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The organising logic of communicative practices in social change is the need to acknowledge the moderating influence of power in the attainment of project outcomes. Power relations embedded within HIV prevention responses that incorporate external interest groups and marginalised local communities, can affect “community ownership and “leadership” in projects that are externally funded. Who owns the project if an external agent has leveraged funds for community project? In such circumstances, what does the community ‘owe’ the funder? The orthographical differentiation of (owe) from ‘power’ in this article’s title is an invitation to rethink the application of communication in social change processes executed under the weight of expectations from external stakeholders. The Woza Asibonisane Community Responses Project (WACRP), an HIV prevention communication project implemented by The Valley Trust (TVT) in informal settlements and rural areas in KwaZulu-Natal, South Africa under the auspices of the United States Agency for International Development (USAID) is applied as a an illustrative case to explore the conundrum of power in a supposed participatory initiative involving community and external stakeholders. The article reveals that the exercise of power in such externally funded community-led interventions masks what has been described as ceremonial adequacy of institutionalised social change communication programs. We, therefore, argue that for social change to be sustainable, power should be acknowledged, accounted for, and planned for in the conceptualisation, implementation, and evaluation of health communication projects in ways that account for local practices and listening.

Abstract The recent call to halt biodiversity loss by protecting half the planet has been hotly contested because of the extent to which people might be excluded from these landscapes. It is clear that incorporating landscapes that implicitly work for indigenous people is vital to achieving any sustainable targets. We examine an attempt to balance the trade‐offs between conservation and development in Enonkishu Conservancy in the Maasai Mara, using a working landscape approach. Mobile livestock production strategies are theoretically consistent with wildlife‐based activities and can present a win‐win solution for both conservation and development. We explore the success and failings of Enonkishu's evolving attempts to achieve this: addressing the criticism of the conservation sector that it fails to learn from its mistakes. We found that Enonkishu has had considerable positive conservation outcomes, preventing the continued encroachment of farmland and maintaining and improving rangeland health relative to the surrounding area, while maintaining diverse and large populations of wildlife and livestock. The learning from certain ventures that failed, particularly on livestock, has created institutions and governance that, while still evolving, are more robust and relevant for conservancy members, by being fluid and inclusive. Practical implication: Diverse revenue streams (beyond tourism, including a residential estate, livestock venture and philanthropy) enabled Enonkishu to withstand the pressures of COVID‐19. Livestock is crucial for defining the vision of the conservancy, and the institutions and governance that underpin it.

Background: Residency programs transitioned to primarily virtual interviews due to the COVID-19 pandemic. This shift raised questions regarding expectations and patterns of applicant cancellation timeliness. The purpose of this study was to examine changes in applicant cancellations after transitioning to virtual interviews. Methods: This was a retrospective cohort study of interview data from a three-year emergency medicine residency at a tertiary-care academic medical center. Using archived data from Interview Broker, we examined scheduling patterns between one in-person (2019–2020) and two virtual interview cohorts (2020–2021 and 2021–2022). Our outcomes were the overall cancellation rates relative to interview slots as well as the proportion of cancellations that occurred within 7 or 14 days of the interview date. Results: There were 453 interview slots and 568 applicants invited. Overall, applicants canceled 17.1% of scheduled interviews. Compared with in-person interviews, applicants canceled significantly fewer virtual interviews (in person: 40/128 (31.3%), virtual year 1: 22/178 (12.4%), virtual year 2: 15/143 (10.5%), P = 0.001). Conversely, applicants canceled significantly more virtual interviews within both the 14-day threshold (in person: 8/40 (20%), virtual year 1: 12/22 (55.5%), virtual year 2: 12/15 (80%), P

