Promoting appreciation of cultural diversity and inclusion with the Stephanie Alexander Kitchen garden program

Purpose – The purpose of this paper is to present emergent findings from an evaluation of the Stephanie Alexander Kitchen Garden (SAKG) Program showing that the program promoted appreciation of cultural diversity and inclusion of culturally diverse groups. Design/methodology/approach – The findings reported here are from the qualitative component of a mixed-method, nonrandomized, pre- and post-comparison evaluation study. Focus groups and interviews were held with school principals, teachers, program specialist staff, parents, volunteers and children at the program schools. Findings – In a culturally diverse school, the program enhanced the school’s capacity to engage and include children and families from migrant backgrounds. In less diverse settings, the program provided opportunities for schools to teach children about cultural diversity. Research limitations/implications – Assessing the program’s impact on multicultural education was not a specific objective of this study, rather these findings emerged as an unanticipated outcome during interviews and focus groups that explored participants’ views on important changes to schools associated with the program. Thus, the quantitative component of the evaluation did not assess the extent of this program impact and further research is recommended. Practical implications – The program may have particular value in culturally diverse schools, providing benefits in terms of engagement of children and families and potentially, in the longer term, associated improvements in learning outcomes. Social implications – These findings suggest that the program can help to promote social equity and inclusion for culturally diverse groups. Originality/value – This paper highlights critical equity implications associated with school-based programs’ capacity to include culturally and linguistically diverse groups

Mental health services for children and adolescents with learning disabilities: a review of research on experiences of service users and providers

Background: Children and young people with learning disabilities experience high rates of mental health problems. Methods: The present study reviewed the literature on mental health services for children with learning disabilities, to identify known models of service provision and what has been experienced as effective or challenging in providing good services. Results: Children with learning disabilities and their parents experience barriers accessing mental health services that are related to a lack of information and perceptions of services as being inadequate. Service providers identified a lack of resources as a barrier to meeting needs. Although positive experiences are also observed, many parents have found services to be inappropriate or overwhelming. Conclusion: Research linking population need to available resources, and service models to services users’ outcomes would be valuable to make clear recommendations on how mental health services can address the needs of this group more effectively

A mixed methods impact and ouotcome research study

To explore and identify the impact of Learning Disability Liaison Nursing (LDLN) Services in NHS Lothian, Forth Valley, Borders and Fife on the healthcare experiences of people with a learning disability attending for general hospital care

Learning Disability Liaising Nursing Services in South East Scotland: A mixed methods impact and outcome research study

To explore and identify the impact of Learning Disability Liaison Nursing (LDLN) Services in NHS Lothian, Forth Valley, Borders and Fife on the healthcare experiences of people with a learning disability attending for general hospital care

Mammalian Y chromosomes retain widely expressed dosage-sensitive regulators

The human X and Y chromosomes evolved from an ordinary pair of autosomes, but millions of years ago genetic decay ravaged the Y chromosome, and only three per cent of its ancestral genes survived. We reconstructed the evolution of the Y chromosome across eight mammals to identify biases in gene content and the selective pressures that preserved the surviving ancestral genes. Our findings indicate that survival was nonrandom, and in two cases, convergent across placental and marsupial mammals. We conclude that the gene content of the Y chromosome became specialized through selection to maintain the ancestral dosage of homologous X-Y gene pairs that function as broadly expressed regulators of transcription, translation and protein stability. We propose that beyond its roles in testis determination and spermatogenesis, the Y chromosome is essential for male viability, and has unappreciated roles in Turner (tm) s syndrome and in phenotypic differences between the sexes in health and disease

GWAS meta-analysis of intrahepatic cholestasis of pregnancy implicates multiple hepatic genes and regulatory elements

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder affecting 0.5–2% of pregnancies. The majority of cases present in the third trimester with pruritus, elevated serum bile acids and abnormal serum liver tests. ICP is associated with an increased risk of adverse outcomes, including spontaneous preterm birth and stillbirth. Whilst rare mutations affecting hepatobiliary transporters contribute to the aetiology of ICP, the role of common genetic variation in ICP has not been systematically characterised to date. Here, we perform genome-wide association studies (GWAS) and meta-analyses for ICP across three studies including 1138 cases and 153,642 controls. Eleven loci achieve genome-wide significance and have been further investigated and fine-mapped using functional genomics approaches. Our results pinpoint common sequence variation in liver-enriched genes and liver-specific cis-regulatory elements as contributing mechanisms to ICP susceptibility

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme