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The separation between people and nature is a key driver of environmental decline. Despite increased interest in nature connectedness, we know little about nature disconnection or the degree of connectedness required for pro-environmental choices. Using a large probability sample of Australians (N = 1101), we explore differences in the characteristics, attitudes, and priorities among those with low, moderate, and high nature connectedness levels. Compared to those more connected, individuals with low connectedness were younger, more urban, and less educated. They spent less time in nature, enjoyed nature less, were less impacted by environmental problems, and rated climate change as less severe, suggesting insulation or detachment from the natural environment. Even a moderate level of connectedness was linked to a significant uplift in pro-environmental attitudes, behaviours, and priorities (e.g. environmental vs. economic issues). Our work contributes towards a comprehensive understanding of nature (dis)connection, with practical implications for interventions targeting a more sustainable future. [ABSTRACT FROM AUTHOR]

Thyroid tumors occur in many domestic species, but are most common in the dog, in which they are classified as follicular or medullary. During 2012–2016, we received tissue specimens or whole carcasses of 4 dogs with variable enlargement of the thyroid glands. The 2 males and 2 females were of mixed (mongrel) inbreeding, 3–4.5-y-old. All tumors had lobulated architecture forming follicular structures variably containing colloid. On immunohistochemistry of the tumors from 3 of the dogs, 2 were thyroglobulin positive, and all 3 were negative for calcitonin, confirming follicular thyroid carcinoma in 2 of the dogs. Thyroid carcinomas have not been reported previously in related mongrel dogs, to our knowledge. [ABSTRACT FROM AUTHOR]

Eight hunting dogs were visited by a state veterinarian on the island of Tobago, Trinidad and Tobago, West Indies, as owners reported anorexia and paralysis in five of their dogs. The veterinarian observed a combination of clinical signs consistent with tick-borne illness, including fever, anorexia, anaemia, lethargy and paralysis. Blood and ticks were collected from each dog and submitted to a diagnostic laboratory for analysis. Microscopic analysis revealed a mixed infection of intracytoplasmic organisms consistent with Babesia spp. (erythrocyte) and Ehrlichia spp. (monocyte), respectively, from one dog, while a complete blood count indicated a regenerative anaemia (n = 1; 12.5%), non-regenerative anaemia (n = 4; 50%), neutrophilia (n = 3; 37.5%), lymphocytosis (n = 2; 25%), thrombocytopaenia (n = 3; 37.5%) and pancytopaenia (n = 1; 12.5%). DNA isolated from the eight blood samples and 20 ticks (16 Rhipicephalus sanguineus and 4 Amblyomma ovale) were subjected to conventional PCR and next-generation sequencing of the 16S rRNA and 18S rRNA gene for Anaplasma/Ehrlichia and Babesia/Theileria/Hepatozoon, respectively. The DNA of Ehrlichia spp., closely related to Ehrlichia canis, was detected in the blood of three dogs (37.5%), Anaplasma spp., closely related to Anaplasma marginale, in two (25%), Babesia vogeli in one dog (12.5%) and seven ticks (35%) and Hepatozoon canis and Anaplasma spp., in one tick (5%), respectively. These findings highlight the need to test both the vector and host for the presence of tick-borne pathogens when undertaking diagnostic investigations. Further studies are also warranted to elucidate the susceptibility of canids to Anaplasma marginale. [ABSTRACT FROM AUTHOR]

Young drivers are overrepresented in road traffic crashes and fatalities. Distracted driving, including use of a smartphone while driving (SWD), is a major risk factor for crashes for this age group. We evaluated a web-based tool (Drive in the Moment or DITM) designed to reduce SWD among young drivers. A pretest-posttest experimental design with a follow-up was used to assess the efficacy of the DITM intervention on SWD intentions and behaviors, and perceived risk (of having a crash and of being apprehended by the police) associated with SWD. One hundred and eighty young drivers (aged 17-25 years old) were randomly assigned to either the DITM intervention or a control group where participants completed an unrelated activity. Self-reported measures of SWD and perceptions of risk were obtained pre-intervention, immediately post-intervention and at a follow-up 25 days after the intervention. Participants who engaged with the DITM showed a significant reduction in the number of times they used their SWD at follow-up compared to their pre-intervention scores. Future intentions to SWD were also reduced from pre-intervention to post-intervention and follow-up. There was also an increase in the perceived risk of SWD following the intervention. Our evaluation of DITM suggests that the intervention had an impact on reducing SWD among young drivers. Further research is needed to establish which particular elements of the DITM are associated with reductions in SWD and whether similar findings would be identified in other age groups. [ABSTRACT FROM AUTHOR]

Purpose: Due to ongoing inequities in the social determinants of health and systemic barriers, homelessness continues to be a significant concern that disproportionately impacts racialized communities. Despite constituting a small proportion of the population, Black individuals are over-represented among people experiencing homelessness in many Canadian cities. However, although Black homelessness in Canada is a pressing issue, it has received limited attention in the academic literature. The purpose of this paper is to examine the reported prevalence of Black homelessness across Canada. Design/methodology/approach: By consulting enumerations from 61 designated communities that participated in the 2018 Nationally Coordinated Point-in-Time Count and two regional repositories – one for homeless counts supported by the government of British Columbia and another from the Rural Development Network – this paper reports on the scale and scope of Black homelessness across Canada. Findings: Significantly, these reports demonstrate that Black people are over-represented among those experiencing homelessness compared to local and national populations. These enumerations also demonstrate significant gaps in the reporting of Black homelessness and inadequate nuance in data collection methods, which limit the ability of respondents to describe their identity beyond "Black." Originality/value: This research provides an unprecedented examination of Black homelessness across Canada and concludes with recommendations to expand knowledge on this important and under-researched issue, provide suggestions for future iterations of homeless enumerations and facilitate the development of inclusive housing policy. [ABSTRACT FROM AUTHOR]

