Sweat rate and sodium loss during work in the heat

Significant and poorly documented electrolyte losses result from prolonged sweating. This study aimed to quantify likely sodium losses during work in heat. Male subjects exercised in an environmental chamber on two consecutive days in both winter and summer. Sweat collecting devices were attached to the upper arms and legs. Sweat rates were higher and sodium concentrations were lower in the summer (acclimatised) than the winter (unacclimatised) trials. Sweat sodium concentration was reduced on the second day in summer but not winter. Regional differences were found in both seasons. The difference between days in summer probably reflects short-term acclimation. The difference between seasons reflects acclimatisation. The data predict average sodium (Na) losses over a work shift of 4.8-6 g, equivalent to 10-15 g salt (NaCl). Losses are potentially greater in unacclimatised individuals. Fluid and electrolyte losses resulting from prolonged sweating must be replaced to prevent imbalance in body fluids, however guidelines for this replacement are often conflicting. This study provides important information for occupational health practitioners by quantifying the likely sodium losses over a work shift and providing recommendations for replacement

Realist evaluation for programs designed to reduce demand and harms of substance misuse at the community level in Australian remote Indigenous community settings

This thesis reviewed NHMRC-funded, community-level substance misuse interventions, documenting: outcomes; study designs; implicit program theory; and assumptions. Data from one intervention project, targeting cannabis misuse in Cape York, exemplified common evaluation constraints, and informed hypothetical context-mechanism-outcome clusters for a plausible program theory and proposed theory-driven evaluation

"Need Everyone Helping to Keep Off Because Everyone Helping to Keep On" – reducing harms from cannabis use in remote Indigenous Australian communities involves more than just users

Background: Heavy cannabis use in remote Indigenous Australian communities potentially contributes to existing health disparities. Community members’ perceptions of cannabis harms will support harm-minimization in these settings. Objective: To describe perceived cannabis harms reported by a cohort of Indigenous Australians living in small, isolated communities as an indication of their existing resources for change. Method: Inductive thematic analysis of 407 semi-structured interviews with participants in a cohort study in three remote communities in Cape York in far north Queensland (Australia) revealed major areas of concern about cannabis. Three attitudinal categories were defined according to reported cannabis impacts and urgency for change: 1- “LOW CONCERN” said cannabis was a low priority community issue; 2- “SOME CONCERN” tolerated cannabis use but identified personal or community-level concerns; and 3- “HIGH CONCERN” expressed strong aversion to cannabis and identified serious personal or community-level harms. The characteristics and the patterns of concerns were summarized across the groups. Results: “Category 1- LOW CONCERN” (n¼107), mostly current users, emphasized personal “financial impacts” and “stress.” “Category 2 – SOME CONCERN” (n¼141) perceived community level impacts warranting systematic action, particularly on “employment”; and “Category 3 – HIGH CONCERN” (n¼159), most of the never users, emphasized concerns for families and youth. Irrespective of use history, the cohort reported financial and abstinence-related stress, overlapping alcohol issues and generally endorsed alleviating impacts on children and youth. Conclusion: Nearly ubiquitous experience with cannabis harms and impacts in this cohort suggests resources for harm reduction including family and cultural obligation, stress relief, financial management, and engagement are available across all community members, not just users

Elevated ACKR2 expression is a common feature of inflammatory arthropathies

Objectives. Chemokines are essential contributors to leucocyte accumulation at sites of inflammatory pathology. Interfering with chemokine or chemokine receptor function therefore represents a plausible therapeutic option. However, our currently limited understanding of chemokine orchestration of inflammatory responses means that such therapies have not yet been fully developed. We have a particular interest in the family of atypical chemokine receptors that fine-tune, or resolve, chemokine-driven responses. In particular we are interested in atypical chemokine receptor 2 (ACKR2), which is a scavenging receptor for inflammatory CC-chemokines and that therefore helps to resolve in vivo inflammatory responses. The objective of the current study was to examine ACKR2 expression in common arthropathies. Methods. ACKR2 expression was measured by a combination of qPCR and immuno-histochemistry. In addition, circulating cytokine and chemokine levels in patient plasma were assessed using multiplexing approaches. Results. Expression of ACKR2 was elevated on peripheral blood cells as well as on leucocytes and stromal cells in synovial tissue. Expression on peripheral blood leucocytes correlated with, and could be regulated by, circulating cytokines with particularly strong associations being seen with IL-6 and hepatocyte growth factor. In addition, expression within the synovium was coincident with aggregates of lymphocytes, potentially atopic follicles and sites of high inflammatory chemokine expression. Similarly increased levels of ACKR2 have been reported in psoriasis and SSc. Conclusion. Our data clearly show increased ACKR2 in a variety of arthropathies and taking into account our, and others’, previous data we now propose that elevated ACKR2 expression is a common feature of inflammatory pathologies

