Latin America and the Debate Over Environmental Protection and National Security

DRMI Working Paper SeriesThe series is intended to convey the preliminary results of [DRMI] ongoing research. The research described in these papers is preliminary and has not completed the usual review process for Institute publications. We welcome feedback from readers and encourage you to convey your comments and criticisms directly to the authors

Person focused directives for end of life care in long term care (PFD-LTC)

Dementias are age-related, neurodegenerative diseases, the cases of which are expected to rise exponentially as the population ages. To date there is no known cure or intervention that appreciably slows the progression of disease. One in ten Ontarians aged 65 and older is currently living with a dementia, and many of them will move into long term care (LTC) as the disease progresses. Advance care planning (ACP) can extend a person’s wishes concerning health care decisions in the event they lose capacity. ACP is especially relevant for LTC residents with dementia because of the resulting cognitive decline, poor health outcomes, and eventual loss of the ability to communicate. To meet its intended goals, ACP needs to be informed and documented using unambiguous language. ACP documentation too often does not meet this standard, and can vary considerably between facilities. LTC residents dying with dementia may be particularly vulnerable to not having their wishes known or honoured. Little is known about how variability in ACP documentation can affect patient care at the end of life (EOL), or whether the presence or absence of dementia presents an added risk for having insufficient ACP. Study One investigated variability in ACP documentation between facilities and compared existing local documents to best practice principles for documenting ACP. Study Two gathered information on the experiences and perceptions of care providers who work with older adults regarding ACP documents, and their opinions on introducing a common language to ACP documentation across facilities. Study Three utilised generalised linear mixed modeling (GLMM) to investigate whether ACP documentation would equate to differences in the EOL care received by residents of LTC across the province of Ontario, and whether the presence or absence of dementia would play a role in end of life decision making (i.e., place of death). Province-wide data from LTC residents who entered and died in LTC over one census year with a thirteen month follow-up was analysed for relationships between place of death and documentation related to ACP

The Role of personality on decision making under uncertainty

Dispositional characteristics appear to impact peoples' decision making when faced with situations characterised by uncertainty, a characterization of an unknown future outcome, and ambiguity, a characterisation of the present situation where multiple possibilities exist. There is a paucity of decision making research of an applied nature which limits the application of theory to practice. This study investigated the role of dispositional reactions to uncertainty in decision making in an applied medical setting by integrating theory and research findings from traditional economics and emerging cognitive and personality psychology models. We examined the relationship and predictive power of emergency physicians' affective and dispositional reactions to uncertainty and propensity for risk taking in clinical situations when deciding to admit a patient or release them home. Patients who present in the Emergency Department do so with a range of medical complaints, each with a different degree of risk and ambiguity. These properties of the patient/physician encounter were hypothesized to impact individual physicians differently, depending on the physician's trait and state reactions to uncertainty and propensity for risk taking. Specifically, it was hypothesized that Emergency Physicians' admission and discharge decisions and length of time required to arrive at a decision would be impacted by the physician's unique personality features and the degree of ambiguity and risk inherent in the patient's condition. Emergency physicians' dispositional characteristics were not found to playa significant role in the decision to admit patients. Limitations and directions for future research are discussed

Religious Coping and Spiritual Struggle Among Emergency Room Patients With Suicidal Intent

Previous literature has shown religion and spirituality to be protective factors for depressive symptoms and suicidal ideation, and that spiritual struggle is associated with increases in suicidal ideation. However, in some cases, positive religious coping may also be associated with risk factors for suicidality. The present study explored aspects of spiritual struggle or religious coping that were spontaneously offered and noted in a medical record during a standard emergency room risk assessment involving the Collaborative Assessment and Management of Suicidality (CAMS). Among 839 archival records from emergency department settings in Yamhill County, Oregon, in 2015 and 2016, only 36 interviews met criteria. It was hypothesized that those with expressed spiritual or religious struggle would indicate a higher risk for suicide through self-report compared with those who express positive religious coping. The current study found no association between self-report of suicidal intent severity and style of spiritual or religious coping, perhaps in part because the number of interviews that met criteria were far fewer than expected. Several possible explanations are considered

Wealth Building in Rural America: Programs, Policies, Research

Wealth Building in Rural America: Programs, Policies, Researc

Biomarkers as Common Data Elements for Symptom and Selfâ Management Science

PurposeBiomarkers as common data elements (CDEs) are important for the characterization of biobehavioral symptoms given that once a biologic moderator or mediator is identified, biologically based strategies can be investigated for treatment efforts. Just as a symptom inventory reflects a symptom experience, a biomarker is an indicator of the symptom, though not the symptom per se. The purposes of this position paper are to (a) identify a â minimum setâ of biomarkers for consideration as CDEs in symptom and selfâ management science, specifically biochemical biomarkers; (b) evaluate the benefits and limitations of such a limited array of biomarkers with implications for symptom science; (c) propose a strategy for the collection of the endorsed minimum set of biologic samples to be employed as CDEs for symptom science; and (d) conceptualize this minimum set of biomarkers consistent with National Institute of Nursing Research (NINR) symptoms of fatigue, depression, cognition, pain, and sleep disturbance.Design and MethodsFrom May 2016 through January 2017, a working group consisting of a subset of the Directors of the NINR Centers of Excellence funded by P20 or P30 mechanisms and NINR staff met bimonthly via telephone to develop this position paper suggesting the addition of biomarkers as CDEs. The full group of Directors reviewed drafts, provided critiques and suggestions, recommended the minimum set of biomarkers, and approved the completed document. Best practices for selecting, identifying, and using biological CDEs as well as challenges to the use of biological CDEs for symptom and selfâ management science are described. Current platforms for sample outcome sharing are presented. Finally, biological CDEs for symptom and selfâ management science are proposed along with implications for future research and use of CDEs in these areas.FindingsThe recommended minimum set of biomarker CDEs include proâ and antiâ inflammatory cytokines, a hypothalamicâ pituitaryâ adrenal axis marker, cortisol, the neuropeptide brainâ derived neurotrophic factor, and DNA polymorphisms.ConclusionsIt is anticipated that this minimum set of biomarker CDEs will be refined as knowledge regarding biologic mechanisms underlying symptom and selfâ management science further develop. The incorporation of biological CDEs may provide insights into mechanisms of symptoms, effectiveness of proposed interventions, and applicability of chosen theoretical frameworks. Similarly, as for the previously suggested NINR CDEs for behavioral symptoms and selfâ management of chronic conditions, biological CDEs offer the potential for collaborative efforts that will strengthen symptom and selfâ management science.Clinical RelevanceThe use of biomarker CDEs in biobehavioral symptoms research will facilitate the reproducibility and generalizability of research findings and benefit symptom and selfâ management science.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143764/1/jnu12378.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143764/2/jnu12378_am.pd