Background: Pulse pressure is a dynamic marker of cardiovascular function and is often impaired in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Pulsatile blood flow also serves as a regulator of vascular endothelium, and continuous-flow mechanical circulatory support can lead to endothelial dysfunction. We explored the impact of early low pulse pressure on occurrence of acute brain injury (ABI) in VA-ECMO. Methods: We conducted a retrospective analysis of adults with VA-ECMO at a tertiary care center between July 2016 and January 2021. Patients underwent standardized multimodal neuromonitoring throughout ECMO support. ABI included intracranial hemorrhage, ischemic stroke, hypoxic ischemic brain injury, cerebral edema, seizure, and brain death. Blood pressures were recorded every 15 min. Low pulse pressure was defined as a median pulse pressure < 20 mm Hg in the first 12 h of ECMO. Multivariable logistic regression was performed to investigate the association between pulse pressure and ABI. Results: We analyzed 5138 blood pressure measurements from 123 (median age 63; 63% male) VA-ECMO patients (54% peripheral; 46% central cannulation), of whom 41 (33%) experienced ABI. Individual ABIs were as follows: ischemic stroke (n = 18, 15%), hypoxic ischemic brain injury (n = 14, 11%), seizure (n = 8, 7%), intracranial hemorrhage (n = 7, 6%), cerebral edema (n = 7, 6%), and brain death (n = 2, 2%). Fifty-eight (47%) patients had low pulse pressure. In a multivariable model adjusting for preselected covariates, including cannulation strategy (central vs. peripheral), lactate on ECMO day 1, and left ventricle venting strategy, low pulse pressure was independently associated with ABI (adjusted odds ratio 2.57, 95% confidence interval 1.05–6.24). In a model with the same covariates, every 10-mm Hg decrease in pulse pressure was associated with 31% increased odds of ABI (95% confidence interval 1.01–1.68). In a sensitivity analysis model adjusting for systolic pressure, pulse pressure remained significantly associated with ABI. Conclusions: Early low pulse pressure (< 20 mm Hg) was associated with ABI in VA-ECMO patients. Low pulse pressure may serve as a marker of ABI risk, which necessitates close neuromonitoring for early detection. [ABSTRACT FROM AUTHOR]

Alternative splicing of AMPA-type glutamate receptors (AMPARs) and allosteric modulation by auxiliary subunits, such as transmembrane AMPAR regulatory proteins (TARPs), are two important mechanisms that regulate the time course of glutamatergic neurotransmission. Prior work has shown that alternative splicing of the flip/flop cassette profoundly regulates TARP c2 modulation, where flip receptor gating exhibits robust sensitivity to TARPs while flop isoforms are relatively insensitive to TARP modulation. Whether this splice variant-specific regulation extends to other auxiliary subunit families, such as cornichons (CNIHs), GSG1L, or CKAMPs, remains unknown. Here, we demonstrate that CNIH-3 modulation is unaffected by AMPAR alternative splicing due to inherent differences in how CNIH-3 and TARP c2 modify channel gating. CNIH-3 slows receptor deactivation from the outset of current decay, consistent with structural evidence showing its point of contact at the level of the pore. In contrast, TARP c2 acts via the KGK site of the ligand-binding domain (LBD) to slow the onset of desensitization. Although GSG1L and CKAMP44 primarily slow recovery from desensitization, their effects on channel gating are unaffected by alternative splicing, further underlining that structural events leading to the onset and recovery from desensitization are separable. Together, this work establishes that alternative splicing and TARP auxiliary subunits form a unique partnership that governs fast glutamatergic signaling at central synapses. Since proteomic studies suggest that all native AMPARs co-assemble with at least two TARPs, allosteric coupling between the flip/flop cassette and TARPs may represent a common design element in all AMPAR complexes of the mammalian brain. [ABSTRACT FROM AUTHOR]

Previous research shows that men eat more meat than women. We explore the extent to which self-rated gender typicality explains differences in meat consumption intentions and behaviour. We recruited a large sample (N = 4897) of Australian men and women to complete an online survey about their attitudes and intentions regarding meat consumption and abstention and measured their self-rated gender typicality (the extent men view themselves as masculine, and women view themselves as feminine). We used moderated regression analyses to investigate self-rated gender typicality as a moderator of the relationship between gender and meat-related variables. We demonstrated that for men, identifying as more masculine was associated with a lower likelihood of reducing meat consumption or considering veg*nism, and a greater belief that eating meat is normal. We also found that men, and those with more gender-typical self-ratings (regardless of gender), viewed meat as more natural, necessary, and nice. These findings suggest that self-rated gender typicality may be relevant for understanding gender differences in meat consumption behaviours. Appeals to adopt low- or no-meat diets may be more effective if they consider the ways Australian diets are interconnected with genders and identities. Increasing acceptance of alternative masculinities, and developing masculinity-friendly advertising of plant-based foods, could be useful in promoting meat reduction. [ABSTRACT FROM AUTHOR]