Introduction: Ensuring high-quality scholarly output by graduate medical trainees can be a challenge. Within many specialties, including emergency medicine (EM), it is unclear what constitutes appropriate resident scholarly activity. We hypothesized that the quantity and quality of scholarly activity would improve with a clearer guideline, including a point system for eligible scholarly activities. Methods: A resident Scholarly Activity Guideline was implemented for EM residents in a university setting. The guideline consists of a point system in which point values, ranging from 1–10, are assigned to various types of scholarly activities. Residents must earn at least 10 points and present their work to meet their scholarly graduation requirement. We tracked scholarly activities for graduates from the classes of 2014–2020, with the guideline being implemented for the class of 2016. In a blind analysis, we compared median total points per resident, mean counts of the Boyer model of scholarship components per resident, and mean counts of significant scholarly output per resident before vs after the guideline was implemented. Significant scholarly output was defined as an implemented protocol, a research project with data collection and analysis, a research abstract presentation, or an oral abstract presentation. Results: Among 64 residents analyzed, 48 residents used the guideline. We found that median points per resident increased after the guideline was implemented (median, interquartile range: before 7 [7], after 11 [10, 13], P = 0.002). Post-guideline scholarly activities were found to represent more of Boyer’s components of scholarship [mean before 0.81 [SD 0.40], mean after 1.52 [SD 0.71], mean difference 0.71, 95% confidence interval [CI] 0.332 ± 1.09, P

Abstract Background A significant number of late middle-aged adults with depression have a high illness burden resulting from chronic conditions which put them at high risk of hospitalization. Many late middle-aged adults are covered by commercial health insurance, but such insurance claims have not been used to identify the risk of hospitalization in individuals with depression. In the present study, we developed and validated a non-proprietary model to identify late middle-aged adults with depression at risk for hospitalization, using machine learning methods. Methods This retrospective cohort study involved 71,682 commercially insured older adults aged 55–64 years diagnosed with depression. National health insurance claims were used to capture demographics, health care utilization, and health status during the base year. Health status was captured using 70 chronic health conditions, and 46 mental health conditions. The outcomes were 1- and 2-year preventable hospitalization. For each of our two outcomes, we evaluated seven modelling approaches: four prediction models utilized logistic regression with different combinations of predictors to evaluate the relative contribution of each group of variables, and three prediction models utilized machine learning approaches - logistic regression with LASSO penalty, random forests (RF), and gradient boosting machine (GBM). Results Our predictive model for 1-year hospitalization achieved an AUC of 0.803, with a sensitivity of 72% and a specificity of 76% under the optimum threshold of 0.463, and our predictive model for 2-year hospitalization achieved an AUC of 0.793, with a sensitivity of 76% and a specificity of 71% under the optimum threshold of 0.452. For predicting both 1-year and 2-year risk of preventable hospitalization, our best performing models utilized the machine learning approach of logistic regression with LASSO penalty which outperformed more black-box machine learning models like RF and GBM. Conclusions Our study demonstrates the feasibility of identifying depressed middle-aged adults at higher risk of future hospitalization due to burden of chronic illnesses using basic demographic information and diagnosis codes recorded in health insurance claims. Identifying this population may assist health care planners in developing effective screening strategies and management approaches and in efficient allocation of public healthcare resources as this population transitions to publicly funded healthcare programs, e.g., Medicare in the US.

Modulation of metabolic pathways is linked to regulation of immune cells including macrophages. Here the authors identify a role for CD1d in the metabolic rewiring of macrophages, which alters responsiveness to innate stimuli.

The objective was to evaluate the impacts of a complex environment and stocking density on Ross 708 broiler chicken behaviors. Eight pens contained either high complexity (HC) or low complexity (LC) environments, and high (HD) or low (LD) density. Through focal-animal sampling, the frequency and duration of behaviors were recorded continuously for 5 min at two timepoints for one day in weeks 2, 4, and 7. Birds were active for 30% of the observed time, with birds showing more activity in HC compared with LC. Birds in HC pens spent more time preening and foraging than birds in LC pens, which was interpreted as a positive outcome. Dustbathing and play were not impacted by complexity, possibly due to the observation method. Birds were more frequently active at HD compared with LD, but did not spend more time being active, suggesting disturbances. Birds foraged, drank, and ate less frequently in HD compared with LD, presumably because birds had more difficulty accessing resources. Activity and active behaviors reduced as birds aged, while preening frequency increased, possibly due to frustration, but this was not confirmed. Perching was unaffected by age, showing a persistent motivation to perform the behavior. Our results indicate that a complex environment provides positive stimulation for foraging, locomotion, preening, and overall activity. Despite reduced activity, many benefits of the tested environmental complexity and low density persisted as birds aged.

