Haven Can’t Wait

A Louisiana sanctuary prepares to welcome more than 100 chimpanzees being permanently retired from research—the latest and most tangible milestone in a decades-long push to end invasive experiments on our closest genetic relative

Tracking the Continuing Trends of the Self-Represented Litigants Phenomenon: Data from the National Self-Represented Litigants Project, 2015-2016

From 2011-2013, Dr. Julie Macfarlane conducted a study about experiences of self- representation in Canada in three provinces, Ontario, British Columbia and Alberta. She conducted detailed personal interviews and/or focus group interviews with 259 self-represented litigants (SRLs). Since the Study’s release in 2013 – “The National Self-Represented Litigants Project: Identifying and Meeting the Needs of Self-Represented Litigants” – SRLs continue to contact the National Self-Represented Litigants Project (NSRLP). This led the research team to develop an “Intake Form” in SurveyMonkey, in order to collect information from SRLs across Canada. While the data provided in the Intake Forms is less detailed and the SurveyMonkey format offers less context than the original study interviews, the questionnaire tracks SRL demographics using the same variables, such as income, education level and party status. The Intake Form also provides a glimpse into SRL personal experiences based on a final question which is “open format”. NSRLP is committed to regular reporting on this data. Our last effort spanned from March 2014-2015. This Report presents our latest data from 73 respondents (collected from April 01 2015-December 31, 2016). Additionally, in this Report, we shall compare what we see in this new data to the same variables reported in both the 2013 Research Report, and in the 2014-2015 Intake Report

Optimisation Modelling to Assess Cost of Dietary Improvement in Remote Aboriginal Australia

BackgroundThe cost and dietary choices required to fulfil nutrient recommendations defined nationally, need investigation, particularly for disadvantaged populations.ObjectiveWe used optimisation modelling to examine the dietary change required to achieve nutrient requirements at minimum cost for an Aboriginal population in remote Australia, using where possible minimally-processed whole foods.DesignA twelve month cross-section of population-level purchased food, food price and nutrient content data was used as the baseline. Relative amounts from 34 food group categories were varied to achieve specific energy and nutrient density goals at minimum cost while meeting model constraints intended to minimise deviation from the purchased diet.ResultsSimultaneous achievement of all nutrient goals was not feasible. The two most successful models (A & B) met all nutrient targets except sodium (146.2% and 148.9% of the respective target) and saturated fat (12.0% and 11.7% of energy). Model A was achieved with 3.2% lower cost than the baseline diet (which cost approximately AUD$13.01/person/day) and Model B at 7.8% lower cost but with a reduction in energy of 4.4%. Both models required very large reductions in sugar sweetened beverages (−90%) and refined cereals (−90%) and an approximate four-fold increase in vegetables, fruit, dairy foods, eggs, fish and seafood, and wholegrain cereals.ConclusionThis modelling approach suggested population level dietary recommendations at minimal cost based on the baseline purchased diet. Large shifts in diet in remote Aboriginal Australian populations are needed to achieve national nutrient targets. The modeling approach used was not able to meet all nutrient targets at less than current food expenditure

Monitoring QI Maturity of Public Health Organizations and Systems in Minnesota: Promising Early Findings and Suggested Next Steps

Public health departments and systems are increasing investments in quality improvement. This paper presents methods used to identify a select number of items from a previously validated QI Maturity Tool as the basis for calculating organizational and system-level QI maturity scores that could be followed over time. Findings suggest that the abbreviated tool measures variation in QI maturity across LHDs, and differences in scores among divisions within a state health department. Minnesota has incorporated the abbreviated tool into an annual reporting system for the MN Local Public Health Act, thereby enabling stakeholders to monitor a system median score and distribution of scores every year. Such information will be used by state and local partners to identify opportunities for system-wide improvements

Coding of Barrett's oesophagus with high-grade dysplasia in national administrative databases: a population-based cohort study.

