Adapting and responding to a pandemic: Patient and family advisory councils in children\u27s hospitals during COVID-19

This mixed-methods study investigated the effects of the COVID-19 pandemic on Patient and Family Advisory Councils (PFACs) within children’s hospitals in the United States. Specifically, the study sought to understand how PFACs adapted operations as a result of the COVID-19 pandemic, how patient and family advisors (PFAs) were engaged in the response to COVID-19, and the intersection of the COVID-19 pandemic with PFAC diversity, equity, and inclusion. The study consisted of a survey distributed to 228 children’s hospitals, with a 73% response rate, and in-depth interviews with selected survey respondents (n=12). While COVID-19 temporarily disrupted PFAC operations and forced rapid adaptations, most children’s hospital PFACs transitioned successfully to virtual meetings, with 86% reporting that their PFAC met at least once from March to December 2020 and 84% indicating that their PFAC planned to meet as frequently or more frequently than before the pandemic. The majority of respondents (72%) reported that attendance at virtual PFAC meetings was the same as or better than with in-person meetings. Interview participants reported benefits associated with virtual meetings, including the potential ability to recruit and engage PFAs who better reflected the diversity of the patients and families served by the hospitals. Children’s hospitals are well-positioned to be leaders in the field, contributing to the development of new approaches, lessons learned, and best practices moving forward. This is especially true as hospitals continue to navigate the evolving realities of the COVID-19 pandemic, and as PFACs address challenges associated with maintaining diverse, equitable, and inclusive councils. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Sigurðar saga fóts (The Saga of Sigurðr Foot): A Translation

This is the first English translation of the short Icelandic romance Sigurðar saga fóts, with an introduction presenting the evidence for its dating and immediate literary context. Like most Icelandic romances, Sigurðar saga is a bridal-quest story; the support of a foster-brother is key to the hero winning the bride; and the foster-brothers start out as opponents before recognising their mutual excellence and swearing foster-brotherhood. Uniquely, however, the men who become foster-brothers begin by competing for the same bride (Signý): the eponymous Sigurðr fótr wins Signý only because Ásmundr gives her to him in exchange for foster-brotherhood. Ásmundr’s decision can be read as demonstrating with unusual starkness the superior importance in much Icelandic romance of homosocial relationships over heterosexual ones, giving the saga a certain paradigmatic status. Translating the saga in an open-access forum and reconstructing its literary context will, we hope, encourage further analyses

Sigurðar saga fóts (The Saga of Sigurðr Foot): A Translation

This is the first English translation of the short Icelandic romance Sigurðar saga fóts, with an introduction presenting the evidence for its dating and immediate literary context. Like most Icelandic romances, Sigurðar saga is a bridal-quest story; the support of a foster-brother is key to the hero winning the bride; and the foster-brothers start out as opponents before recognising their mutual excellence and swearing foster-brotherhood. Uniquely, however, the men who become foster-brothers begin by competing for the same bride (Signý): the eponymous Sigurðr fótr wins Signý only because Ásmundr gives her to him in exchange for foster-brotherhood. Ásmundr’s decision can be read as demonstrating with unusual starkness the superior importance in much Icelandic romance of homosocial relationships over heterosexual ones, giving the saga a certain paradigmatic status. Translating the saga in an open-access forum and reconstructing its literary context will, we hope, encourage further analyses

Dynamical mechanisms linking Indian monsoon precipitation and the circumglobal teleconnection

The circumglobal teleconnection (CGT) is an important mode of circulation variability, with an influence across many parts of the northern hemisphere. Here, we examine the excitation mechanisms of the CGT in the ECMWF seasonal forecast model, and the relationship between the Indian summer monsoon (ISM), the CGT and the extratropical northern hemisphere circulation. Results from relaxation experiments, in which the model is corrected to reanalysis in specific regions, suggest that errors over northwest Europe are more important in inhibiting the model skill at representing the CGT, in addition to northern hemisphere skill more widely, than west-central Asia and the ISM region, although the link between ISM precipitation and the extratropical circulation is weak in all experiments. Thermal forcing experiments in the ECMWF model, in which a heating is applied over India, suggest that the ISM does force an extratropical Rossby wave train, with upper tropospheric anticyclonic anomalies over east Asia, the North Pacific and North America associated with increased ISM heating. However, this eastward-propagating branch of the wave train does not project into Europe, and the response there occurs largely through westward-propagating Rossby waves. Results from barotropic model experiments show a response that is highly consistent with the seasonal forecast model, with similar eastward- and westward-propagating Rossby waves. This westward-propagating response is shown to be important in the downstream reinforcement of the wave train between Asia and North America

Health Effects of Climate Change (HECC) in the UK: 2023 report. Chapter 6: Outdoor airborne allergenic pollen & fungal spores.