PURPOSE We sought to determine the feasibility of delivering a Supportive Oncology Care at Home intervention among patients with pancreatic cancer. METHODS We prospectively enrolled patients with pancreatic cancer from a parent trial of neoadjuvant fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFIRINOX). The intervention entailed (1) remote monitoring of patient-reported symptoms, vital signs, and body weight; (2) a hospital-at-home care model; and (3) structured communication with the oncology team. We defined the intervention as feasible if ≥ 60% of patients enrolled in the study and ≥ 60% completed the daily assessments within the first 2-weeks of enrollment. We determined rates of treatment delays, urgent clinic visits, emergency department visits, and hospitalizations among those who did (n = 20) and did not (n = 24) receive Supportive Oncology Care at Home from the parent trial. RESULTS From January 2019 to September 2020, we enrolled 80.8% (21/26) of potentially eligible patients. One patient became ineligible following consent because of moving out of state, resulting in 20 participants (median age = 67 years). In the first 2 weeks of enrollment, 65.0% of participants completed all daily assessments. Overall, patients reported 96.1% of daily symptoms, 96.1% of daily vital signs, and 92.5% of weekly body weights. Patients receiving the intervention had lower rates of treatment delays (55.0% v 75.0%), urgent clinic visits (10.0% v 25.0%), and emergency department visits/hospitalizations (45.0% v 62.5%) compared with those not receiving the intervention from the same parent trial. CONCLUSION Findings demonstrate the feasibility and acceptability of a Supportive Oncology Care at Home intervention. Future work will investigate the efficacy of this intervention for decreasing health care use and improving patient outcomes. [ABSTRACT FROM AUTHOR]

Enteral nutrition (EN) is a vital component of nutrition around the world. EN allows for delivery of nutrients to those who cannot maintain adequate nutrition by oral intake alone. Common questions regarding EN are when to initiate and in what scenarios it is safe. The answers to these questions are often complex and require an evidence-based approach. The Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) established an Enteral Nutrition Committtee to address the important questions surrounding the indications for EN. Consensus recommendations were established based on eight extremely clinically relevant questions regarding EN indications as deemed by the Enteral Nutrition Committee. These consensus recommendations may act as a guide for clinicians and stakeholders on difficult questions pertaining to indications for EN. This paper was approved by the ASPEN Board of Directors. [ABSTRACT FROM AUTHOR]

Background: Individuals with advanced Parkinson's Disease (PD) and Parkinson-related disorders (PRD) are frequently referred for home allied therapies and nursing care, yet home healthcare professionals have limited training in PD/PRD. While recognizing the need for such care, patients and families report home healthcare professionals are unfamiliar with these conditions, which may be driven by neurophobia and may contribute to suboptimal care and early termination of services. We sought to determine the feasibility and effects of a virtual, multimodal educational intervention on PD knowledge, confidence, and empathy among home health professionals. Methods: Home health nurses, occupational therapists, physical therapists and physical therapy assistants, and speech-language pathologists participated in a daylong, virtual symposium on advanced PD/PRD, combining focused lectures, discipline-specific breakout sessions, immersive virtual reality vignettes, and interactive panels with both patients and families, and movement disorders and home healthcare experts. Participants completed online pre- and post-symposium surveys including: demographics; PD/PRD knowledge (0–10 points possible); empathy (Interpersonal Reactivity Index); and 10-point scales of confidence with and attitudes towards individuals with PD/PRD, respectively. Pre-post intervention changes and effect sizes were evaluated with paired t-tests and Cohen's d. We performed qualitative analyses of post-symposium free-text feedback using a grounded theory approach to identify participants' intentions to change their practice. Results: Participants had a mean improvement of 3.1 points on the PD/PRD knowledge test (p < 0.001, d = 1.97), and improvement in confidence managing individuals with PD/PRD (p = 0.0003, d =.36), and no change in empathy. The interactive, virtual format was rated as effective by 95%. Common themes regarding symposium-motivated practice change included: interdisciplinary collaboration; greater involvement and weighting of the patient and caregiver voice in care plans; attention to visit scheduling in relation to patient function; recognition and practical management of the causes of sudden change in PD/PRD, including infections and orthostatic hypotension. Conclusions: A virtual, multimodal, brief educational pilot intervention improved PD/PRD-specific knowledge and confidence among home healthcare nurses and allied health professionals. Future studies are necessary to test the short- and long-term effects of this intervention more broadly and to investigate the impact of this education on patient and caregiver outcomes. [ABSTRACT FROM AUTHOR]

