Dilemmas of Representation, Citizenship, and Semi-Citizenship

This Article takes up the question of “who counts?” with a three-part argument. The first part of the argument makes the case that citizenship in liberal democracies is subject to stresses caused by internal doctrinal conflict that result in the creation of semi-citizenship statuses that offer some individuals partial bundles of rights and semi-citizen statuses. Semi-citizenship is inevitable. The second part of the argument looks closely at how this affects the distribution of the political rights of citizenship: voting and representation. I make the argument that we ought not conflate voting and representation. Each is a distinct political right. People who cannot vote or do not vote are not necessarily entirely unrepresented. This is particularly evident if one takes seriously the trustee model of representation. The third part of the Article compares three different cases of semi-citizenship in which groups who are counted for the purposes of the census and legislative apportionment are not accorded the vote. I examine the cases of children, non-citizens, and felons, briefly illustrating how and why trusteeship serves the first two groups and fails the third. These conclusions bolster the case for treating trusteeship as a necessary component of a liberal democratic state and for treating it skeptically in circumstances in which the trusteeship is not clearly linked to the political capabilities of the population in question

A systematic review and critical appraisal of quality indicators to assess optimal palliative care for older people with dementia

© The Author(s) 2019Background: A challenge for commissioners and providers of end-of-life care in dementia is to translate recommendations for good or effective care into quality indicators that inform service development and evaluation. Aim: To identify and critically evaluate quality indicators for end-of-life care in dementia. Results: We found 8657 references, after de-duplication. In all, 19 publications describing 10 new and 3 updated sets of indicators were included in this review. Ultimately, 246 individual indicators were identified as being relevant to dementia end-of-life care and mapped against EAPC guidelines. Conclusions: We systematically derived and assessed a set of quality indicators using a robust framework that provides clear definitions of aspects of palliative care, which are dementia specific, and strengthens the theoretical underpinning of new complex interventions in end-of-life care in dementia.Peer reviewedFinal Published versio

Dietary Patterns and their Association with Hypertension Among Pakistani Urban Adults

Hypertension is one of the most common chronic diseases affecting more than 25% of adults worldwide. In Pakistan, 33% of the adult population suffers from hypertension. Numerous epidemiological studies have demonstrated the critical role of dietary patterns in the causation, prevention and management of hypertension. There’s a dearth of evidence from South Asia in this regard. The present study aimed to identify the association between dietary patterns and hypertension among 4304 low income urban adults who participated in the Control of Blood Pressure and Risk Attenuation (COBRA) study in Karachi, Pakistan. Dietary information was collected by a 33- item food frequency questionnaire and 3 unique dietary patterns namely; fat and sweet, fruit and vegetable, and seafood and yogurt patterns were derived using principal component factor analyses. We used univariate and multivariable logistic regression to examine the association between dietary patterns and hypertension. Men were more likely to have hypertension, while increase in age, and body mass index were also associated with hypertension (p\u3c0.001). After adjusting for age, gender, education, marital status, body mass index, and tobacco use; the seafood and yogurt pattern was less likely (OR=0.78: 95% CI: 0.63, 0.98; p-value 0.03) to be associated with hypertension, whereas no significant associations were seen for other two dietary patterns. These findings suggest that certain dietary patterns may be associated with hypertension among Pakistani low income urban adults

Do Dietary Patterns Explain High Prevalence of Cardiovascular Risk Factors Among Pakistani Urban Adults? A Cross-Sectional Study

