Co-constructing Simulations with Learners: Roles, Responsibilities, and Impact

Co-constructed simulations were designed and piloted with senior occupational therapy master’s students in a neurorehabilitation practice module. The instructor served as the guide for the students through all phases of the case creation, simulation development, delivery, and debrief. The instructor facilitation promoted self-regulated learning (SRL) of knowledge and skill development through independent discovery and peer learning. This paper provides an evidence-informed co-construction simulation design with outlined stages, roles, and responsibilities for the instructor and learner. Thematic qualitative analysis of student feedback highlighted enhanced insight and SRL as a result of multiple role preparation, observation and interaction with peers, close interaction with the instructor, and the multi-stage debrief process. Recommended key features and critical interactions for a successful co-constructed design are also identified for the learner, instructor, and simulation. The co-construction simulation process and design elements are suitable for learners in any health-related field of study

Co-constructing Simulations with Learners: Roles, Responsibilities, and Impact

Co-constructed simulations were designed and piloted with senior occupational therapy master’s students in a neurorehabilitation practice module. The instructor served as the guide for the students through all phases of the case creation, simulation development, delivery, and debrief. The instructor facilitation promoted self-regulated learning (SRL) of knowledge and skill development through independent discovery and peer learning. This paper provides an evidence-informed co-construction simulation design with outlined stages, roles, and responsibilities for the instructor and learner. Thematic qualitative analysis of student feedback highlighted enhanced insight and SRL as a result of multiple role preparation, observation and interaction with peers, close interaction with the instructor, and the multi-stage debrief process. Recommended key features and critical interactions for a successful co-constructed design are also identified for the learner, instructor, and simulation. The co-construction simulation process and design elements are suitable for learners in any health-related field of stud

Epigenetics and developmental programming of welfare and production traits in farm animals

The concept that postnatal health and development can be influenced by events that occur in utero originated from epidemiological studies in humans supported by numerous mechanistic (including epigenetic) studies in a variety of model species. Referred to as the ‘developmental origins of health and disease’ or ‘DOHaD’ hypothesis, the primary focus of large-animal studies until quite recently had been biomedical. Attention has since turned towards traits of commercial importance in farm animals. Herein we review the evidence that prenatal risk factors, including suboptimal parental nutrition, gestational stress, exposure to environmental chemicals and advanced breeding technologies, can determine traits such as postnatal growth, feed efficiency, milk yield, carcass composition, animal welfare and reproductive potential. We consider the role of epigenetic and cytoplasmic mechanisms of inheritance, and discuss implications for livestock production and future research endeavours. We conclude that although the concept is proven for several traits, issues relating to effect size, and hence commercial importance, remain. Studies have also invariably been conducted under controlled experimental conditions, frequently assessing single risk factors, thereby limiting their translational value for livestock production. We propose concerted international research efforts that consider multiple, concurrent stressors to better represent effects of contemporary animal production systems

Regulation:Managing the Antinomies of Economic Vice and Virtue

In the quarter-century that SLS has been published, regulation has emerged as a new, and for many exciting, inter-disciplinary field. The concept itself requires a wider view of normativity than the narrow positivist one of law as command. It is certainly protean, ranging over many fundamental questions about the changing nature of the public sphere of politics and the state, and its interactions with the ‘private’ sphere of economic activity and social relations, as well as the mediation of these interactions, especially through law. This survey aims to outline and evaluate some of the main contours of the field as it has developed in this recent period, focusing on the regulation of economic activity. Regulation is seen as having emerged with the withdrawal by governments from direct provision of many economic and social services, to be replaced by corporatist bureaucracies and quasi-public agencies managing the complex public-private interactions of financialised capitalism. The arguments for ‘smart’ regulation have, in an era fixated on neo-liberalism, generally legitimised delegation of responsibility to big business. Its advocates, having been drawn into policy fields, have perhaps too often lost their critical edge, and allowed it to become instrumentalised, reflecting the technicist character of its practice

