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Studies show ethnic inequalities in rates of involuntary admission and types of clinical care (such as psychological therapies). However, few studies have investigated if there is a relationship between clinical care practices and ethnic inequalities in involuntary admission.
This study investigated the impact of ethnicity and clinical care on involuntary admission and the potential mediation effects of prior clinical care.
In this retrospective cohort study, we used data from the electronic records of the South London and Maudsley NHS Foundation Trust and identified patients with a first hospital admission between January 2008 and May 2021. Logistic regression and mediation analyses were used to investigate the association between ethnicity and involuntary admission, and whether clinical care, in the 12 months preceding admission, mediates the association.
Compared with White British people, higher odds of involuntary admission were observed among 10 of 14 minority ethnic groups; with more than twice the odds observed among people of Asian Chinese, of Asian Bangladeshi and of any Black background. There were some ethnic differences in clinical care prior to admission, but these had a minimal impact on the inequalities in involuntary admission. More out-patient appointments and home treatment were associated with higher odds of involuntary admission, whereas psychological therapies and having a care plan were associated with reduced odds of involuntary admission.
Ethnic inequalities in involuntary admission persist after accounting for potential mediating effects of several types and frequencies of clinical care. Promoting access to psychological therapies and ensuring that care plans are in place may reduce involuntary admissions.
To examine associations between maternal characteristics and feeding styles in Caribbean mothers.
Participants were mother–child pairs enrolled in a cluster randomised trial of a parenting intervention in three Caribbean islands. Maternal characteristics were obtained by questionnaires when infants were 6–8 weeks old. Items adapted from the Toddler Feeding Behaviour Questionnaire were used to assess infant feeding styles at the age of 1 year. Feeding styles were identified using factor analysis and associations with maternal characteristics assessed using multilevel linear regression.
Health clinics in St. Lucia (n 9), Antigua (n 10) and Jamaica (n 20).
A total of 405 mother–child pairs from the larger trial.
Maternal depressive symptoms were associated with uninvolved (β = 0·38, 95 % CI (0·14, 0·62)), restrictive (β = 0·44, 95 % CI (0·19, 0·69)) and forceful (β = 0·31, 95 % CI (0·06, 0·57)) feeding and inversely associated with responsive feeding (β = −0·30, 95 % CI (−0·56, −0·05)). Maternal vocabulary was inversely associated with uninvolved (β = −0·31, 95 % CI (−0·57, −0·06)), restrictive (β = −0·30, 95 % CI (−0·56, −0·04)), indulgent (β = −0·47, 95 % CI (−0·73, −0·21)) and forceful (β = −0·54, 95 % CI (−0·81, −0·28)) feeding. Indulgent feeding was negatively associated with socio-economic status (β = −0·27, 95 % CI (−0·53, −0·00)) and was lower among mothers ≥35 years (β = −0·32, 95 % CI (−0·62, −0·02)). Breast-feeding at 1 year was associated with forceful feeding (β = 0·41, 95 % CI (0·21, 0·61)). No significant associations were found between maternal education, BMI, occupation and feeding styles.
Services to identify and assist mothers with depressive symptoms may benefit infant feeding style. Interventions to promote responsive feeding may be important for less educated, younger and socio-economically disadvantaged mothers.
Societal changes of the twenty-first century have implications for the future of rehabilitation counselling in the United States and in Australia. An emerging knowledge society, new populations with diverse needs, third wave messages from the disability community, and culture wars of politics influence the direction of rehabilitation counselling. The demographics of disability and the professional status of rehabilitation counsellors in the United States are reviewed. The adaptability and durability of rehabilitation counselling skills and knowledge is discussed.
This article provides an outline of the Libyan Antiquities at Risk (LAaR) project, which has developed a reference database and website recording Libyan antiquities that are under threat of being stolen and sold on the illegal art market. Since the Arab Spring in 2011 and the subsequent political instability, the number of antiquities that are trafficked out of Libya has risen sharply. The illustrated reference collection created by LAaR is mainly aimed at customs officials, international agencies, museum curators, the police and cultural heritage sector, to alert them about the likelihood of Libyan provenance of previously unrecorded material of similar appearance to known pieces, and thereby help to prevent the sale of Libyan antiquities on the illegal art market. LAaR is a collaboration between the Society for Libyan Studies and the University of Leicester.