Background The prevalence of cardiovascular disease (CVD) in South Asia is higher than in any other developing countries. The diversity of diets in populations among developing countries may be one explanation for the differences in CVD. This study was carried out to explore the association between dietary patterns and the presence of cardiovascular risk factors among Pakistani low income urban adults. Methods Socio demographic, physical activity and dietary information was collected from 1546 Pakistani subjects aged ≥40 years from the Control of Hypertension and Risk Attenuation (COBRA) study. Anthropometric, clinical and biomarker measures were assessed. Cluster analysis was used to identify dietary patterns from a food frequency questionnaire (FFQ) and multinomial regression was employed to investigate the association between dietary clusters and cardiovascular risk factors, using one of the dietary clusters as a reference category. Results The most prevalent CVD risk factors among participants were elevated low density lipoprotein- cholesterol (LDL-C) (69.8 %) and systolic blood pressure (SBP) (68.2 %), followed by central obesity (57.1 %), low levels of high density lipoprotein-Cholesterol (HDL-C) (56.3 %), overall obesity (46.0 %), high total cholesterol (32.3 %), and elevated fasting blood sugar (FBS) (34.9 %). The cluster analysis generated 3 non-overlapping diet patterns. Cluster 1(Traditional Pakistani Diet), was dominated by fruits, vegetables, milk products and chicken, included participants with high mean body mass index (BMI), waist circumference (WC), HDL-C and low mean SBP. Cluster 2 (Moderate Diet) reflected a moderate intake of most food items and included participants with significantly higher mean SBP. Cluster 3 (Fatty Diet) was characterized by high intake of beef, whole milk, paratha and lentils and those following this cluster had a low mean HDL-C and high SBP. In analyses controlling for age, gender, tobacco use and physical activity, participants in the Traditional diet cluster were more likely to be overweight (OR 1.39, 95 % CI 1.08 to 1.78) and high central adiposity (1.33, 95 % CI 1.04 to 1.71) than participants in the Moderate diet cluster, though less likely to have elevated SBP (OR 0.67, 95 % CI 0.51 to 0.86). LDL-C levels were higher in both the traditional Pakistani diet and Fatty diet cluster compared to the Moderate diet cluster. Low HDL-C was also more prevalent among the Traditional Pakistani diet cluster. Conclusion Among Pakistani population discernable diet patterns can be derived using clusters analysis. CVD risk factors prevalence differed by cluster membership, though relations for specific CVD risk are not consistent across clusters

Advancing Team Cohesion: Using an Escape Room as a Novel Approach

Objective: An escape room was used to study teamwork and its determinants, which have been found to relate to the quality and safety of patient care delivery. This pilot study aimed to explore the value of an escape room as a mechanism for improving cohesion among interdisciplinary healthcare teams. Methods: This research was conducted at a nonprofit medical center in Southern California. All participants who work on a team were invited to participate. Authors employed an interrupted within-subjects design, with two pre- and post- escape room questionnaires related to two facets of group cohesion: (belonging – (PGC-B) and morale (PGC-M)). Participants rated their perceptions of group cohesion before, after, and one-month after the escape room. The main outcome measures included PGC-B/M. Results: Sixty-two teams participated (n 280 participants) of which 31 teams (50%) successfully “escaped” in the allotted 45 minutes. There was a statistically significant difference in PGC between the three time periods, F(4, 254) 24.10, p \u3c .001; Wilks’ K .725; partial g2 .275. Results indicated significantly higher scores for PGC immediately after the escape room and at the one-month follow-up compared to baseline. Conclusions: This work offers insights into the utility of using an escape room as a team building intervention in interprofessional healthcare teams. Considering the modifiability of escape rooms, they may function as valuable team building mechanisms in healthcare. More work is needed to determine how escape rooms compare to more traditional team building curriculums

Loss of the <i>Arabidopsis thaliana</i> P4-ATPases ALA6 and ALA7 impairs pollen fitness and alters the pollen tube plasma membrane

Members of the P4 subfamily of P-type ATPases are thought to create and maintain lipid asymmetry in biological membranes by flipping specific lipids between membrane leaflets. In Arabidopsis, 7 of the 12 Aminophospholipid ATPase (ALA) family members are expressed in pollen. Here we show that double knockout of ALA6 and ALA7 (ala6/7) results in siliques with a ~2-fold reduction in seed set with a high frequency of empty seed positions near the bottom. Seed set was reduced to near zero when plants were grown under a hot/cold temperature stress. Reciprocal crosses indicate that the ala6/7 reproductive deficiencies are due to a defect related to pollen transmission. In-vitro growth assays provide evidence that that ala6/7 pollen tubes are short and slow, with ~2-fold reductions in both maximal growth rate and overall length relative to wild-type. Outcrosses show that when ala6/7 pollen are in competition with wild-type pollen, they have a near 0% success rate in fertilizing ovules near the bottom of the pistil, consistent with ala6/7 pollen having short and slow growth defects. The ala6/7 phenotypes were rescued by the expression of either an ALA6-YFP or GFP-ALA6 fusion protein, which showed localization to both the plasma membrane and highly-mobile endomembrane structures. A mass spectrometry analysis of mature pollen grains revealed significant differences between ala6/7 and wild-type, both in the relative abundance of lipid classes and in the average number of double bonds present in acyl side chains. A change in the properties of the ala6/7 plasma membrane was also indicated by a ~10-fold reduction of labeling by lipophilic FM-dyes relative to wild-type. Together, these results indicate that ALA6 and ALA7 provide redundant activities that function to directly or indirectly change the distribution and abundance lipids in pollen, and support a model in which ALA6 and ALA7 are critical for pollen fitness under normal and temperature-stress conditions

