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No established risk prediction tool exists in United Kingdom and Irish Paediatric Cardiology practice for patients undergoing cardiac catheterisation. The Catheterisation RISk score for Paediatrics is used primarily in North American practice to assess risk prior to cardiac catheterisation. Validating the utility and transferability of such a tool in practice provides the opportunity to employ an already established risk assessment tool in everyday practice.
To ascertain whether the Catheterisation RISk score for Paediatrics assessment tool can accurately predict complications within United Kingdom and Irish congenital catheterisation practice.
Clinical and procedural data including National Institute for Cardiovascular Outcomes Research derived outcome data from 1500 patients across five large congenital cardiology centres in the United Kingdom and Ireland were retrospectively collected. Catheterisation RISk score for Paediatrics were then calculated for each case and compared with the observed procedural outcomes. Chi-square analysis was used to determine the relationship between observed and predicted events.
Ninety-eight (6.6%) patients in this study experienced a significant complication as qualified by National Institute for Cardiovascular Outcomes Research classification. 4% experienced a moderate complication, 2.3% experienced a major complication and 0.3% experienced a catastrophic complication resulting in death. Calculated Catheterisation RISk score for Paediatrics scores correlated well with all observed adverse events for paediatric patients across all CRISP categories. The association was also transferable to adult congenital heart disease patients in lower Catheterisation RISk score for Paediatrics categories (CRISP 1–3).
The Catheterisation RISk score for Paediatrics score accurately predicts significant complications in congenital catheterisation practice in the United Kingdom and Ireland. Our data validated the Catheterisation RISk score for Paediatrics assessment tool in five congenital centres using National Institute for Cardiovascular Outcomes Research-derived outcome data.
This chapter contributes to discourses of youth participation by developing understanding about which forms of participation might make a difference for marginalised young people living in the context of structural inequality. The chapter critically reflects on some of the complexities and limitations currently at play in relation to enhancing the participation of marginalised young people and sets out key elements of a more critical epistemological framework. Drawing on youth participatory action research (YPAR) and critical utopian action research (CUAR), the chapter makes the case for a transformational learning approach to participation that involves learning and change at both an individual level and professional level in interventions with marginalised young people. The chapter is supported by case-study empirical material focusing on one project developed in collaboration with young people engaged in criminal and violent activities in Denmark. This case study provides an opportunity to reflect on the challenges and possibilities of using ‘alternative’, transformative, action-based interpretations of youth participation and empowerment involving social learning rooted in professional encounters with young people's lifeworlds.
• Conventional, formalised approaches and interpretations of youth participation are falling short in terms of efficacy and accountability of policy and professional-led responses to youth marginalisation and inequality.
• Participatory action research offers an alternative possibility for transformative work rooted in the everyday lived realities of marginalised young people rather than professional agendas based on normative assumptions of youth.
• Reconstructing interventions using YPAR and CUAR reframes professional relationships with young people in ways that redress power imbalances and engender co-inquiry and mutual reciprocity in relationships of respect.
Participation of marginalised youth: contesting orthodoxies and assumptions
Austerity across Europe in the past decade has exacerbated the plight of large sections of the youth population already experiencing marginalisation and exclusion at the edge of society (Blackman and Rogers, 2017; Davies, 2019). In Europe, the current numbers of young people in the Not in Employment, Education or Training (NEET) category range from 7% to 24%. At the same time, in the context of post-austerity, inequality has given rise to higher levels of crime, homelessness, poverty and mental health problems for young people in Europe (Horton, 2016) and decreasing levels of participation in education and the labour market (Andersen et al, 2017).
With many countries still in some form of lockdown, young people stand to be affected by the COVID-19 pandemic in quite specific ways. Children and young people's voices have been notably absent in media coverage about COVID-19. Measures are being proposed, but often with little consideration of the views and perspectives of young people (Fox, 2020). Research highlights the role and value of children in responding to crisis situations (Ray, 2010; Save the Children, 2015); however, little is known about children and young people's roles specifically in major public health crises such as pandemics. This chapter draws on early lessons from an international longitudinal participatory research project involving young people as co-researchers and experts in their own lives (Thomson, 2008; Abebe, 2009). The project seeks to understand the experiences and realities of young people living under COVID-19 according to their own priorities, concerns and terms of reference and puts forward recommendations for how to promote young people's wellbeing, rights and participation during and after the pandemic. The chapter focuses on the challenges (logistical and ethical) of engaging young people from seven countries in participatory action research while working entirely online. It provides an overview of the research methodology and outlines how young people were recruited to the project. At the time of writing (July 2020), this project is ongoing. Thus, we provide several reflections on our experience of designing an international study online and present a number of emerging findings.
