Lake St. Martin First Nation Community Members’ Experiences of Induced Displacement: “We’re like refugees”

In 2011, a massive flood occurred in the Canadian province of Manitoba, and provincial government officials decided to divert water to Lake St. Martin and First Nation land to protect urban, cottage, and agricultural properties. As a result of this artificial flood, all community members were evacuated, with infrastructures and housing at Lake St. Martin First Nation permanently destroyed. Three years later, 1,064 Lake St. Martin First Nation members reside in urban hotels and other temporary residences. Data from participatory videography and community workshops were analyzed using the sustainable livelihoods framework. Environmentally and developmentally induced displacement transformed an entire First Nation community into refugees in their homeland. Jurisdictional issues and racism prevented provisioning of services to meet their basic needs, help rebuild their lives, and relocate their community. Inclusive evacuation, relocation, and water-management policies and procedures are recommended.En 2011 a eu lieu une importante inondation dans la province canadienne du Manitoba. Les fonctionnaires du gouvernement provincial ont décidé de détourner les eaux vers le lac St-Martin et les terres des premières nations afin de protéger les propriétés urbaines, rurales et agricoles. En conséquence de cette inondation artificielle, tous les membres de la communauté ont été évacués, et les infrastructures et les habitations de la communauté autochtone du lac St-Martin ont été détruites de façon permanente. Trois ans plus tard, 1064 membres de la communauté autochtone du lac St-Martin habitent dans des hôtels urbains et d’autres habitations temporaires. Nous avons analysé les données de vidéographies participatives et des ateliers communautaires à l’aide d’une grille de moyen de subsistance durable. Les déplacements environnementaux et développementaux ont transformé toute une communauté autochtone en refugiés dans leur propre région. Des questions de juridictions et de racisme empêchent de fournir les services de base, d’aider à la reconstruction de leur vie, et de réinstaller leur communauté. Des évacuations inclusives, des déménagements, et des politiques et des procédures de gestion de l’eau sont recommandées

Improving the quality of life of care home residents with dementia: cost-effectiveness of an optimized intervention for residents with clinically significant agitation in dementia

Introduction: To examine whether an optimized intervention is a more cost-effective option than treatment as usual (TAU) for improving agitation and quality of life in nursing home residents with clinically significant agitation and dementia. Methods: A cost-effectiveness analysis within a cluster-randomized factorial study in 69 care homes with 549 residents was conducted. Each cluster was randomized to receive either the Well-being and Health for people with Dementia (WHELD) intervention or TAU for nine months. Health and social care costs, agitation, and quality of life outcomes were evaluated. Results: Improvements in agitation and quality of life were evident in residents allocated to the WHELD intervention group. The additional cost of the WHELD intervention was offset by the higher health and social care costs incurred by TAU group residents (mean difference, £2103; 95% confidence interval, −13 to 4219). Discussion: The WHELD intervention has clinical and economic benefits when used in residents with clinically significant agitation

Apathy and its response to antipsychotic review and non-pharmacological interventions in people with dementia living in nursing homes : WHELD, A factorial cluster randomised controlled trial

Objectives: Apathy is common, impactful, and difficult to manage in people with dementia. We evaluated the efficacy of non-pharmacological interventions, exercise and social interaction, in combination with antipsychotic review, to reduce apathy in people with dementia living in nursing homes in a cluster randomised controlled trial (RCT). Methods: Well-being and health for people with dementia (WHELD) programme included a 2X2X2 factorial cluster RCT involving people with dementia living in 16 nursing homes in UK. All homes received training in person-centred care, and were randomised to receive antipsychotic review, social interaction, and exercise, either alone or in combinations. Apathy was one of the secondary outcomes of the WHELD trial, and it was measured by the Neuropsychiatric Inventory-nursing home version at baseline and nine months (N=273). We employed multilevel mixed effects linear regression models to assess the impact of the interventions on apathy. Results: Prevalence of apathy was 44.0% (n=120; 95% CI 38.1-49.9%) at baseline. Severity of apathy had significant positive correlations with dementia severity, neuropsychiatric symptoms, depressive symptoms, agitation, and the needs of the people with dementia (p<0.001). Antipsychotic review reduced antipsychotic use, but it significantly increased apathy (β=5.37; SE=0.91; p<0.001). However, antipsychotic review in combination with either social interaction (β=-5.84; SE=1.15; p<0.001) or exercise (β=-7.54; SE=0.93; p<0.001) significantly reduced apathy. Conclusions: Antipsychotic review can play a significant role in improving apathy in people with dementia living in nursing homes, when combined with psychosocial interventions such as social interaction and exercise. Guidance must be adapted to reflect this subtlety in care