Aeroallergens are airborne particles that can cause or exacerbate allergic disorders including pollen and fungal spores. Aeroallergens can trigger hay fever and exacerbate asthma which affects about 11% of the UK population. Chapter 6 considers the seasonality of these allergens and how they may be impacted by climate change. The chapter was led by academic experts from University of Leicester, with contributions from the University of Worcester, University of Exeter and UKHSA. Weather and climate are well-recognised drivers of aeroallergen production. Climate also impacts atmospheric transport of pollen grains, including atmospheric transport of allergenic pollen from the continent. There is thus significant potential for a changing climate to shift the start-date, duration, and severity of pollen seasons and associated health risks. The authors present new empirical analyses assessing the relationship between fungal spores and temperature using a 52-year data set (1970 to 2021) and review the published evidence and surveillance data for oak, alder, birch, and grass pollen at 6 sites across the UK (1995 to 2020). The link between aeroallergen production, seasonality and temperature differs widely between species. Current evidence outlined in this chapter suggests that there has been a significant trend towards higher concentrations of pollen (such as birch) or increased length of the pollen season (such as oak). Other species (such as alder and grass pollen) show a mixed picture, however for grass pollen, this is likely due to the high number of different grass species and interacting variables that affect these seasons. The occurrence of the first high day for grass pollen annually is getting earlier, however, and heatwaves are predicted to shorten the season duration. The authors note that trends over time are most pronounced in the Midlands; however, existing surveillance provides early indications only, and data is still relatively limited. The impact of climate change on pollens is likely to be mixed and vary considerably across the UK for different species and based on level of warming. In future decades, the first high pollen day is likely to occur earlier for alder, oak and grass pollen, while alder and birch pollen seasons are expected to continue to increase in severity in the Midlands and further north and west over the next 2 decades. In contrast, trees in the south and the east of the UK are likely to become stressed due to increased frequency and severity of heat and drought, which is expected to reduce pollen output and duration of the pollen season. Grass and nettle family pollen seasons are not expected to increase or decrease over time. It is likely that pollen potency will increase and this will enhance the season for hay fever sufferers in most years, although this may decline from the 2030s and with higher levels of warming. The authors’ assessment of trends in fungal spores found an earlier start of the season for all spores, partly associated with warmer temperatures in spring and summer coupled with higher precipitation. In a warmer and wetter future climate, there could be a further advance in the start of the season for many spores. Notably, the authors highlight the potential for interactions between pollutants and airborne fungal spores. Exposure to some urban air pollutants has been shown to increase the allergenicity of some fungal spores. The authors suggest that there are likely to be health benefits for allergy suffers under decarbonisation scenarios involving electrification of transport and associated air pollutants, though there is limited evidence to quantify possible health co-benefits. The results presented in this chapter highlight the relationship between aeroallergen species and climate, with several implications for public health. Firstly, earlier and prolonged pollen seasons may increase population exposure to airborne spores and extend the allergy season, meaning that hay fever and allergy sufferers may suffer symptoms earlier and for longer periods of the year. These trends will be highly variable by region and species; therefore, aeroallergen forecasting, preparedness, and response will need to be highly localised. For example, local health organisations should provide information in locally appropriate ways, outlining the risks, protective behaviours and support. Communication pathways should also exist to warn and inform residents, in addition to professionals. Secondly, it is possible that where temperatures reach levels high enough to cause pollen-producing species to wither or die, this will result in reduced aeroallergen exposure resulting in fewer hay fever and allergy symptoms. This is most likely in the south and west regions of England and at higher levels of warming. The results in this chapter highlight several research gaps and priorities, including the need to: develop allergen-specific and highly localised public health forecasts, given that weather and climate impacts on aeroallergens range widely between species; continue advancement of taxa-specific forecasts and research to support these as the climate changes will remain a priority; build the evidence on how airborne fungal spores interact with air pollutants and how decarbonisation strategies could maximise health co-benefits associated with aeroallergens; develop the evidence-base to inform urban planning and green infrastructure development on the implications of alternate designs for aeroallergen production, including potential health co-benefits and trade-offs