The research approach
In keeping with the values of the research team, the study adopts a child and youth-centred, rights-based approach involving young people documenting and making sense of their own views and experiences while also undertaking their own research projects into their own interests, priorities and concerns. The project is informed and framed by three theoretical influences. First, a whole systems approach to inquiry (Burns, 2007) seeks to understand the dynamic interaction between COVID-19 and young people in terms of multiple layers of contextual influence (Bronfenbrenner, 1979) that play out in children's lived realities – their family, peers, community, socio-structural position, political economy and the virtual world.
Involving children and young people in NHS services has become an imperative for Hospital Trusts and given momentum by the Patient and Public Involvement (PPI) initiative and organisations such as National Institute for Health Research (NIHR) INVOLVE. An overriding concern with attempts to ‘involve’ children and young people in health settings has been on seeking their views or advice on matters defined by health professionals and researchers. Yet with a growing ethos towards shared decision-making, co‑production, and developments to the theory and practice of children's participation (Banks et al, 2018; Tisdall, 2013; Percy-Smith, 2018), there is a shift towards more active approaches to children's participation in healthcare settings that recognise the importance of involving children and young people in all phases of the project cycle and in a wider range of contexts. This chapter draws on a collaborative action inquiry project with a UK NHS Hospital Trust to share the experience of developing meaningful and effective opportunities for involving children and young people across the Trust. Different strategies adopted, as well as some of the issues and challenges faced, will be discussed. In particular, the chapter will critically reflect on the significance of participation as patient experience and the challenges of integrating children's participation into organisational cultures and systems. Emphasis is placed on the need for creativity and flexibility in work with children, the critical role of adults as advocates and the importance of integrating a learning ethos into systems and practices across the Trust.
Developing the participation of children and young people in healthcare settings has been slower than in many other sectors such as schools and broader contexts of local governance in local authorities (ECORYS, 2015), in spite of the PPI initiative. Emphasis in involving children and young people has predominantly focused on seeking consultation and advice from children and young people, for example, through the gold standard of young people's research advisory groups (Nuffield Council on Bioethics, 2015; Caldwell and Jarrett, 2018). Children's participation in health settings is primarily about influencing the way in which hospital services are delivered, and in turn experienced, by children and young people.
Background: Surgical site infections (SSIs) are among the most common healthcare-associated infections (HAIs) in low- and middle-income countries (LMICs). SSI surveillance can be challenging and resource-intensive to implement in LMICs. To support feasible LMIC SSI surveillance, we piloted a multisite SSI surveillance protocol using simplified case definitions and methodology in Sierra Leone. Methods: A standardized evaluation tool was used to assess SSI surveillance knowledge, capacity, and attitudes at 5 proposed facilities. We used simplified case definitions restricted to objective, observable criteria (eg, wound purulence or intentional reopening) without considering the depth of infection. Surveillance was limited to post-cesarean delivery patients to control variability of patient-level infection risk and to decrease data collection requirements. Phone-based patient interviews at 30-days facilitated postdischarge case finding. Surveillance activities utilized existing clinical staff without monetary incentives. The Ministry of Health provided training and support for data management and analysis. Results: Three facilities were selected for initial implementation. At all facilities, administration and surgical staff described most, or all, infections as “preventable” and all considered SSIs an “important problem” at their facility. However, capacity assessments revealed limited staff availability to support surveillance activities, limited experience in systematic data collection, nonstandardized patient records as the basis for data collection, lack of unique and consistent patient identifiers to link patient encounters, and no quality-assured microbiology services. To limit system demands and to maximize usefulness, our surveillance data collection elements were built into a newly developed clinical surgical safety checklist that was designed to support surgeons’ clinical decision making. Following implementation and 2 months of SSI surveillance activities, 77% (392 of 509) of post-cesarean delivery patients had a checklist completed within the surveillance system. Only 145 of 392 patients (37%) under surveillance were contacted for final 30-day phone interview. Combined SSI rate for the initial 2-months of data collection in Sierra Leone was 8% (32 of 392) with 31% (10 of 32) identified through postdischarge case finding. Discussion: The surveillance strategy piloted in Sierra Leone represents a departure from established HAI strategies in the use of simplified case definitions and implementation methods that prioritize current feasibility in a resource-limited setting. However, our pilot implementation results suggest that even these simplified SSI surveillance methods may lack sustainability without additional resources, especially in postdischarge case finding. However, even limited phone-based patient interviews identified a substantial number of infections in this population. Although it was not addressed in this pilot study, feasible laboratory capacity building to support HAI surveillance efforts and promote appropriate treatment should be explored.