Black Professional Women in Predominately White Universities

White colleagues, looking through the singular Black female before them, maintain perceptions based on stereotypes or past dealings with other Black women

Cost-Effectiveness of an Online Intervention for Caregivers of People Living With Dementia

OBJECTIVES: Little evidence exists on costs or cost-effectiveness of online interventions for caregivers of people living with dementia. We aimed to assess cost-effectiveness of online cognitive behavioral therapy (CBT) for dementia caregivers with mild-to-moderate depression/anxiety, with or without telephone support, relative to a psychoeducational control treatment. DESIGN: Cost-effectiveness study of data from 3-armed randomized controlled trial comparing computerized CBT (cCBT) or telephone-supported cCBT (cCBT+Telephone) to modular online educational program on dementia (Psychoeducation). SETTING AND PARTICIPANTS: UK-resident adult dementia caregivers with mild-to-moderate anxiety/depression. COST-EFFECTIVENESS ANALYSIS: We calculated health and social care costs, from participant-reported data collected at baseline, 12, 26 weeks, costs of intervention delivery. We examined 3 outcomes: cost of one-point reduction in General Health Questionnaire-12 (GHQ-12) rating at 26-weeks, cost of prevented "caseness" on GHQ-12 at 26 weeks, and cost per quality-adjusted life year (QALY) based on Short Form-6 Dimensions (SF-6D) over 26 weeks. RESULTS: Data from 176 participants (44 cCBT, 91 cCBT+Telephone, 41 Psychoeducation) were analyzed. Costs did not differ between cCBT and Psychoeducation; costs were £125 higher in cCBT+Telephone. Control and intervention groups did not differ on GHQ-12. Caseness was lower in cCBT+Telephone than Psychoeducation; cost of preventing a case was £610, and probability of cost-effectiveness on this outcome reached 98.5% at willingness to pay (WTP) of £12,900. Mean QALY did not differ between cCBT+Telephone and Psychoeducation. QALY gain in cCBT was 0.01 (95% CI 0.001, 0.021). Cost per QALY was £8130. Although base case probability of cost-effectiveness of cCBT was 93% at WTP-per-QALY of £27,600, sensitivity analyses suggested cCBT+Telephone was the more cost-effective. CONCLUSIONS AND IMPLICATIONS: We report preliminary evidence for adopting telephone-supported online CBT. This may be cost-effective in preventing a case of mental health disorder if, absent a societally accepted WTP threshold for this outcome, payers are willing to pay £12,900. Future research should investigate whether supported/unsupported online CBT improves health-related quality of life

Bathymetric Artifacts in Sea Beam Data: How to Recognize Them and What Causes Them

Sea Beam multibeam bathymetric data have greatly advanced understanding of the deep seafloor. However, several types of bathymetric artifacts have been identified in Sea Beam\u27s contoured output. Surveys with many overlapping swaths and digital recording on magnetic tape of Sea Beam\u27s 16 acoustic returns made it possible to evaluate actual system performance. The artifacts are not due to the contouring algorithm used. Rather, they result from errors in echo detection and processing. These errors are due to internal factors such as side lobe interference, bottom-tracking gate malfunctions, or external interference from other sound sources (e.g., 3.5 kHz echo sounders or seismic sound sources). Although many artifacts are obviously spurious and would be disregarded, some (particularly the omega effects described in this paper) are more subtle and could mislead the unwary observer. Artifacts observed could be mistaken for volcanic constructs, abyssal hill trends, hydrothermal mounds, slump blocks, or channels and could seriously affect volcanic, tectonic, or sedimentological interpretations. Misinterpretation of these artifacts may result in positioning errors when seafloor bathymetry is used to navigate the ship. Considering these possible geological misinterpretations, a clear understanding of the Sea Beam system\u27s capabilities and limitations is deemed essential

Advancing Community Engaged Approaches to Identifying Structural Drivers of Racial Bias in Health Diagnostic Algorithms

Much attention and concern has been raised recently about bias and the use of machine learning algorithms in healthcare, especially as it relates to perpetuating racial discrimination and health disparities. Following an initial system dynamics workshop at the Data for Black Lives II conference hosted at MIT in January of 2019, a group of conference participants interested in building capabilities to use system dynamics to understand complex societal issues convened monthly to explore issues related to racial bias in AI and implications for health disparities through qualitative and simulation modeling. In this paper we present results and insights from the modeling process and highlight the importance of centering the discussion of data and healthcare on people and their experiences with healthcare and science, and recognizing the societal context where the algorithm is operating. Collective memory of community trauma, through deaths attributed to poor healthcare, and negative experiences with healthcare are endogenous drivers of seeking treatment and experiencing effective care, which impact the availability and quality of data for algorithms. These drivers have drastically disparate initial conditions for different racial groups and point to limited impact of focusing solely on improving diagnostic algorithms for achieving better health outcomes for some groups.Comment: 2020 International System Dynamics Conference, Honorable Mention Award, 28 pages, 8 figure