A kin-selection model of fairness in heterogeneous populations

Humans and other primates exhibit pro-social preferences for fairness. These preferences are thought to be reinforced by strong reciprocity, a policy that rewards fair actors and punishes unfair ones. Theories of fairness based on strong reciprocity have been criticized for overlooking the importance of individual differences in socially heterogeneous populations. Here, we explore the evolution of fairness in a heterogeneous population. We analyse the Ultimatum Game in cases where players’ roles in the game are determined by their status. Importantly, our model allows for non-random pairing of players, and so we also explore the role played by kin selection in shaping fairness. Our kin-selection model shows that, when individuals condition their behaviour on their role in the game, fairness can be understood as either altruistic or spiteful. Altruistic fairness directs resources from less valuable members of a genetic lineage to more valuable members of the same lineage, whereas spiteful fairness keeps resources away from the competitors of the actor’s high-value relatives. When individuals express fairness unconditionally it can be understood as altruistic or selfish. When it is altruistic, unconditional fairness again serves to direct resources to high-value members of genetic lineages. When it is selfish, unconditional fairness simply improves an individual’s own standing. Overall, we expand kin-selection based explanations for fairness to include motivations other than spite. We show, therefore, that one need not invoke strong reciprocity to explain the advantage of fairness in heterogeneous populations

Effects of Micronutrients on the status of HIV-infected African American Women

Weight loss among HIV-infected African American women (AAW), results in the fall of the cluster of differentiation (CD4) cell count and an increase in the viral load. There are 48,126 HIV-infected AAW who reported weight loss within the first year. AAW who report more than 10% weight loss within the first year progress to AIDS due to a deficiency in micronutrients and poor linkage to care. The phenomenon that occurs with individuals living with HIV does not necessarily occur among individuals who have cancer, heart disease, or some other life-threatening illness, and this phenomenon indicates a direct threat to the individual\u27s physical, mental, and social survival beyond the effects of chronic diseases. Using the health belief model in this study helped emphasize the physical change that occurs during weight loss among HIV-infected AAW. The research questions addressed if there was a direct correlation between the use of micronutrients and the decrease in weight, decrease in CD4 cell count, and the increase in viral load. The results of the multilinear regression revealed there was direct correlation between the use of micronutrients and the increase/maintain in weight, an increase in CD4 cell count, and a decrease in the viral load, thus promoting the need for more research and funding. The need to educate HIV-infected AAW on the use of micronutrients was evident. Providing research to providers on changes in standard of care for HIV-infected AAW would allow for an increase in the social, economic, and personal impact on the way an individual approaches care and treatment to prevent the progress to AIDS

Towards best practice during COVID-19: A responsive and relational program with remote schools to enhance the wellbeing of Aboriginal and Torres Strait Islander students

Purpose: From 2018, the Schools Up North (SUN) programme worked with three remote Australian schools to enhance their capability and resilience to support the wellbeing and mental health of Aboriginal and Torres Strait Islander students and staff. This paper explores the implementation of SUN during the first two years of COVID-19 (2020–2021). Method: Using grounded theory methods, school staff, other service providers and SUN facilitators were interviewed, with transcripts and programme documents coded and interrelationships between codes identified. An implementation model was developed. Results: The SUN approach was place-based, locally informed and relational, fostering school resilience through staff reflection on and response to emerging contextual challenges. Challenges were the: community lockdowns and school closures; (un)availability of other services; community uncertainty and anxiety; school staff capability and wellbeing; and risk of educational slippage. SUN strategies were: enhancing teachers’ capabilities and resources, facilitating public health discussions, and advocating at regional level. Outcomes were: enhanced capability of school staff; greater school-community engagement; student belonging and engagement; a voice for advocacy; and continuity of SUN's momentum. Conclusions: The resilience approach (rather than specific strategies) was critical for building schools’ capabilities for promoting students and staff wellbeing and provides an exemplar for remote schools globally

A comparison of emergency department utilization by elderly and younger adult patients presenting to three hospitals in Hong Kong