Background: Patients with cancer often endure substantial symptoms and treatment toxicities leading to high healthcare utilization, including hospitalizations and emergency department visits, throughout the continuum of their illness. Innovative oncology care models are needed to improve patient outcomes and reduce their healthcare utilization. Using a novel hospital at home care platform, we developed a Supportive Oncology Care at Home intervention to address the needs of patients with cancer.Methods: We are conducting three trials to delineate the role of Supportive Oncology Care at Home for patients with cancer. The Supportive Oncology Care at Home intervention includes: (1) a hospital at home care model for symptom assessment and management; (2) remote monitoring of daily patient-reported symptoms, vital signs, and body weight; and (3) structured communication with the oncology team. Our first study is a randomized controlled trial to test the efficacy of Supportive Oncology Care at Home versus standard oncology care for improving healthcare utilization, cancer treatment interruptions, and patient-reported outcomes in patients with cancer receiving definitive treatment of their cancer. Participants include adult patients with gastrointestinal and head and neck cancer, as well as lymphoma, receiving definitive treatment (e.g., treatment with curative intent). The second study is a single-arm trial assessing the feasibility and acceptability of the Supportive Oncology Care at Home intervention for hospitalized patients with advanced cancer. Eligible participants include adult patients with incurable cancer who are admitted with an unplanned hospitalization. The third study is a single-arm trial assessing the feasibility and acceptability of the Supportive Oncology Care at Home intervention to enhance the end-of-life care for patients with advanced hematologic malignancies. Eligible participants include adult patients with relapsed or refractory hematologic malignancy receiving palliative therapy or supportive care alone.Discussion: These studies are approved by the Dana-Farber/Harvard Cancer Center Institutional Review Board and are being conducted in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials. This work has the potential to transform the paradigm of care for patients with cancer by providing them with the necessary support at home to improve their health outcomes and care delivery.Trial Registrations: NCT04544046, NCT04637035, NCT04690205. [ABSTRACT FROM AUTHOR]

Background: Ticks are important vectors of many pathogens that have contributed to the morbidity and mortality of humans and domestic animals worldwide. Wildlife species have also been implicated as reservoir hosts of a variety of tick-borne pathogens. The objective of this study was to determine which tick-transmitted pathogens were present in the animals harvested from the forest in Trinidad for human consumption. Methods: Thin blood smears from 43 neotropical animals were examined microscopically for tick-borne pathogens. Additionally, DNA extraction and PCR amplification of the 16S rRNA gene were used for amplification of Anaplasma and Ehrlichia while the gltA gene was used for Bartonella, and Rickettsia spp. and the 18S rRNA gene for Babesia, Hepatozoon and Theileria species. Results: Pathogen DNA was amplified from four samples (a deer, collared peccary and two agoutis). Sequencing of the amplified products from the deer and collared peccary revealed 99.8% homology to Anaplasma bovis and 98.8% homology to Ehrlichia canis, respectively. Sequences from two agoutis revealed 90.4% homology to Theileria spp. DNA of Hepatozoon spp., Bartonella spp. Babesia spp. and Rickettsia spp. was not detected in any of the screened samples. An incidental finding in this study was the presence of bacteria in the blood of animals. Conclusions: The results indicate that the DNA of tick-transmitted pathogens is present at a frequency of about 10% in the study population and suggests that neotropical mammals may serve as a source for the potential transmission of tick-borne pathogens to domestic animals and humans. In addition, physicians and hunters should be aware of the symptoms associated with zoonotic tick-borne pathogens so that these infections can be recognised, diagnosed and treated promptly. Bacteria present in carcasses can pose a food safety hazard and hunters should be trained in proper harvesting and handling of carcasses. [ABSTRACT FROM AUTHOR]

Objective: To explore health professionals' (clinicians) approach to the provision of care in a dementia setting. Methods: Participants were clinicians from two older persons' mental health services (community and inpatient). Participants completed an interview about strategies to engage with, and barriers to providing person‐centred care to consumers with a co‐morbid diagnosis of dementia. Thematic analysis was used to analyse the data. Results: Three main themes were developed through analysis of the interview data: (1) overall approach to care (synthesis of care and cure principles), (2) the challenges in the provision of care, and (3) coping strategies to manage care demands. Conclusion: Developing a relationship with a patient and attending to their medical needs were seen as optimal care, relevant to both person‐centred and task‐oriented approaches to dementia care. Clinicians also highlighted the importance of their own personal resources and attitudes in shaping the type of care provided. [ABSTRACT FROM AUTHOR]

Mental health practitioners' beliefs about the causes of mental illness may influence their approach to treatment and impact therapeutic outcomes. There has been limited research on this topic. This study explores mental health practitioners' views and experiences of addressing causal beliefs in treatment. A thematic framework guided the analysis of semi-structured interviews with 17 mental health practitioners. Participants stated that their causal beliefs impact their approach to treatment, and clients' causal beliefs influence how clients approach treatment. Participants thought that it was important to discuss causes with clients and identified several barriers to, and consequences of, doing so. Participants identified that addressing causal beliefs in treatment influenced factors such as practitioner empathy, therapeutic alliance, engagement in treatment and clients' self-blame. [ABSTRACT FROM AUTHOR]

Objective: Measurement feedback systems provide clinicians with regular snapshots of a client's mental health status, which can be used in treatment planning and client feedback. There are numerous barriers to clinicians using outcome measures routinely. This study aimed to investigate factors affecting the use of a measurement feedback system across youth mental health settings. Methods: The participants were 210 clinicians from headspace youth mental health services across Australia. They were surveyed on predictors and use of MyLifeTracker, a routine outcome measure. This was explored through three processes: looking at MyLifeTracker before session, using MyLifeTracker in treatment planning, and providing feedback of MyLifeTracker scores to clients. Results: Clinicians were more likely to look at MyLifeTracker before session, less likely to use it in treatment planning, and least likely to provide MyLifeTracker scores to clients. Each measurement feedback system process had a distinct group of predictors. Perceptions of MyLifeTracker's practicality was the only significant predictor of all three processes. Conclusion: Practically, organisations and supervisors can increase the use of measurement feedback systems through targeted supports. [ABSTRACT FROM AUTHOR]