Health professionals, their medical interventions and uncertainty : a study focusing on women at midlife

Health professionals face a tension between focusing on the individual and attending to health issues for the population as a whole. This tension is intrinsic to medicine and gives rise to medical uncertainty, which here is explored through accounts of three medical interventions focused on women at midlife: breast screening, hormone replacement therapy and bone densitometry. The accounts come from interviews with UK health professionals using these medical interventions in their daily work. Drawing on the analysis of Fox [(2002). Health and Healing: The public/private divide (pp. 236–253). London: Routledge] we distinguish three aspects of medical uncertainty and explore each one of them in relation to one of the interventions. First is uncertainty about the balance between the individual and distributive ethic of medicine, explored in relation to breast screening. Second is the dilemma faced by health professionals when using medicial evidence generated through studies of populations and applying this to individuals. We explore this dilemma for hormone replacement therapy. Thirdly there is uncertainty because of the lack of a conceptual framework for understanding how new micro knowledge, such as human genetic information, can be combined with knowledge of other biological and social dimensions of health. The accounts from the bone denistometry clinic indicate the beginnings of an understanding of the need for such a framework, which would acknowledge complexity, recognising that factors from many different levels of analysis, from heredity through to social factors, interact with each other and influence the individual and their health. However, our analysis suggests biomedicine continues to be dominated by an individualised, context free, concept of health and health risk with individuals alone responsible for their own health and for the health of the population. This may continue to dominate how we perceive responsibilities for health until we establish a conceptual framework that recognises the complex interaction of many factors at macro and micro level affecting health

Early life sensory ability—ventilatory responses of thornback ray embryos (Raja clavata) to predator-type electric fields

Predator avoidance is fundamental for survival and it can be particularly challenging for prey animals if physical movement away from a predatory threat is restricted. Many sharks and rays begin life within an egg capsule that is attached to the sea bed. The vulnerability of this sedentary life stage is exacerbated in skates (Rajidae) as the compulsory ventilatory activity of embryos makes them conspicuous to potential predators. Embryos can reduce this risk by mediating ventilatory activity if they detect the presence of a predator using an acute electrosense. To determine how early in embryonic life predator elicited behavioral responses can occur, the reactions of three different age groups (1/3 developed, 2/3 developed, and near hatching) of embryonic thornback rays Raja clavata were tested using predator-type electric field stimuli. Egg capsules were exposed to continuous or intermittent stimuli in order to assess varying predator-type encounter scenarios on the ventilatory behavior of different developmental stages. All embryos reacted with a “freeze response” following initial electric field (E-field) exposure, ceasing ventilatory behavior in response to predator presence, demonstrating electroreceptive functionality for the first time at the earliest possible stage in ontogeny. This ability coincided with the onset of egg ventilatory behavior and may represent an effective means to enhance survival. A continuous application of stimuli over time revealed that embryos can adapt their behavior and resume normal activity, whereas when presented intermittently, the E-field resulted in a significant reduction in overall ventilatory activity across all ages. Recovery from stimuli was significantly quicker in older embryos, potentially indicative of the trade-off between avoiding predation and adequate respiration. © 2015 Wiley Periodicals, Inc. Develop Neurobiol 76: 721–729, 201

High-resolution underwater robotic vision-based mapping and three-dimensional reconstruction for archaeology

Documenting underwater archaeological sites is an extremely challenging problem. Sites covering large areas are particularly daunting for traditional techniques. In this paper, we present a novel approach to this problem using both an autonomous underwater vehicle (AUV) and a diver-controlled stereo imaging platform to document the submerged Bronze Age city at Pavlopetri, Greece. The result is a three-dimensional (3D) reconstruction covering 26,600 m2 at a resolution of 2 mm/pixel, the largest-scale underwater optical 3D map, at such a resolution, in the world to date. We discuss the advances necessary to achieve this result, including i) an approach to color correct large numbers of images at varying altitudes and over varying bottom types; ii) a large-scale bundle adjustment framework that is capable of handling upward of 400,000 stereo images; and iii) a novel approach to the registration and rapid documentation of an underwater excavations area that can quickly produce maps of site change. We present visual and quantitative comparisons to the authors' previous underwater mapping approaches