Background The elderly population is increasing in absolute and relative terms in most developed countries, and this is protected to have a major impact on the delivery of health care, particularly acute and emergency services. The aim of this study is to describe the pattern of utilization of emergency department (ED) services in Hong Kong by the elderly and to compare it to the utilization by younger adults. Methods Data on ED visits to three acute hospitals in the eastern New Territories were retrieved from a central computerized database of ED attendances. Data on all adult patients (aged ≥15 years) who attended the three EDs in 2006 were analyzed retrospectively. Patients aged 15 to 64 years were defined as younger adults; patients aged ≥65 years were defined as elderly. The attendance rate, ED consultation process, hospital admission rate and disease pattern of the two age groups were compared. Results Elderly patients required significantly more emergency care resources than younger adults. Elderly ED patients were brought to hospital more frequently by ambulance (42.8% vs. 14.8%, p < 0.0001) and required hospital admission more often (45.0% vs. 15.5%, p < 0.0001) than younger adults. A significantly higher proportion of elderly patients were triaged as being in the critical, emergency or urgent categories compared to younger adults (44.4% vs. 18.2%, p < 0.0001). Laboratory tests, radiography and CT scanning were performed on elderly patients more frequently than on younger adults (p < 0.0001), and their lengths of stay in EDs and emergency wards were significantly longer (p < 0.0001). Neurological symptoms and chest pain were the most common presenting symptoms in elderly ED patients. Conclusion With the foreseeable rapid growth of the elderly population, ED utilization by the elderly will increase. Health service delivery, including that in the ED, needs to take account of the specific features and requirements of the elderly population in each locale

Preserving organizational trust during disruption

How is organizational trust preserved during times of disruption? We address this question, building on the concept of active trust which views trust as an ongoing accomplishment constituted by reflexive actors. Drawing on a multi-case study of four organizations that experienced major disruption in response to the global financial crisis of 2009, we contribute to trust theory in three ways. First, we extend beyond the current focus on trust building and repair by developing conceptual understanding of trust preservation as a distinct phenomenon. Second, we develop a theoretical model that explains how organizational actors accomplish the preservation of employees’ trust in their organization. We identify three trust preservation practices used in the successful case organizations – cognitive bridging, emotional embodying and inclusive enacting – and show that organizational members’ understanding of the established foundations of trust in the organization, and their ability to mobilize these, are critical to the preservation of trust. Third, we position trust preservation as a manifestation and extension of active trust, and show that for trust to be preserved in disruptive contexts, both familiarization and transformation of existing trust practices are required.<br/

Systems intervention to promote colon cancer screening in safety net settings: Protocol for a community-based participatory randomized controlled trial

BACKGROUND: Colorectal cancer is a leading cause of cancer mortality. Screening can be effective but is underutilized. System- or multi-level interventions could be effective at increasing screening, but most have been implemented and evaluated in higher-resource settings such as health maintenance organizations. Given the disparities evident for colorectal cancer and the potential for screening to improve outcomes, there is a need to expand this work to include diverse settings, including those who treat economically disadvantaged patients. This paper describes the study protocol for a trial designed to increase colorectal cancer screening in those ‘safety-net’ health centers that serve underinsured and uninsured patients. This trial was designed and is being implemented using a community-based participatory approach. METHODS/DESIGN: We developed a practical clinical cluster-randomized controlled trial. We will recruit 16 community health centers to this trial. This systems-level intervention consists of a menu of evidence-based implementation strategies for increasing colorectal cancer screening. Health centers in the intervention arm then collaborate with the study team to tailor strategies to their own setting in order to maximize fit and acceptability. Data are collected at the organizational level through interviews, and at the provider and patient levels through surveys. Patients complete a survey about their healthcare and screening utilization at baseline, six months, and twelve months. OUTCOMES: The primary outcome is colorectal cancer screening by patient self-report, supplemented by a chart-audit in a subsample of patients. Implementation outcomes informed by the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) conceptual framework will be measured at patient, provider, and practice levels. DISCUSSION: Our study is one of the first to integrate community participatory strategies to a randomized controlled trial in a healthcare setting. The multi-level approach will support the ability of the intervention to affect screening through multiple avenues. The participatory approach will strengthen the chance that implementation strategies will be maintained after study completion and, supports external validity by increasing health center interest and willingness to participate. TRIAL REGISTRATION: NCT0129949