To examine patterns of taxed and untaxed food and beverage shopping across store types after Mexico’s sugary drink and non-essential food taxes, the nutritional quality of these patterns and the socio-economic characteristics associated with them.
We performed k-means cluster analyses using households’ percentage of food and beverage purchases from each store type (i.e. convenience stores, traditional shops (e.g. bodegas, tiendas, mom-and-pop shops), supermarkets, wholesalers and others). We calculated adjusted mean proportions of taxed and untaxed products (ml or g/capita per d) purchased in each pattern. We studied the associations between households’ SES and shopping patterns using multinomial logistic regressions. Within shopping patterns, we obtained mean volumes and proportions of taxed and untaxed food and beverage subgroups and calculated the proportion of products purchased at each store type.
Urban Mexican households (n 5493) from the Nielsen Mexico Consumer Panel Survey 2015.
We found four beverage shopping patterns and three food shopping patterns, driven by the store type where most purchases were made. For beverages, 48 % of households were clustered in the Traditional pattern and purchased the highest proportion of taxed beverages. Low-SES households had the highest probability of clustering in the Traditional beverage shopping pattern. For foods, 35 % of households were clustered into the Supermarket pattern. High-SES households had the highest probability of clustering in the Supermarket food shopping pattern.
The combination of store types where Mexican households purchase packaged foods and beverages varies. However, households in all shopping patterns and SES purchase taxed beverages mainly at traditional stores. Store-level strategies should be developed to intervene on traditional stores to improve the healthfulness of purchases.
Populations of native North American parasitoids attacking Agrilus Curtis (Coleoptera: Buprestidae) species have recently been considered as part of an augmentative biological control programme in an attempt to manage emerald ash borer, Agrilus planipennis Fairmaire, a destructive wood-boring beetle discovered in North America in 2002. We evaluate trapping methods to detect and monitor populations of two important native larval parasitoids, Phasgonophora sulcata Westwood (Hymenoptera: Chalcididae) and Atanycolus Förster (Hymenoptera: Braconidae) species, attacking emerald ash borer in its introduced range. We found that purple prism traps captured more P. sulcata than green prism traps, yellow pan traps, and log samples and thus were considered better for detecting and monitoring P. sulcata populations. Trap type did not affect the number of captures of Atanycolus species. Surprisingly, baiting prism traps with a green leaf volatile or manuka oil did not significantly increase captures of P. sulcata or Atanycolus species. Based on these results, unbaited purple prism traps would be optimal for sampling these native emerald ash borer parasitoids in long-term management programmes.
Understanding the association between diet quality and cardiometabolic risk by education level is important for preventing increased cardiometabolic risk in the Mexican population, especially considering pre-existing disparities in diet quality. The present study examined the cross-sectional association of overall diet quality with cardiometabolic risk, overall and by education level, among Mexican men and women.
Cardiometabolic risk was defined by using biomarkers and diet quality by the Mexican Diet Quality Index. We computed sex-specific multivariable logistic regression models.
Mexican men (n 634) and women (n 875) participating in the Mexican National Health and Nutrition Survey 2012.
