize the growth potential of the brain. To justify such an approach, the significance of all anomalies should be recognized prior to treatment. The authors have reviewed 41 cases of hydrocephalus diagnosed in utero in order to define associated anomalies and patient outcome.
75% of our personal series and 72% of the reviewed literature cases had other anomalies of the central nervous system. Other system malformations, some of which proved fatal, were seen commonly. Prenatal diagnostic techniques did not always reveal these additional problems.
The outcome of these pregnancies is not good. Approximately one third of these fetuses have survived to be treated postnatally and to be followed up clinically. Only 7.5% of this series were felt to have attained normal developmental milestones. The remainder of the survivors have various focal and/or global cerebral deficits.
The purpose of this study was to describe the longitudinal trajectories and bidirectional relationships of the physical-social and emotional functioning (EF) dimensions of positive aging and to identify their baseline characteristics.
Women age 65 and older who enrolled in one or more Women's Health Initiative clinical trials (WHI CTs) and who had positive aging indicators measured at baseline and years 1, 3, 6, and 9 were included in these analyses (N = 2281). Analytic strategies included latent class growth modeling to identify longitudinal trajectories and multinomial logistic regression to examine the effects of baseline predictors on these trajectories.
A five-trajectory model was chosen to best represent the data. For Physical-Social Functioning (PSF), trajectory groups included Low Maintainer (8.3%), Mid-Low Improver (10.4%), Medium Decliner (10.7%), Mid-High Maintainer (31.2%), and High Maintainer (39.4%); for EF, trajectories included Low Maintainer (3%), Mid-Low Improver (9%), Medium Decliner (7.7%), Mid-High Maintainer (22.8%), and High Maintainer (57.5%). Cross-classification of the groups of trajectories demonstrated that the impact of a high and stable EF on PSF might be greater than the reverse. Low depression symptoms, low pain, and high social support were the most consistent predictors of high EF trajectories.
Aging women are heterogeneous in terms of positive aging indicators for up to 9 years of follow-up. Interventions aimed at promoting sustainable EF might have diffused effects on other domains of healthy aging.
We surveyed acute care facilities in Florida to assess components of and barriers to sustained antimicrobial stewardship programs (ASPs). Most respondents with and without ASPs are doing some stewardship-related activities to improve antimicrobial use. Collaborative efforts between facilities and health departments are important to providing better resources for ASPs.
The current study examined whether a traditional exposure-based treatment for blood-injection-injury (BII) phobia would be effective at reducing disgust responses to BII stimuli and whether the addition of modules targeting disgust would provide incremental efficacy. Participants, many of whom reported subclinical BII phobia symptoms, underwent one of two single-session exposure protocols, one targeting fear alone, and the other targeting both fear and disgust. Both treatments consisted of education components (fear-only or fear-disgust) and in vivo exposure (fear-only or fear-disgust). Both the fear-only and the fear-disgust treatment groups significantly decreased fear and avoidance behaviour toward BII stimuli over time. The two groups also experienced similar reductions in disgust responses to BII-related stimuli and global as well as domain-specific disgust sensitivity. The effect sizes indicated that the fear-disgust group evidenced greater reduction in symptoms than did the fear-only group. The implications of the results for models of phobia maintenance and treatment are discussed.
The operation and longevity of hydropower dams are often negatively impacted by sedimentation. Forest conservation can reduce soil erosion, and therefore efforts to maintain upstream forest cover within a watershed contribute to the economic life span of a hydropower facility. The cost of forest conservation can be viewed as an investment in hydropower and be financed via a payment for ecosystem services (PES) scheme. A novel modelling framework is used to estimate payments for forest conservation consisting of: (1) land-use change projection; (2) watershed erosion modelling; (3) reservoir sedimentation estimation; (4) power generation loss calculation; and (5) PES scheme design. The framework was applied to a proposed dam in Cambodia (Pursat 1). The estimated net present value of forest conservation was US$ 4.7 million when using average annual climate values over 100 years, or US$ 6.4 million when considering droughts every eight years. This can be remunerated with annual payments of US$ 4.26 ha−1 or US$ 5.78 ha−1, respectively, covering forest protection costs estimated at US$ 0.9 ha−1 yr−1. The application of this type of PES represents a rational option that allows for conservation and development of hydropower watersheds susceptible to erosion and sedimentation.
The present study examined characteristics of autobiographical memories retrieved by individuals with social phobia (n=15) and nonanxious individuals (n=17). Participants were presented with social threat, positive, and neutral cue words and instructed to retrieve the first specific personal memory that came to mind. Memories were coded for retrieval latency, overgenerality (vs. specificity), and affective tone. Nonanxious individuals, rather than social phobic individuals, demonstrated a bias toward the retrieval of specific negative memories when cued by social threat words. Significant omnibus results were attenuated when self-reported depression was included as a covariate in analyses. These results suggest that memories cued by social threat words are particularly salient for nonanxious individuals but not for individuals with social phobia and that depressive symptoms must be accounted for in studies examining cognitive biases toward threat.