Establishing a relationship is considered the foundation of providing person‐centred care (PCC) when working with a person who has a diagnosis of dementia. Currently, there is a lack of consensus about the how to develop this relationship. This aim of this study was to explore the key skills adopted by clinicians to establish an effective care relationship, referred to as therapeutic alliance, specific to working with patients who have dementia. Participants were clinicians (nursing and allied health professionals) from two older person's mental health service teams (inpatient and community) who routinely provided clinical care to patients with a diagnosis of dementia. Participants self‐selected from a purposive sample to complete a semi‐structured interview about their provision of care to, and strategies used to engage with, people with a diagnosis of dementia. Exploratory qualitative thematic analysis was conducted using mixed inductive and deductive procedures. Five themes were identified as the interpersonal skills used to develop relationships with patients including the following: empathy, unconditional positive regard, congruence, psychological flexibility, and communication. Findings from this study provide direction for training of clinicians employed in a dementia setting and can also be generalized to other non‐specific clinical settings where clinicians may incidentally provide treatment to patients with a diagnosis of dementia. [ABSTRACT FROM AUTHOR]

In this study, we examined American Indian and Alaska Native (AI/AN) Head Start directors' perceptions of the Classroom Assessment Scoring System (CLASS) and critically examined those perceptions to provide insight into the cultural appropriateness of the CLASS in the AI/AN Head Start context. Based on qualitative data from 76 AI/AN Head Start administrators, our findings provide evidence that there are advantages and limitations in using the CLASS in AI/AN Head Start programs. While two of the three broad constructs measured by the CLASS fit well with the experiences of AI/AN early childhood education programs, our data provide evidence of cultural misalignment in the CLASS trainings, some of the CLASS behavioral markers, and the Instructional Support domain. Based upon our findings, we suggest further work be conducted to understand how to modify the instrument or create a new instrument to be better aligned with AI/AN Head Start classroom experiences. [ABSTRACT FROM AUTHOR]

The three-dimensional positions of atoms in protein molecules define their structure and their roles in biological processes. The more precisely atomic coordinates are determined, the more chemical information can be derived and the more mechanistic insights into protein function may be inferred. Electron cryo-microscopy (cryo-EM) single-particle analysis has yielded protein structures with increasing levels of detail in recent years1,2. However, it has proved difficult to obtain cryo-EM reconstructions with sufficient resolution to visualize individual atoms in proteins. Here we use a new electron source, energy filter and camera to obtain a 1.7 Å resolution cryo-EM reconstruction for a human membrane protein, the β3 GABAA receptor homopentamer3. Such maps allow a detailed understanding of small-molecule coordination, visualization of solvent molecules and alternative conformations for multiple amino acids, and unambiguous building of ordered acidic side chains and glycans. Applied to mouse apoferritin, our strategy led to a 1.22 Å resolution reconstruction that offers a genuine atomic-resolution view of a protein molecule using single-particle cryo-EM. Moreover, the scattering potential from many hydrogen atoms can be visualized in difference maps, allowing a direct analysis of hydrogen-bonding networks. Our technological advances, combined with further approaches to accelerate data acquisition and improve sample quality, provide a route towards routine application of cryo-EM in high-throughput screening of small molecule modulators and structure-based drug discovery. Advances in electron cryo-microscopy hardware allow proteins to be studied at atomic resolution. [ABSTRACT FROM AUTHOR]

Background: Vasoactive and inotropic support (VIS) may predispose cardiac surgery patients to ischemic gut complications (IGCx). The purpose of this study was to describe the effect of VIS on the manner in which we deliver tube feeds (TFs) and determine its relationship with IGCx in cardiac surgery patients. Methods: We reviewed cardiac surgery patients at a single institution and examined the effect of VIS (none, low, medium, high) on TF administration and evaluated IGCx. Results: Of 3088 cardiac surgery patients, 249 (8%) required TFs, comprising 2151 total TF‐days. Increasing VIS was associated with decreased amounts of TF administered per day (P =.001) and an increase in time that TF was held per day (P <.001). High VIS was associated with less intact, more semi‐elemental/elemental formula use (P <.001) and increased use of gastric route (P <.001). Of all cardiac surgery patients, 11 of 3125 suffered IGCx (0.4%), with a mortality of 73%. Of the 3 receiving TF, 2 IGCx were focal and consistent with acute embolus, whereas one was diffuse, on high VIS and an intra‐aortic balloon pump. Of the 8 IGCx in the patients not receiving TF, 5 were focal, whereas 3 were diffuse and not embolic (P =.21). Conclusions: Despite 32% of TF‐days on moderate to high VIS, non‐embolic IGCx were not increased compared with patients not receiving TF. As delivered at this institution, TF in even those requiring moderate to high inotropic and pressor support were not associated with an increase in attributable IGCx. [ABSTRACT FROM AUTHOR]