We did not find associations of diet quality with cardiometabolic risk factors in the total sample or in men by education level. However, we observed that for each 10-unit increase in the dietary quality score, the odds of diabetes risk in women with no reading/writing skills was 0·47 (95 % CI 0·26, 0·85) relative to the odds in women with ≥10 years of school (referent). Similarly, for each 10-unit increase of the dietary quality score, the odds of having three v. no lipid biomarker level beyond the risk threshold in lower-educated women was 0·27 (95 % CI 0·12, 0·63) relative to the odds in higher-educated women.
Diet quality has a stronger protective association with some cardiometabolic disease risk factors for lower- than higher-educated Mexican women, but no association with cardiometabolic disease risk factors among men. Future research will be needed to understand what diet factors could be influencing the cardiometabolic disease risk disparities in this population.
The growth of continuously generated, large-scale datasets, and new analytics to handle them, has created expectations, in some quarters, that new insights can be generated that will help us address the biggest challenges that face us as a species and therefore can shape future societal outcomes. It is hoped that these new technologies will lead not just to new discoveries but also to new questions and thinking that will deliver significant scientific advances. Perhaps there will be some genuine scientific advances but since many of the challenges that face us reside in the human world and depend upon how humans behave, we need to turn to the humanities and the social sciences as well as the natural sciences and look at the role Big Data could play there in adding to, or shaping, our future. And here, what concerns us is not just the assumptions guiding the new analytic techniques for data mining, data merging, linking and analysis, born out of smarter AI algorithms, it is a more fundamental issue about the constraints and limitations of the kind of data inputs and outputs being appealed to in Big Data systems and whether they are well served to provide an understanding of the human world.
The present study evaluated the association of two measures of diet quality with BMI and waist circumference (WC), overall and by education level, among Mexican men and women.
We constructed two a priori indices of diet quality, the Mexican Diet Quality Index (MxDQI) and the Mexican Alternate Healthy Eating Index (MxAHEI), which we examined relative to BMI and WC. We computed sex-specific multivariable linear regression models for the total sample and by education level.
Mexican men (n 954) and women (n 1356) participating in the Mexican National Health and Nutrition Survey 2012.
Total dietary scores were not associated with BMI in men and women, but total MxDQI was inversely associated with WC in men (−0·10, 95 % CI −0·20, −0·004 cm). We also found that some results differed by education level in men. For men with the lowest education level, a one-unit increase in total MxDQI and MxAHEI score was associated with a mean reduction in BMI of 0·11 (95 % CI −0·18, 0·04) and 0·18 (95 % CI −0·25, −0·10) kg/m2, respectively. Likewise, a one-unit increase in total MxDQI and MxAHEI score was associated with a mean change in WC of −0·30 (95 % CI −0·49, −0·11) and −0·53 (95 % CI −0·75, −0·30) cm, respectively, in men with the lowest level of education. In women, the association of diet quality scores with BMI and WC was not different by education level.
Our findings suggest that a higher diet quality in men with low but not high education is associated with lower BMI and WC.
To examine snacking patterns, food sources and nutrient profiles of snacks in low- and middle-income Chilean children and adolescents.
Cross-sectional. Dietary data were collected via 24 h food recalls. We determined the proportion of snackers, snacks per day and energy from top food and beverage groups consumed. We compared the nutrient profile (energy, sodium, total sugars and saturated fat) of snacks v. meals.
South-east region of Chile.
Children and adolescents from two cohorts: the Food Environment Chilean Cohort (n 958, 4–6 years old) and the Growth and Obesity Cohort Study (n 752, 12–14 years old).
With a mean of 2·30 (se 0·03) snacks consumed daily, 95·2 % of children and 89·9 % of adolescents reported at least one snacking event. Snacks contributed on average 1506 kJ/d (360 kcal/d) in snacking children and 2218 kJ/d (530 kcal/d) in snacking adolescents (29·0 and 27·4 % daily energy contribution, respectively). Grain-based desserts, salty snacks, other sweets and desserts, dairy foods and cereal-based foods contributed the most energy from snacks in the overall sample. For meals, cereal-based foods, dairy beverages, meat and meat substitutes, oils and fats, and fruits and vegetables were the top energy contributors.
Widespread snacking among Chilean youth provides over a quarter of their daily energy and includes foods generally considered high in energy, saturated fat, sodium and/or total sugars. Future research should explore whether snacking behaviours change as the result of Chile’s national regulations on food marketing, labelling and school environments.