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

EXAMINING PSYCHOLOGICAL SYMPTOMS AS MODERATORS OF THE EFFECT OF A YOGA INTERVENTION ON SLEEP AND FATIGUE FOR WOMEN WOTH BREAT CANCER UNDERGOING CHEMOTHERAPY

Chemotherapy has been shown to be an effective treatment option for breast cancer patients; however, there are various side effects that often impact patients during and after treatment, including sleep disturbance and fatigue (Davidson et al., 2002). Yoga shows promise for reducing sleep disturbances (Cohen et al., 2004; Mustain et al., 2013) and fatigue among breast cancer patients. Mental health has been shown to be a consistent moderator of other supportive interventions in cancer patients (Schneider et al., 2010), and two studies suggest baseline mental health may also moderate the effect of yoga interventions (Ratcliff et al., 2016; Danhauer et al, 2009). This study examined the moderating effects of baseline mental health (i.e., anxiety and depression) on the effect of a Tibetan yoga (TYP) intervention compared to a stretching condition (STP) and a waitlist control (UC) indicated that baseline condition on sleep and fatigue in patients undergoing chemotherapy for breast cancer at 1-week post-intervention. The moderating effects of mental health at later time points (i.e., 3, 6, and 12-months post intervention) along with sleep and fatigue at 1-week and follow-up time points were examined as exploratory analyses. Significant results indicated that baseline global sleep disturbance moderated the effect of group on global sleep disturbance at 1-week follow-up, When compared between groups there were significant differences between UC and TYP (=-.337, p = .001) and UC and STP (=-.292, p = .003). Additional, significant analyses were shown between baseline sleep efficiency, global sleep, and anxiety symptoms on the effect of group on sleep disturbances at various follow-up time points; however, group differences were not significant. This study indicated that when allocating yoga or stretching related resources to patients with breast cancer, baseline sleep should be assessed to determine which patients would receive the most benefit

Associations between adverse childhood experiences and history of weight cycling

Abstract Background Adverse childhood experiences (ACEs) predict obesity onset; however, the relationship between ACEs and history of weight cycling has not been adequately explored. This gap is problematic given the difficulty in weight loss maintenance and the impact of ACEs on obesity development, chronicity, and associated weight stigma. The objective of this study was to examine associations between self‐reported history of ACEs and weight cycling in a sample of weight loss treatment‐seeking adults with overweight/obesity. Methods The number of participants in the analyzed sample was 78, mostly white educated adult women (80% female, 81% Caucasian, 75% ≥ bachelor's degree) with excess adiposity enrolled in the Cognitive and Self‐regulatory Mechanisms of Obesity Study. ACEs were measured at baseline using the ACEs Scale. History of weight cycling was measured using the Weight and Lifestyle Inventory that documented weight loss(es) of 10 or more pounds. Results Higher ACE scores were associated with a greater likelihood of reporting a history of weight cycling. Participants with four or more ACEs had 8 times higher odds (OR = 8.301, 95% CI = 2.271–54.209, p = 0.027) of reporting weight cycling compared with participants with no ACEs. The association of weight cycling for those who endorsed one to three ACEs was not significant (OR = 2.3, 95% CI = 0.771–6.857, p = 0.135) in this sample. Conclusions The role of ACEs in health may be related to associations with weight cycling. Results indicated that those who reported four or more ACEs had significantly higher odds of reporting weight cycling compared with those with no ACEs. Further research is needed to further explore how ACEs predict the likelihood of weight cycling, which may be prognostic for sustained weight loss treatment response and weight stigma impacts

Framing the Crisis: Private Capital to the Rescue

How, in the UK, were the financial then economic crises which erupted from 2007 onwards politically and popularly framed – framed, indeed, in ways which have allowed business-more-or-less-as-usual to proceed in their aftermath? The focus of this chapter is upon various discursive initiatives and narratives which were constructed and utilised as and since the crisis unfolded. I argue that it was through a series of (quite often contradictory) blaming and framing techniques - in turn resting upon the use of analogy, motivated myopia and deceit, and often invoking some form of morality - that the construction, use and fact of economic, legal, political and social ignorance transformed the financial crisis into one of the public and the social