Gilliland et al. (2000) have reported HST photometric observations of 34000 stars in the globular cluster 47 Tuc, showing an absence of close-in giant planets in that cluster relative to their frequency in the solar neighborhood. Here we describe the methods of time-series analysis that were used to search the 47 Tuc data for transits by giant extrasolar planets, and the means by which these methods were validated.
Since the superior properties of multi-wall carbon nanotubes (MWCNT) could improve numerous devices such as electronics and sensors, many efforts have been made in investigating the growth mechanism of MWCNT to synthesize high quality MWCNT. Chemical vapor deposition (CVD) is widely used for MWCNT synthesis, and scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDS) are useful methods for analyzing the structure, morphology and composition of MWCNT.
Temperature and pressure are two important growth parameters for fabricating carbon nanotubes. in MWCNT growth by CVD, the plasma assisted method is normally used for low temperature growth. However, a high temperature environment is required for thermal CVD. A systematic study of temperature and pressure-dependence is very helpful to understanding MWCNT growth. Transition metal particles are commonly used as catalysts in carbon nanotube growth. It is also interesting to know the how temperature and pressure affect the interface of carbon species and catalyst particles.
Carbon nanotubes are synthesized using thermal chemical vapor deposition. Various temperature and pressure are used to fabricate carbon nanotubes. It is found that the nanotube-diameter distribution mainly depends on the growth-temperature. With the substrate surface normal either along or against the gravity vector, different growth orientations of multi-walled carbon nanotubes are observed by scanning electron microscopy although the Raman spectra are similar for samples synthesized at different locations. The sizes of these carbon nanotubes in each sample are quite uniform and the length of the tube is up to hundreds of micrometers. These results suggest the gravitation effects in the growth of long and small diameter CNT.
Large-scale cognitive-behavioural Stress Management workshops were run for
members of the general public as part of a city-wide mental health promotion
campaign. Four groups were compared: a workshop run over one day (Full-Day),
one run over two half-days (Half-Day), a non-specific intervention control
group, and a waiting list control group. Results indicate that the
participants in the workshop groups improved more than those in either of
the control groups, supporting the idea that the psychoeducational approach
can be valuable and economical in a health promotion and public health
context. The use of this format in clinical situations and in primary care
settings is also discussed.
Commission 30 has 120 members in 28 countries who are active in the area of radial velocities. During the past triennium 11 new members have joined the commission. The work of the commission covers a wide range of topics all of which concern the application of the Doppler effect to astronomical objects, including galaxies and the interstellar medium as well as stars, and in all wavelength ranges of the electromagnetic spectrum. Although the commission focuses mainly on stellar and galaxy radial velocities, it is noted that stellar rotation, spectroscopic binaries, extrasolar planet searches, pulsating variable stars, asteroseismology and turbulence in stellar atmospheres are also included.
Results are presented from the first five years of the high precision RV survey carried out with the 1.4m CAT+CES spectrograph at ESO La Silla. This RV survey of 37 solar-type stars was begun in Nov. 1992. Using an iodine gas absorption cell for self-calibration we currently achieve a long-term precision of 20 m/s in a 30-min exposure of a 5.5 mag star. This value is the typical ‘working’ precision in survey work, i.e. an average over all observing conditions.
We present the RV data for our most variable star, ι Hor (G0V), with a possible periodicity of 600 d that could imply a companion of minimum mass m sin i = 2.0 MJup. However, these data are severely complicated by stellar activity to which a large part of the variability must be attributed. Our RV data for ϕ2 Pav (F8V) contain a possible period of 43 d which would imply a planet with m sin i = 0.69 MJup. It must be stressed that for both stars the significance of the periods is still insufficient to conclude that planets are indeed orbiting them. We also show our data for a Hipparcos astrometric brown dwarf candidate, GJ 570A, that do not confirm expectations for a correspondingly high RV signal. Longer monitoring of the star is required in order to confirm a possible low amplitude variation.
This study investigates whether large-scale, day-long stress management
workshops open to the general public can work as well as small, weekly
groups run for referred clients. It is suggested that the self-referral
route may enable some people who might otherwise have been
‘‘filtered out’’ from the traditional health services
to get help for their stress-related problems. Analysis showed that the
large-scale format was just as effective with a more distressed subgroup as
was the small weekly format for formally referred clients, which suggests
that the effectiveness of this approach is not only related to a restricted
client group. It would appear that the low drop-out rate, the effectiveness
of the workshops and the severity of problem handled within this format
indicates potential value in this type of approach.
X-ray reflectivity and magnetotransport studies have been used to probe the effects of ion-beam irradiation and subsequent thermal annealing on the structure and giant magnetoresistance (GMR) in Co/Cu multilayers. Low-dose ion bombardment produces interfacial mixing which is accompanied by a systematic suppression of the anti ferromagnetic (AF) coupling and the GMR. For ion doses not exceeding 5 × 1014 ions/cm2, subsequent thermal annealing restores the abrupt interlayer structure as well as the GMR. The combination of low-dose ion bombardment and thermal annealing provides an ex situ technique to modify interface structure reversibly over a gnificant range.