Neutron imaging is a nondestructive application capable of producing two- and three-dimensional maps of archaeological objects’ external and internal structure, properties, and composition. This report presents the recent development of neutron imaging data collection and processing methods at Oak Ridge National Laboratory (ORNL), which have been advanced, in part, by information gathered from the experimental imaging of 25 archaeological objects over the past three years. The dual objectives of these imaging experiments included (1) establishing the first methodological procedures for the neutron imaging of archaeomaterials involving the CG-1D beamline and (2) further illustrating the potential of neutron imaging for archaeologists to use in the reverse engineering of ancient and historical objects. Examples of objects imaged in two and three dimensions are provided to highlight the application’s strengths and limitations for archaeological investigations, especially those that address ancient and historic technologies, materials science, and conservation issues.
The benefits of fetoscopic laser photocoagulation (FLP) for treatment of twin-to-twin transfusion syndrome (TTTS) have been recognized for over a decade, yet access to FLP remains limited in many settings. This means at a population level, the potential benefits of FLP for TTTS are far from being fully realized. In part, this is because there are many centers where the case volume is relatively low. This creates an inevitable tension; on one hand, wanting FLP to be readily accessible to all women who may need it, yet on the other, needing to ensure that a high degree of procedural competence is maintained. Some of the solutions to these apparently competing priorities may be found in novel training solutions to achieve, and maintain, procedural proficiency, and with the increased utilization of ‘competence based’ assessment and credentialing frameworks. We suggest an under-utilized approach is the development of collaborative surgical services, where pooling of personnel and resources can improve timely access to surgery, improve standardized assessment and management of TTTS, minimize the impact of the surgical learning curve, and facilitate audit, education, and research. When deciding which centers should offer laser for TTTS and how we decide, we propose some solutions from a collaborative model.
Adipose tissue (AT) fatty acid (FA) composition partly reflects habitual dietary intake. Circulating NEFA are mobilised from AT and might act as a minimally invasive surrogate marker of AT FA profile. Agreement between twenty-eight FA in AT and plasma NEFA was assessed using concordance coefficients in 204 male and female participants in a 12-month intervention using supplements to increase the intake of EPA and DHA. Concordance coefficients generally showed very poor agreement between AT FA and plasma NEFA at baseline SFA: 0·07; MUFA: 0·03; n-6 PUFA: 0·28; n-3 PUFA: 0·01). Participants were randomly divided into training (70 %) and validation (30 %) data sets, and models to predict AT and dietary FA were fitted using data from the training set, and their predictive ability was assessed using data from the validation set. AT n-6 PUFA and SFA were predicted from plasma NEFA with moderate accuracy (mean absolute percentage error n-6 PUFA: 11 % and SFA: 8 %), but predicted values were unable to distinguish between low, medium and high FA values, with only 25 % of n-6 PUFA and 33 % of SFA predicted values correctly assigned to the appropriate tertile group. Despite an association between AT and plasma NEFA EPA (P=0·001) and DHA (P=0·01) at baseline, there was no association after the intervention. To conclude, plasma NEFA are not a suitable surrogate for AT FA.
Monochorionic twins as part of a high order multiple pregnancy can be an unintended consequence of the increasingly common practice of blastocyst transfer for couples requiring in vitro fertilisation (IVF) for infertility. Dichorionic triamniotic (DCTA) triplets is the most common presentation, and these pregnancies are particularly high risk because of the additional risks associated with monochorionicity. Surveillance for twin-to-twin transfusion syndrome, including twin anemia polycythemia sequence, may be more difficult, and any intervention to treat the monochorionic pair needs to balance the proposed benefits against the risks posed to the unaffected singleton. Counseling of families with DCTA triplets is therefore complex. Here, we report a case of DCTA triplets, where the pregnancy was complicated by threatened preterm labour, and twin anemia polycythemia sequence (TAPS) was later diagnosed at 28 weeks. The TAPS was managed with a single intraperitoneal transfusion, enabling safe prolongation of the pregnancy for over 2 weeks until recurrence of TAPS and preterm labour supervened. Postnatal TAPS was confirmed, and all three infants were later discharged home at term corrected age, and were normal at follow-up. This case highlights that in utero therapy has an important role in multiple pregnancies of mixed chorionicity, and can achieve safe prolongation of pregnancy at critical gestations.