Physical function and associations with diet and exercise: Results of a cross-sectional survey among elders with breast or prostate cancer

BACKGROUND: Functional decline threatens independent living and is common among individuals diagnosed with cancer, especially those who are elderly. The purpose of this study was to explore whether dietary and exercise practices are associated with physical function status among older cancer survivors. METHODS: Mailed surveys were used to ascertain data on physical function, dietary fat, fruit and vegetable (F&V) consumption, and exercise among elderly diagnosed with early stage (I-II) breast (N = 286) or prostate cancer (N = 402) within the past 18 months. RESULTS: Sixty-one percent of respondents reported diets with <30% of energy from fat, 20.4% reported F&V intakes of 5+ daily servings, and 44.6% reported regular vigorous exercise. Significant, independent associations were found between physical functioning and reported dietary fat intake, F&V consumption, and exercise. A simultaneous multiple regression model controlled for age, race, gender, time since diagnosis and concurrent health behaviors yielded the following estimates: (1) 0.2 increase in the SF-36 physical function subscale (PFS) score with each reported 1% decrease in percent energy from fat (p < .0001); (2) 0.9 increase in the SF-36 PFS score for each reported serving of F&V/day (p = .0049); and (3) 15.4 increase in the SF-36 PFS score with a positive response for regular vigorous exercise (p < .0001). CONCLUSIONS: Results of this cross-sectional survey suggest that regular vigorous exercise and consumption of diets low in fat and rich in F&Vs are associated with higher levels of physical functioning among older cancer survivors. Interventions that promote healthful lifestyle change may deliver considerable benefit within this ever increasing and vulnerable population

A Phase I Randomized Placebo Controlled Trial of the Safety of 3% SPL7013 Gel (VivaGel®) in Healthy Young Women Administered Twice Daily for 14 Days

To assess the safety of VivaGel® used vaginally twice daily for 14 days among healthy, sexually-abstinent women, aged 18-24 years in the USA and Kenya.Randomized placebo controlled trial.Participants were randomized 2∶1, VivaGel to placebo. Safety was assessed by comparing genitourinary (GU) adverse events (AEs), colposcopy findings, vaginal lactobacilli and laboratory abnormalities by arm.Fifty-four women were enrolled; 35 in the VivaGel arm and 19 in the placebo arm. Twenty-six (74%) and 10 (53%) women reported taking all doses of VivaGel and placebo, respectively. No grade 3 or 4 AEs, or serious AEs occurred. Twenty-five (71%) participants in the VivaGel arm compared to 10 (53%) participants in the placebo arm had at least one grade 1 or 2 GU AE associated with product use (RR = 1.4, 95% CI 0.8-2.2). All seven grade 2 GU AEs associated with product use occurred among four women in the VivaGel arm. Vulvar and cervical erythema, cervical lesions, symptomatic BV, urinary frequency and metrorrhagia were more common in the VivaGel arm than the placebo arm. Twenty-nine (83%) participants in the VivaGel arm had a colposcopic finding compared to 10 (53%) participants in the placebo arm (RR = 1.6, 95%CI = 1.0-2.5). Two women in the VivaGel arm prematurely discontinued product use themselves due to a reported GU AE. Persistence of H₂O₂-producing and non-producing lactobacilli did not differ by study arm.GU AEs and colposcopic findings consistent with mild epithelial irritation and inflammation occurred more commonly among women in the VivaGel arm.ClinicalTrials.gov NCT003311032

On the structure of large N cancellations in baryon chiral perturbation theory

We show how to compute loop graphs in heavy baryon chiral perturbation theory including the full functional dependence on the ratio of the Delta--nucleon mass difference to the pion mass, while at the same time automatically incorporating the 1/N cancellations that follow from the large-N spin-flavor symmetry of baryons in QCD. The one-loop renormalization of the baryon axial vector current is studied to demonstrate the procedure. A new cancellation is identified in the one-loop contribution to the baryon axial vector current. We show that loop corrections to the axial vector currents are exceptionally sensitive to deviations of the ratios of baryon-pion axial couplings from SU(6) values