Assessment of a Program for SARS-CoV-2 Screening and Environmental Monitoring in an Urban Public School District

Importance: Scalable programs for school-based SARS-CoV-2 testing and surveillance are needed to guide in-person learning practices and inform risk assessments in kindergarten through 12th grade settings. Objectives: To characterize SARS-CoV-2 infections in staff and students in an urban public school setting and evaluate test-based strategies to support ongoing risk assessment and mitigation for kindergarten through 12th grade in-person learning. Design, Setting, and Participants: This pilot quality improvement program engaged 3 schools in Omaha, Nebraska, for weekly saliva polymerase chain reaction testing of staff and students participating in in-person learning over a 5-week period from November 9 to December 11, 2020. Wastewater, air, and surface samples were collected weekly and tested for SARS-CoV-2 RNA to evaluate surrogacy for case detection and interrogate transmission risk of in-building activities. Main Outcomes and Measures: SARS-CoV-2 detection in saliva and environmental samples and risk factors for SARS-CoV-2 infection. Results: A total of 2885 supervised, self-collected saliva samples were tested from 458 asymptomatic staff members (mean [SD] age, 42.9 [12.4] years; 303 women [66.2%]; 25 Black or African American [5.5%], 83 Hispanic [18.1%], 312 White [68.1%], and 35 other or not provided [7.6%]) and 315 students (mean age, 14.2 [0.7] years; 151 female students [48%]; 20 Black or African American [6.3%], 201 Hispanic [63.8%], 75 White [23.8%], and 19 other race or not provided [6.0%]). A total of 46 cases of SARS-CoV-2 (22 students and 24 staff members) were detected, representing an increase in cumulative case detection rates from 1.2% (12 of 1000) to 7.0% (70 of 1000) among students and from 2.1% (21 of 1000) to 5.3% (53 of 1000) among staff compared with conventional reporting mechanisms during the pilot period. SARS-CoV-2 RNA was detected in wastewater samples from all pilot schools as well as in air samples collected from 2 choir rooms. Sequencing of 21 viral genomes in saliva specimens demonstrated minimal clustering associated with 1 school. Geographical analysis of SARS-CoV-2 cases reported district-wide demonstrated higher community risk in zip codes proximal to the pilot schools. Conclusions and Relevance: In this study of staff and students in 3 urban public schools in Omaha, Nebraska, weekly screening of asymptomatic staff and students by saliva polymerase chain reaction testing was associated with increased SARS-CoV-2 case detection, exceeding infection rates reported at the county level. Experiences differed among schools, and virus sequencing and geographical analyses suggested a dynamic interplay of school-based and community-derived transmission risk. Collectively, these findings provide insight into the performance and community value of test-based SARS-CoV-2 screening and surveillance strategies in the kindergarten through 12th grade educational setting

Chromosomes 4 and 8 implicated in a genome wide SNP linkage scan of 762 prostate cancer families collected by the ICPCG

BACKGROUND In spite of intensive efforts, understanding of the genetic aspects of familial prostate cancer (PC) remains largely incomplete. In a previous microsatellite‐based linkage scan of 1,233 PC families, we identified suggestive evidence for linkage (i.e., LOD ≥ 1.86) at 5q12, 15q11, 17q21, 22q12, and two loci on 8p, with additional regions implicated in subsets of families defined by age at diagnosis, disease aggressiveness, or number of affected members. METHODS In an attempt to replicate these findings and increase linkage resolution, we used the Illumina 6000 SNP linkage panel to perform a genome‐wide linkage scan of an independent set of 762 multiplex PC families, collected by 11 International Consortium for Prostate Cancer Genetics (ICPCG) groups. RESULTS Of the regions identified previously, modest evidence of replication was observed only on the short arm of chromosome 8, where HLOD scores of 1.63 and 3.60 were observed in the complete set of families and families with young average age at diagnosis, respectively. The most significant linkage signals found in the complete set of families were observed across a broad, 37 cM interval on 4q13–25, with LOD scores ranging from 2.02 to 2.62, increasing to 4.50 in families with older average age at diagnosis. In families with multiple cases presenting with more aggressive disease, LOD scores over 3.0 were observed at 8q24 in the vicinity of previously identified common PC risk variants, as well as MYC , an important gene in PC biology. CONCLUSIONS These results will be useful in prioritizing future susceptibility gene discovery efforts in this common cancer. Prostate 72:410–426, 2012. © 2011 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90245/1/21443_ftp.pd