OBJECTIVES: The International Classification of Diseases 10th Revision (ICD-10) system used in the English hospital administrative database (Hospital Episode Statistics (HES)) does not contain a specific code for oesophageal high-grade dysplasia (HGD). The aim of this paper was to examine how patients with HGD were coded in HES and whether it was done consistently. SETTING: National population-based cohort study of patients with newly diagnosed with HGD in England. The study used data collected prospectively as part of the National Oesophago-Gastric Cancer Audit (NOGCA). These records were linked to HES to investigate the pattern of ICD-10 codes recorded for these patients at the time of diagnosis. PARTICIPANTS: All patients with a new diagnosis of HGD between 1 April 2013 and 31 March 2014 in England, who had data submitted to the NOGCA. OUTCOMES MEASURED: The main outcome assessed was the pattern of primary and secondary ICD-10 diagnostic codes recorded in the HES records at endoscopy at the time of diagnosis of HGD. RESULTS: Among 452 patients with a new diagnosis of HGD between 1 April 2013 and 31 March 2014, Barrett's oesophagus was the only condition coded in 200 (44.2%) HES records. Records for 59 patients (13.1%) contained no oesophageal conditions. The remaining 193 patients had various diagnostic codes recorded, 93 included a diagnosis of Barrett's oesophagus and 57 included a diagnosis of oesophageal/gastric cardia cancer. CONCLUSIONS: HES is not suitable to support national studies looking at the management of HGD. This is one reason for the UK to adopt an extended ICD system (akin to ICD-10-CM)

Mechanisms of Fetal Programming in Hypertension

Events that occur in the early fetal environment have been linked to long-term health and lifespan consequences in the adult. Intrauterine growth restriction (IUGR), which may occur as a result of nutrient insufficiency, exposure to hormones, or disruptions in placental structure or function, may induce the fetus to alter its developmental program in order to adapt to the new conditions. IUGR may result in a decrease in the expression of genes that are responsible for nephrogenesis as nutrients are rerouted to the development of more essential organs. Fetal survival under these conditions often results in low birth weight and a deficit in nephron endowment, which are associated with hypertension in adults. Interestingly, male IUGR offspring appear to be more severely affected than females, suggesting that sex hormones may be involved. The processes of fetal programming of hypertension are complex, and we are only beginning to understand the underlying mechanisms

Observed restrictive feeding practices among low- income mothers of pre- adolescents

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162798/2/ijpo12666_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162798/1/ijpo12666.pd

Performance of the Universal Vital Assessment (UVA) Mortality Risk Score in Hospitalized Adults with Infection in Rwanda: A Retrospective External Validation Study

BACKGROUND: We previously derived a Universal Vital Assessment (UVA) score to better risk-stratify hospitalized patients in sub-Saharan Africa, including those with infection. Here, we aimed to externally validate the performance of the UVA score using previously collected data from patients hospitalized with acute infection in Rwanda. METHODS: We performed a secondary analysis of data collected from adults ≥18 years with acute infection admitted to Gitwe District Hospital in Rwanda from 2016 until 2017. We calculated the UVA score from the time of admission and at 72 hours after admission. We also calculated quick sepsis-related organ failure assessment (qSOFA) and modified early warning scores (MEWS). We calculated amalgamated qSOFA scores by inserting UVA cut-offs into the qSOFA score, and modified UVA scores by removing the HIV criterion. The performance of each score determined by the area under the receiver operator characteristic curve (AUC) was the primary outcome measure. RESULTS: We included 573 hospitalized adult patients with acute infection of whom 40 (7%) died in-hospital. The admission AUCs (95% confidence interval [CI]) for the prediction of mortality by the scores were: UVA, 0.77 (0.68-0.85); modified UVA, 0.77 (0.68-0.85); qSOFA, 0.66 (0.56-0.75), amalgamated qSOFA, 0.71 (0.61-0.80); and MEWS, 0.74 (0.64, 0.83). The positive predictive values (95% CI) of the scores at commonly used cut-offs were: UVA \u3e4, 0.35 (0.15-0.59); modified UVA \u3e4, 0.35 (0.15-0.59); qSOFA \u3e1, 0.14 (0.07-0.24); amalgamated qSOFA \u3e1, 0.44 (0.20-0.70); and MEWS \u3e5, 0.14 (0.08-0.22). The 72 hour (N = 236) AUC (95% CI) for the prediction of mortality by UVA was 0.59 (0.43-0.74). The Chi-Square test for linear trend did not identify an association between mortality and delta UVA score at 72 hours (p = 0.82). CONCLUSIONS: The admission UVA score and amalgamated qSOFA score had good predictive ability for mortality in adult patients admitted to hospital with acute infection in Rwanda. The UVA score could be used to assist with triage decisions and clinical interventions, for baseline risk stratification in clinical studies, and in a clinical definition of sepsis in Africa