This study investigated the characteristics of subjective memory complaints (SMCs) and their association with current and future cognitive functions.
A cohort of 209 community-dwelling individuals without dementia aged 47–90 years old was recruited for this 3-year study. Participants underwent neuropsychological and clinical assessments annually. Participants were divided into SMCs and non-memory complainers (NMCs) using a single question at baseline and a memory complaints questionnaire following baseline, to evaluate differential patterns of complaints. In addition, comprehensive assessment of memory complaints was undertaken to evaluate whether severity and consistency of complaints differentially predicted cognitive function.
SMC and NMC individuals were significantly different on various features of SMCs. Greater overall severity (but not consistency) of complaints was significantly associated with current and future cognitive functioning.
SMC individuals present distinctive features of memory complaints as compared to NMCs. Further, the severity of complaints was a significant predictor of future cognition. However, SMC did not significantly predict change over time in this sample. These findings warrant further research into the specific features of SMCs that may portend subsequent neuropathological and cognitive changes when screening individuals at increased future risk of dementia.
Away-from-home foods have been shown to have lower nutritional quality and larger portion sizes than many foods prepared at home. We aimed to describe energy and nutrient intakes among 2–13-year-old Mexican children by eating location (at home and away from home), overall, by socio-economic status (SES) and by urbanicity.
Dietary intake was collected via one 24 h recall in the 2012 Mexican National Health and Nutrition Survey (ENSANUT). Location was reported for each food consumed. Results were adjusted for sex, day of recall, region, weight status, SES and urbanicity.
Mexico (nationally representative).
Children aged 2–5 years (n 1905) and 6–13 years (n 2868).
Children consumed the majority of daily energy at home (89% of 2–5-year-olds; 82 % of 6–13-year-olds). The most common away-from-home eating location was school (22 % of 2–5-year-olds; 43 % of 6–13-year-olds), followed by the street (14 % of 2–5-year-olds; 13 % of 6–13-year-olds). The most common foods consumed away from home were wheat/rice and corn mixed dishes, sugar-sweetened beverages, pastries/candy/desserts, milk (2–5-year-olds only) and salty snacks (6–13-year-olds). Multivariate models showed that high-SES 2–5-year-olds consumed 14 % of daily energy away from home v. 8 % among low-SES 2–5-year-olds, and high-SES 6–13-year-olds consumed 21 % of daily energy away from home v. 14 % among low-SES 6–13 year-olds. There were no differences by urban residence.
Among Mexican children, most foods and beverages were consumed at home. However, the percentage of foods consumed or purchased away from home increased with age and with SES.
Under laboratory and field conditions in Ontario, Canada, we explored the natural history of Phasgonophora sulcata Westwood (Hymenoptera: Chalcididae), an indigenous solitary endoparasitoid of Agrilus planipennis Fairmaire (Coleoptera: Buprestidae) in North America. Adult P. sulcata emergence was ~20.2–23.9 days after host emergence at 21°C, with P. sulcata females emerging an ~5.4–5.8 days before males. Females also represented 61.8 and 67.0% of emerging adults in the two years sampled. Mean adult longevities for males and females of P. sulcata were 23.8±1.10 and 28.9±1.11 days at 21°C, respectively. Mean potential fecundity of P. sulcata at emergence was 55.7±2.9 eggs per female. Based on adult emergence, parasitism at two sites varied from 11.7% to 34.4%. Adult parasitoids were first observed in the field in early June, with peak capture occurring in late June. Parasitism rates in A. planipennis-infested ash trees was not affected by tree height below 360 cm, whereas parasitism was not observed at heights>360 cm. Our results suggest that although mass rearing will be challenging, observed parasitism rates in conjunction with temporal and spatial synchrony indicate that indigenous P. sulcata may be an important source of mortality for A. planipennis populations.
In an article published in September 1939, in the very eye of the storm of twentieth-century Europe's ‘age of extremes’, the British historian Christopher Dawson attempted to get to grips with the temper of his times. Opining on what he saw as the failure of nineteenth-century liberal individualism and its deleterious encroachment on spiritual values, he wrote:
Now the coming of the totalitarian state marks the emergence of a new type of politics which recognises no limits and seeks to subordinate every social and intellectual activity to its own ends. Thus the new politics are in a sense more idealistic than the old; they are political religions based on a Messianic hope of social salvation. But at the same time they are more realist since they actually involve a brutal struggle for life between rival powers which are prepared to use every kind of treachery and violence to gain their ends.