Aims: To explore student nurses' and nurse mentors' perceptions and experiences of raising concerns on clinical placement and the influence (if any) of their relationship on this process. A secondary aim is to consider the above, from a regulatory perspective in light of current literature and policy developments. Background: Raising concerns whilst on clinical placement has been shown to be challenging for student nurses internationally. Registered nurses in the UK (in this case called "nurse mentors") facilitate learning and assessment in practice. However, limited research exists on the influence of the relationship between the nurse mentor and student nurse on the raising concerns process. Design: A qualitative approach was used to undertake secondary thematic analysis of interview data. The primary data set was generated during a PhD study, focusing on the mentor–student dynamic and the possible influence of this relationship on students' raising concerns. Methods: 30 individual semi‐structured interviews were subjected to concurrent and thematic analysis. Interviews were undertaken with student nurses (n = 16) and nurse mentors (n = 14) between April 2016–January 2018. The COREQ 32‐item checklist was used during the preparation of this article. Findings: The following three interrelated analytical themes were generated from the data, "developing a mentor‐student relationship," "keeping your mentor sweet" and "the mentor role in the raising concerns process." Conclusion: Our analysis of participants' experiences and perceptions offers an original contribution to understanding the factors associated with student nurses raising concerns in practice. Student nurses and most mentors believed that students should be encouraged and supported to raise concerns, but students' decisions were strongly influenced by their perceptions of the immediate interpersonal and educational context. Similar barriers to raising concerns have been shown to exist regardless of geographical boundaries, therefore the findings of this study are nationally and internationally relevant. Relevance to clinical practice: This study provides new insight into the role of the nurse mentor in supporting students who raise concerns on clinical placements. The majority of the mentor participants believed that students should be encouraged and supported to speak up if they witness poor care or unprofessional behaviour. Focusing on the compexities around raising concerns in mentorship training and updates would rovide a forum for open discussion amongst mentors and educators. [ABSTRACT FROM AUTHOR]

Ticks and the pathogens they transmit can cause high morbidity and mortality in domestic animals. As part of a larger study to determine the tick‐borne pathogens infesting domestic animals and wildlife, the aim of this study was to survey the tick species infesting the canine and cattle populations in Trinidad, Tobago and St. Lucia. A total of 1,990 ticks were collected off 179 dogs in Trinidad (n = 163) and Tobago (n = 16) between June 2016 and 2018. Ticks were also collected from cattle throughout Trinidad (n = 1,098), Tobago (n = 306) and St. Lucia (n = 176). Collected ticks were morphologically identified using standard taxonomic keys. Tick‐infested dogs were characterized as pets (n = 161) or hunting dogs (n = 18). Only two tick species, Rhipicephalus sanguineus (1,926; 96.8%) and Amblyomma ovale (64; 3.2%), were found on the dogs. A total of 169 (94.4%) dogs and 10 (5.6%) dogs were infested with R. sanguineus and A. ovale, respectively. Three dogs (1.7%) were infested with both tick species. Hunting dogs or those closely associated with them were infested with A. ovale. Rhipicephalus sanguineus was widely distributed throughout both islands, whereas A. ovale was restricted to small foci in three rural settlements in both Trinidad (n = 2) and Tobago (n = 1). Rhipicephalus (Boophilus) microplus (n = 1,404) was the only tick species found in cattle from Trinidad (n = 62) and Tobago (n = 20), whilst R. B. microplus (n = 171) and Amblyomma variegatum (n = 5) were found infesting 14 and two heads of cattle, respectively, in St. Lucia. These preliminary findings will aid in determining whether there are links between ticks and tick‐borne pathogens associated with domestic, wildlife species and humans and give further insight into the potential movement of ticks and their pathogens between the human, animal and tropical forest interface. [ABSTRACT FROM AUTHOR]

This article was one submitted at the editor's invitation to write about personal experiences of librarianship during COVID-19. In this article, the author reflects on several titles related to librarianship and how they pertain to notions of service as part of librarianship within the context of COVID-19. [ABSTRACT FROM AUTHOR]

The United States has fewer tax treaties with countries in Latin America and the Caribbean than the United Kingdom, France, Germany, Spain and even China have with such countries. After first describing ways in which tax treaties reduce barriers to cross-border trade and investment, this Article considers in turn various possible explanations for this situation. It examines, and rejects, the hypothesis that Latin American countries are reluctant to enter into tax treaties in general. It then considers, and rejects, the possibility that Latin American countries are opposed to increased trade and investment from the United States in particular. It then considers the possibility that U.S. tax treaty policy presents insurmountable difficulties to the conclusion of tax treaties. It concludes that U.S. tax treaty policies may present obstacles to successful negotiations with some, but not all, Latin American countries, suggesting that the United States might make more progress by negotiating with some smaller countries if progress cannot be made with, for example, Brazil or Argentina. [ABSTRACT FROM AUTHOR]

Over 50 years' experience at the Children's Court Clinic of Victoria informs this valedictory account of its director. Changes over time to the model of service at the Clinic are detailed; an independent practitioner model (psychologist/psychiatrist) with oversight now endures, while the Clinic works exclusively for the Court. Clinic operations, clinicians, clients, reputation, the nature of referrals and the need for kindness in report writing are discussed. An integral theme is the politics of the child protection field, which can affect the Clinic, and lately – through new child law – has also affected the powers of the Court and the lives of children on care applications (and the purview of the Clinic's protection assessments). New child protection legislation is discussed along with its impacts on the care of a growing number of children, signalling the need to revisit the legislation, promote better engagement of families and greatly increase coordinated expert services to them. [ABSTRACT FROM AUTHOR]