The formation of cilia depends on centriole’s distal appendages. Here, the authors use correlative 3D-superresolution, electron microscopy and electron tomography to detail the architecture of distal appendages, to describe the initial stages of appendage assembly and show that appendages of mature centrioles remodel during mitosis.

Background To develop an effective, patient-centred and sustainable service, we set up a virtual clinic (VC) for patients with Parkinson’s disease, combining phone consultations and reports from wearable technology. The Parkinson’s Kinetigraph (PKG) is a wrist-worn device providing objective motor assessment, generating a report used by clinicians to optimise medication regimens.Interventions A pilot study of VC was designed using quality improvement methodology. For a VC appointment, patients were phoned by a clinician. After discussing symptoms and reviewing the PKG report, the clinician could decide on any medication changes or other interventions and relay this to the patient’s general practitioner in a clinic letter. Patient feedback was gathered via questionnaires and data collected on the outcomes and timings of the consultations.Results Over 12 clinics, 61 patients had VC appointments. Of questionnaire respondents, 89% were satisfied with VC (n=41). At VC, the clinician was able to make a treatment decision comparable to a face-to-face clinic in 79% of cases (n=48). Reasons appointments were deemed unsuccessful included issues with the PKG, speech or hearing problems and complex phase of disease. VC appointments, including administration time, last on average 22 min. This compares to 20 min face-to-face appointments but these do not include administration time.Conclusions We have demonstrated a safe and effective VC template. Most VC appointments are equivalent to face-to-face clinic in terms of treatment outcome. Success could be further improved by appropriate patient selection. Using VC is time saving and can result in releasing face-to-face appointment slots for those in urgent need or newly referred patients. Further cost analysis is required; the cost of the PKG alone is more expensive than a face-to-face appointment, but this does not take into account other value added, such as patient convenience and satisfaction, and reduced need for ambulance transport.

In non-small cell lung cancer (NSCLC), stroma-resident and tumour-infiltrating macrophages may facilitate an immunosuppressive tumour microenvironment (TME) and hamper immunotherapeutic responses. Analysis of tumour-associated macrophage (TAM) plasticity in NSCLC is largely lacking. We established a novel, multi-marker, dual analysis approach for assessing monocyte-derived macrophage (Mφ) polarisation and M1/M2 phenotypic plasticity. We developed a flow cytometry-based, two-marker analysis (CD64 and CD206) of CD14+ cells. The phenotype and immune function of in vitro-induced TAMs was studied in a heterotypic spheroid and tumour-derived explant model of NSCLC. Heterotypic spheroids and NSCLC explants skewed Mφs from an M1- (CD206loCD64hi) to M2-like (CD206hiCD64lo) phenotype. Lipopolysaccharide (LPS) and IFNγ treatment reversed M2-like Mφ polarisation, indicating the plasticity of Mφs. Importantly, antigen-specific CD8+ T cell responses were reduced in the presence of tumour explant-conditioned Mφs, but not spheroid-conditioned Mφs, suggesting explants are likely a more relevant model of the immune TME than cell line-derived spheroids. Our data indicates the importance of multi-marker, functional analyses within Mφ subsets and the advantages of the ex vivo NSCLC explant model in immunomodulation studies. We highlight the plasticity of the M1/M2 phenotype using the explant model and provide a tool for studying therapeutic interventions designed to reprogram M2-like Mφ-induced immunosuppression.