When not researching medieval Christian encounters with the Mongols, Dawson wrote history with a grand narrative sweep such as he admired in the work of the German historian Oswald Spengler. His output has recently sparked a revival of interest, with claims that he was one of most significant Catholic historians of the century. Yet this Augustinian pessimist was only one of a broader band of contemporary intellectuals – not all of them religious apologists – to brandish the label of ‘political religion’ as a descriptor, and as a moral warning. Seventy years on, the same moral seriousness characterises several of the books under review here, especially those addressing the more terrifying consequences of political religion in its various forms. For as A. James Gregor declares when introducing his intellectual history of Totalitarianism and Political Religion, ‘the unnumbered dead of the past century’ are surely owed some posthumous explanation:
Amid all the other factors that contributed to the tragedy, there was a kind of creedal ferocity that made every exchange a matter of existential importance. The twentieth century was host to systems of doctrinal conviction that made unorthodox belief a capital affront, made conflict mortal, and all enterprise sacrificial (Gregor, xi).
Phasgonophora sulcata Westwood (Hymenoptera: Chalcididae) is a North American parasitoid now using Agrilus planipennis Fairmaire (Coleoptera: Buprestidae) as a novel host, and may prove useful in biocontrol. Unfortunately, information is lacking regarding mating and the presence of pheromones, which may be important when attempting to exploit this parasitoid within a management context. Herein we used olfactometer assays and behavioural observations to determine the courtship and mating sequences of P. sulcata. A significantly higher proportion of males oriented towards females over the control arm containing filtered air in an olfactometer regardless of the age classes of females or males examined. We also observed four pre-copulatory behaviours that were consistent in all mating pairs. Our results indicate that courtship may be mediated by male perception of female-produced pheromones. Understanding the courtship sequence may be useful in rearing laboratory populations, while the putative pheromones may be useful in detection and retention of P. sulcata populations.
The need to control multiple languages is thought to require domain-general executive control in bilinguals such that the executive control and language systems become interdependent. However, there has been no systematic investigation into how and where executive control and language processes overlap in the bilingual brain. If the concurrent recruitment of executive control during bilingual language processing is domain-general and extends to non-linguistic control, we hypothesize that regions commonly involved in language processing, linguistic control, and non-linguistic control may be selectively altered in bilinguals compared to monolinguals. A conjunction of functional magnetic resonance imaging (fMRI) data from a flanker task with linguistic and non-linguistic distractors and a semantic categorization task showed functional overlap in the left inferior frontal gyrus (LIFG) in bilinguals, whereas no overlap occurred in monolinguals. This research therefore identifies a neural locus of functional overlap of language and executive control in the bilingual brain.
To examine the acceptability and feasibility of using smartphone technology to assess beverage intake and evaluate whether the feasibility of smartphone use is greater among key sub-populations.
An acceptability and feasibility study of recording the video dietary record, the acceptability of the ecological momentary assessment (EMA), wearing smartphones and whether the videos helped participants recall intake after a cross-over validation study.
Rural and urban area in Shanghai, China.
Healthy adults (n 110) aged 20–40 years old.
Most participants reported that the phone was acceptable in most aspects, including that videos were easy to use (70 %), helped with recalls (77 %), EMA reminders helped them record intake (75 %) and apps were easy to understand (85 %). However, 49 % of the participants reported that they had trouble remembering to take videos of the beverages before consumption or 46 % felt embarrassed taking videos in front of others. Moreover, 72 % reported that the EMA reminders affected their consumption. When assessing overall acceptability of using smartphones, 72 % of the participants were favourable responders. There were no statistically significant differences in overall acceptability for overweight v. normal-weight participants or for rural v. urban residents. However, we did find that the overall acceptability was higher for males (81 %) than females (61 %, P=0·017).
Our study did not find smartphone technology helped with dietary assessments in a Chinese population. However, simpler approaches, such as using photographs instead of videos, may be more feasible for enhancing 24 h dietary recalls.