Background: Causal beliefs are thought to influence consumers' perceptions of their mental illness and self-stigma, and may impact treatment and recovery. Understanding consumers' perspective on causes being addressed in treatment is vital to help guide future research and improve services. Aim: This study aimed to explore consumers' views on causes of mental illness being addressed in treatment, along with their subjective experiences of how causes were focused on in their treatment. Methods: Using a qualitative approach, semi-structured interviews were conducted with 23 consumers who self-identified as having a mental illness. A thematic analytic framework was used to identify and analyse themes that emerged within the data. Results: Consumers believed that causes were important and should be addressed in treatment, and identified several associated benefits including increased insight/personal understanding of their illness, symptom management and relapse prevention and reduced self-blame. Negative consequences and considerations were also identified. Conclusion: Causes help consumers make sense of their illness, and consumers would like causes to be addressed in treatment. More research is needed on how mental health professionals can address causes effectively as consumers are currently dissatisfied with how causes were discussed in their treatment. [ABSTRACT FROM AUTHOR]

Because the traditional non-discrimination article of tax treaties seemingly provides protection against only the most blatant discrimination against non-residents and non-nationals of a taxing State, governments may be emboldened to adopt "anti-abuse" rules that are in reality disguised trade barriers. On the other hand, trade disciplines in non-tax agreements may include protections against discriminatory taxes that non-specialist courts interpret in expansive ways, contrary to the wishes of tax authorities. An OECD project in the mid-2000s was an opportunity for governments to re-think the piecemeal nature of the traditional non-discrimination article in tax treaties and develop a coherent national treatment system that takes into account legitimate tax policy concerns. Instead, the project resulted in a mishmash of changes that largely blessed the various discriminatory practices that governments had adopted to that date. If tax authorities want to continue to play a leading role in developing international tax policy, they should consider whether a tax treaty approach that borrows concepts from non-tax agreements would better balance the interests of governments and taxpayers than the current version of Article 24 (and the Commentaries thereon). [ABSTRACT FROM AUTHOR]

In April 2020, the VA Ann Arbor Healthcare System (AAVA) and the VA Detroit Medical Center (DVA) began caring for non-Veteran patients in the midst of the COVID-19 pandemic,[1],[2] subsequently caring for the second and third most non-Veteran patients in the nation, respectively. VA The care was about the same Other facility11 (47.8%)10 (43.5%)2 (8.7%)How would you rate care provided to you by physicians at the VA compared to the hospital you were transferred to the VA from? In general, non-Veterans were highly satisfied with the care received at the VA and often preferred VA care over non-VA care. [Extracted from the article]

The article discusses the Determining Effects of Platelet Inhibition on Vaso-Occlusive Events (DOVE) study which assessed the potential efficacy of the antiplatelet agent, Prasugrel, to reduce veno-occlusive crisis (VOC). Topics include VOC as the primary reason that SCA patients seek medical care, way rates of pain and analgesic use were calculated for each participant, and identification of pre-adolescence as a transition point in chronic pain development.

This study compared the effects of 2 art activities (structured and nonstructured) and a focused breathing exercise on outcome measures of mindfulness, anxiety, and affect. Seventy-seven participants, recruited from university students and the general public, were randomly assigned to either 15 min of coloring a mandala (structured), free drawing (nonstructured), or a focused breathing exercise. Results demonstrated that all 3 interventions produced significant improvements in the outcome measures at posttest compared with pretest. However, no significant differences were found across the 3 intervention conditions. These findings inform the design of brief interventions aimed at achieving short-term positive psychological benefits in nonclinical populations. [ABSTRACT FROM AUTHOR]

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Accountable Care Organizations (ACOs), like other care entities, must be strategic about which initiatives they support in the quest for higher value. This article reviews the current strategic planning process for the Johns Hopkins Medicine Alliance for Patients (JMAP), a Medicare Shared Savings Program Track 1 ACO. It reviews the 3 focus areas for the 2017 strategic review process – (1) optimizing care coordination for complex, at-risk patients, (2) post-acute care, and (3) specialty care integration – reviewing cost savings and quality improvement opportunities, associated best practices from the literature, and opportunities to leverage and advance existing ACO and health system efforts in each area. It then reviews the ultimate selection of priorities for the coming year and early thoughts on implementation. After the robust review process, key stakeholders voted to select interventions targeted at care coordination, post-acute care, and specialty integration including Part B drug and imaging costs. The interventions selected incorporate a mixture of enhancing current ACO initiatives, working collaboratively and synergistically on other health system initiatives, and taking on new projects deemed targeted, cost-effective, and manageable in scope. The annual strategic review has been an essential and iterative process based on performance data and informed by the collective experience of other organizations. The process allows for an evidence-based strategic plan for the ACO in pursuit of the best care for patients. [ABSTRACT FROM AUTHOR]

Abstract: Viewing mental illness as an ‘illness like any other’ and promoting biogenetic causes have been explored as a stigma‐reduction strategy. The relationship between causal beliefs and mental illness stigma has been researched extensively in the general public, but has gained less attention in more clinically‐relevant populations (i.e. people with mental illness and mental health professionals). A systematic review examining whether endorsing biogenetic causes decreases mental illness stigma in people with mental illness and mental health professionals was undertaken using the preferred reporting items for systematic reviews and meta‐analyses guidelines. Multiple databases were searched, and studies that explored the relationship between biogenetic causal beliefs and mental illness stigma in people with mental illness or mental health professionals were considered. Studies were included if they focussed on depression, schizophrenia, or mental illness in general, were in English, and had adult participants. The search identified 11 journal articles reporting on 15 studies, which were included in this review. Of these, only two provided evidence that endorsing biogenetic causes was associated with less mental illness stigma in people with mental illness or mental health professionals. The majority of studies in the present review (n = 10) found that biogenetic causal beliefs were associated with increased stigma or negative attitudes towards mental illness. The present review highlights the lack of research exploring the impacts of endorsing biogenetic causes in people with mental illness and mental health professionals. Clinical implications associated with these results are discussed, and suggestions are made for further research that examines the relationship between causal beliefs and treatment variables. [ABSTRACT FROM AUTHOR]