Class talk: habitus and class in parental narratives of school choice

© 2016 Westburn Publishers Ltd. This article explores how social class is linguistically negotiated and contested in parental narratives of school choice in the British education marketplace. Our study reveals prevalent yet obscured vestiges of ‘class talk’, and in doing so, unmasks ‘micro-political’ acts of status claiming. Using interactional narrative interviewing with 30 parents, we explore how inter- and intra-class differences are emotionally expressed, thus exposing the embodied dispositions of parents’ habitus and its’ subtle influence on school choice. The parental narratives also unveil a moral and political tension between the neoliberal ideal of entrepreneurial self-advancement and an egalitarian sentiment for social equality. Our study therefore challenges the neoliberal educational policy of market choice in closing the attainment gap

Conjugative Botulinum Neurotoxin-Encoding Plasmids in Clostridium botulinum

Clostridium botulinum produces seven distinct serotypes of botulinum neurotoxins (BoNTs). The genes encoding different subtype neurotoxins of serotypes A, B, F and several dual neurotoxin-producing strains have been shown to reside on plasmids, suggesting that intra- and interspecies transfer of BoNT-encoding plasmids may occur. The objective of the present study was to determine whether these C. botulinum BoNT-encoding plasmids are conjugative.C. botulinum BoNT-encoding plasmids pBotCDC-A3 (strain CDC-A3), pCLJ (strain 657Ba) and pCLL (strain Eklund 17B) were tagged with the erythromycin resistance marker (Erm) using the ClosTron mutagenesis system by inserting a group II intron into the neurotoxin genes carried on these plasmids. Transfer of the tagged plasmids from the donor strains CDC-A3, 657Ba and Eklund 17B to tetracycline-resistant recipient C. botulinum strains was evaluated in mating experiments. Erythromycin and tetracycline resistant transconjugants were isolated from donor:recipient mating pairs tested. Transfer of the plasmids to the transconjugants was confirmed by pulsed-field gel electrophoresis (PFGE) and Southern hybridizations. Transfer required cell-to-cell contact and was DNase resistant. This indicates that transfer of these plasmids occurs via a conjugation mechanism.This is the first evidence supporting conjugal transfer of native botulinum neurotoxin-encoding plasmids in C. botulinum, and provides a probable mechanism for the lateral distribution of BoNT-encoding plasmids to other C. botulinum strains. The potential transfer of C. botulinum BoNT-encoding plasmids to other bacterial hosts in the environment or within the human intestine is of great concern for human pathogenicity and necessitates further characterization of these plasmids

Genome-wide trans-ancestry meta-analysis provides insight into the genetic architecture of type 2 diabetes susceptibility.

To further understanding of the genetic basis of type 2 diabetes (T2D) susceptibility, we aggregated published meta-analyses of genome-wide association studies (GWAS), including 26,488 cases and 83,964 controls of European, east Asian, south Asian and Mexican and Mexican American ancestry. We observed a significant excess in the directional consistency of T2D risk alleles across ancestry groups, even at SNPs demonstrating only weak evidence of association. By following up the strongest signals of association from the trans-ethnic meta-analysis in an additional 21,491 cases and 55,647 controls of European ancestry, we identified seven new T2D susceptibility loci. Furthermore, we observed considerable improvements in the fine-mapping resolution of common variant association signals at several T2D susceptibility loci. These observations highlight the benefits of trans-ethnic GWAS for the discovery and characterization of complex trait loci and emphasize an exciting opportunity to extend insight into the genetic architecture and pathogenesis of human diseases across populations of diverse ancestry

New genetic loci implicated in fasting glucose homeostasis and their impact on type 2 diabetes risk.

Levels of circulating glucose are tightly regulated. To identify new loci influencing glycemic traits, we performed meta-analyses of 21 genome-wide association studies informative for fasting glucose, fasting insulin and indices of beta-cell function (HOMA-B) and insulin resistance (HOMA-IR) in up to 46,186 nondiabetic participants. Follow-up of 25 loci in up to 76,558 additional subjects identified 16 loci associated with fasting glucose and HOMA-B and two loci associated with fasting insulin and HOMA-IR. These include nine loci newly associated with fasting glucose (in or near ADCY5, MADD, ADRA2A, CRY2, FADS1, GLIS3, SLC2A2, PROX1 and C2CD4B) and one influencing fasting insulin and HOMA-IR (near IGF1). We also demonstrated association of ADCY5, PROX1, GCK, GCKR and DGKB-TMEM195 with type 2 diabetes. Within these loci, likely biological candidate genes influence signal transduction, cell proliferation, development, glucose-sensing and circadian regulation. Our results demonstrate that genetic studies of glycemic traits can identify type 2 diabetes risk loci, as well as loci containing gene variants that are associated with a modest elevation in glucose levels but are not associated with overt diabetes