Live-shearing of wild guanacos Lama guanicoe may affect their reproductive success and population resilience, and therefore it is important to assess the biological sustainability of obtaining their wool. We evaluated effects of capture and shearing on survival and reproduction, population parameters, daily movements, ranging behaviour and spatial distribution in sedentary and migratory populations. We assessed population variables by radio-telemetry and line-transect surveys before and after capture. We estimated high post-shearing survival rates in both populations and similar yearling production in shorn and non-shorn females in the migratory population. We did not find significant variations in density and population structure before and after shearing in the sedentary population, whereas in the migratory population density decreased and the population structure changed significantly after assembly of the capture structure, returning to pre-assembly levels 1 month later. The mean daily distance moved by radio-collared guanacos during the first 2 days after shearing was three times longer than during the following 30 days. There was a 25% decrease in the mean home-range size of shorn guanacos between the first and second month after shearing but this decline appeared to be associated with a seasonal change in movement, because a similar reduction occurred during the same period the following year, when the guanacos were not shorn. Live-shearing modified the spatial distribution pattern in the sedentary population but did not have a significant effect on the migratory population. Management of guanacos may contribute towards developing a biologically sustainable economic activity that promotes conservation of wildlife and habitats.
We report changes in guanaco Lama guanicoe density, recruitment, and social structure associated with increased access of poachers along an extensive network of hydrocarbon-exploration roads in northern Patagonia, and conservation measures taken in response. Mean guanaco densities declined 93–96% and mean group size declined from 9.8 to 5.0 guanacos per group at three sites surveyed during 1982–1983 and 2002–2007, whereas yearling proportions did not change significantly. Additional surveys during 2002–2007 suggest population declines and fragmentation have occurred over a wide area of intense hydrocarbon exploration and extraction. Guanaco densities in 2002–2007 showed a strong negative association with the density of access points along hydrocarbon-exploration roads and, to a lesser degree, with livestock densities. The increase in poaching in recent decades, resulting from increased access and an urban population that has appropriate vehicles, has probably been the main cause of the decline of the guanaco population, although overgrazing by livestock and decreased plant productivity may also be contributing factors. Closing of exploration roads with levees and ditches in 2006 and 2010 by a hydrocarbon company, under supervision by the local government and scientists, restricted access by unauthorized vehicles to a 220,000-ha area, including two of the sites where guanaco numbers collapsed. This action, in combination with increased ranger patrols, may allow guanaco recovery in the coming years.
A half-life-sized copper-alloy head of a bearded man was published in the Portable Antiquities Scheme's report of finds from Roman Britain in 2009.1 The head was purchased by the Ashmolean Museum in 2011. In this paper evidence for the identification of the subject as a portrait of the emperor Marcus Aurelius is reviewed by comparison with metropolitan and other certainly identified heads of deities and portraits of the emperor. The technique and likely function of the head are compared with those of similarly worked Roman copper-alloy heads of emperors and deities found in South-East Britain. Finally, a brief account is given of geophysical survey and trial excavation conducted in 2012–13 in the field where the head was found. This offers a unique opportunity to explore the head's archaeological context.
Congenital cytomegalovirus (CMV) infection is now the commonest infective cause of neurological handicap. Arguably, there is no other single contributor to developmental disability where a greater opportunity, and imperative, exists to improve outcomes than CMV. CMV is the most common intrauterine infection and congenital CMV is the leading non-inherited cause of sensorineural deafness. The public health impact of CMV is significant: the overall birth prevalence of congenital CMV is estimated at 0.64%, with 11% of live born infants displaying symptoms.