We use a unique data set containing information from state individual income tax returns, Wisconsin unemployment insurance wage data, and data collected by hand from Wisconsin courthouses to examine the earned income tax credit (EITC) usage by divorced men and women with children. We show that a large percentage of divorced adults with children file tax returns. Moreover, many receive the EITC benefit through the tax system, which results in substantial additional resources for the household. We find little evidence of divorced parents engaging in strategic allocations of their children to maximize EITC claims. We also find that many EITC-eligible low-income parents fail to claim it. A potentially cost-effective way to increase the resources available to low-income working families is to provide easy-to-understand information on child-related provisions in the tax code at the time the court order is established. [ABSTRACT FROM AUTHOR]

Background: Childhood overnutrition is a serious public health problem, with consequences that extend into adulthood. The aim of this study was to determine the prevalence and determinants of overweight and obesity among school-age children in two urban settings in Ghana. Methods: This cross-sectional study involved 3089 children (9-15 years) recruited between December 2009 and February 2012 in Accra and Kumasi, Ghana. Socio-demographic, dietary, and physical activity data were collected using pretested questionnaires. BMI-for-age z-scores were used to categorize anthropometric data of the children as thin, normal, or overweight/obese. Determinants of overweight were examined using multiple logistic regressions. Results: Seventeen percent of children were overweight or obese. Children who reported lower participation (< 3 times/week) in sports activity were 44% more likely to be overweight or obese (AOR = 1.44; 95% CI: 1.07, 1.94). Maternal tertiary education (AOR = 1.91, 95% CI: 1.07, 3.42), higher household socioeconomic status (AOR = 1. 56, 95% CI: 1.18, 2.06), and attending private school (AOR = 1.74, 95% CI: 1.31, 2.32) were also associated with elevated risk of overweight and obesity. Conclusions: Physical inactivity is a modifiable independent determinant of overweight or obesity among Ghanaian school-aged children. Promoting and supporting a physically active lifestyle in this population is likely to reduce risk of childhood overnutrition. [ABSTRACT FROM AUTHOR]

Background/Aims: Patients with sickle cell anemia can experience recurrent pain episodes, which affect quality of life. The reported prevalence of pain is higher in studies using patient diaries than in healthcare facility utilization data. Determining Effects of Platelet Inhibition on Vaso-Occlusive Events was a multinational study that assessed the efficacy and safety of prasugrel in reducing the rate of vaso-occlusive events in children with sickle cell anemia (NCT01794000) and included an electronic patient-reported outcome diary to record pain occurrence. We aimed to capture diary completion rates and compliance in children who used the electronic patient-reported outcome diary during the Determining Effects of Platelet Inhibition on Vaso-Occlusive Events study and examine factors contributing to diary completion rates and compliance. Methods: Daily electronic patient-reported outcome diary data were collected for up to 9 months in Determining Effects of Platelet Inhibition on Vaso-Occlusive Events participants aged 4 to <18 years in Africa, the Americas, Europe, and the Middle East. The questionnaires were available in 11 languages/dialects for collecting subjective (pain intensity, activity interference) and objective (study drug use, analgesic use, school attendance) data. Pain intensity was measured using the Faces Pain Scale-Revised. Data were entered by participants or caregivers and transferred wirelessly each day to a central database. Diary completion rates were the number of daily diary entries divided by the total number of expected daily diary entries. Percentages of participants who were compliant with the diary (=80% diary completion) were calculated. Results: A total of 311 participants received a diary; 268 provided diary data through Month 9. Diary completion rates and compliance were high throughout the collection period and across all groups and regions, despite no games being included on the device. For subjective data, the overall completion rate was 94.4%, and 92.6% of participants were compliant. For objective data, the overall completion rate was 93.3%, and 89.7% of participants were compliant. Completion rates and compliance differed significantly by age and region and were higher for 4 to <12 year olds and very much higher for participants from Africa and the Middle East. Caregivers almost always entered data for participants <6 years and rarely entered data for participants =12 years. Comparing participant-entered and caregiver-entered data, pain intensity score data were more consistent for 4 to <12 year olds than older children, but pain intensity scores for older children were higher when entered by caregivers. Conclusion: With appropriate design, participant training, and sufficient monitoring, an electronic patient-reported outcome diary can capture daily sickle cell-related pain data in large multinational studies. Providing a mechanism for caregiver reporting is particularly valuable for participants <6 years and may also facilitate compliance in older children who experience high levels of pain. [ABSTRACT FROM AUTHOR]

Objective This study investigated the relationship between death anxiety (DA) and fear towards patients according to the age and illness of the patient. Methods A sample of 94 undergraduate nursing students from an Australian university were presented with a hypothetical patient, who varied by age (29 years or 71 years) and illness (arthritis, cancer or dementia). They then completed measures of DA and fear towards the patient. Results Older patients with dementia were associated with higher DA compared to all other conditions. Greater fear was associated with patients in the dementia target condition. Conclusion The findings from this study are consistent with terror management theory; specifically, older age and terminal illness are associated with greater DA. Implications are discussed regarding the quality of care provided to older people with dementia. [ABSTRACT FROM AUTHOR]