Novice Nurses’ Experiences With Palliative and End-of-Life Communication

Health care providers recognize that delivery of effective communication with family members of children with life-threatening illnesses is essential to palliative and end-of-life care (PC/EOL). Parents value the presence of nurses during PC/EOL of their dying child. It is vital that nurses, regardless of their years of work experience, are competent and feel comfortable engaging family members of dying children in PC/EOL discussions. This qualitative-descriptive study used focus groups to explore the PC/EOL communication perspectives of 14 novice pediatric oncology nurses (eg, with less than 1 year of experience). Audio-taped focus group discussions were reviewed to develop the following 6 theme categories: (a) Sacred Trust to Care for the Child and Family, (b) An Elephant in the Room, (c) Struggling with Emotional Unknowns, (d) Kaleidoscope of Death: Patterns and Complexity, (e) Training Wheels for Connectedness: Critical Mentors during PC/EOL of Children, and (f) Being Present with an Open Heart: Ways to Maintain Hope and Minimize Emotional Distress. To date, this is the first study to focus on PC/EOL communication perspectives of novice pediatric oncology nurses

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

“Have You Seen This Drivel?” A Comparison of How Common Health Issues Are Discussed within Brachycephalic and Non-Brachycephalic Dog Breed Groups on Social Media

As brachycephalic dog breed ownership increases, there is a growing concern for the welfare of these breeds due to extreme brachycephalism. Understanding the motivations and behaviours of those choosing to own these breeds is important if we wish to address these concerns. The aim of this study was to investigate how owners of brachycephalic and non-brachycephalic dog breeds use social media dog breed groups to discuss common health issues. The purpose of Facebook posts in relation to common health issues, owner awareness of health issues and the role of Facebook facilitated social support were explored between brachycephalic and non-brachycephalic dog owners. Twelve Facebook breed goups were selected (brachycephalic breed groups, n = 6, non-brachycephalic breed groups, n = 6). Using key word searches we extracted the first twenty posts from each group. Thematic analysis revealed three overarching themes: advice seeking, advice giving and community bonding mechanisms. Whilst the purpose of posting did not differ between groups, non-brachycephalic owners appeared to display greater awareness of breed-specific health issues, whilst social support played a more prominent role in brachycephalic groups. This research highlights that social media groups can act as platforms for knowledge exchange and emotional support. These could be utilised by owners, veterinarians and welfare organisations to more effectively enhance dog health and wellbeing

Constructing Cultural Identity : Jin-me Yoon, Bob Boyer, Liz Magor

Kidd contextualizes the three exhibitions within discussions of identity, representation, cultural difference, and appropriation. Essays elaborate on each artist's work and on the identities and locations that they address. Biographical notes. 16 bibl. ref

Nightmare on Nevsky Prospekt : The Blue Bird and the Curious Episode of Soviet-American Film Collaboration during the Cold War

Tony Shaw, 'Nightmare on Nevsky Prospekt: The Blue Bird as a Curious Instance of U.S.-Soviet Film Collaboration during the Cold War', Journal of Cold War Studies, Vol. 14(1): 3-33, March 2012, available online at: http://www.mitpressjournals.org/doi/10.1162/JCWS_a_00174#.WNphy2cm59A © 2012 by the President and Fellows of Harvard College and the Massachusetts Institute of TechnologyCombining cinematic and diplomatic history, this article examines a curious relic of the détente phase of the Cold War, the fantasy-musical The Blue Bird. Released on the silver screen in 1976, The Blue Bird was the only U.S.-Soviet cinematic coproduction during the Cold War. The movie was made for a variety of commercial, artistic, and ideological reasons but failed to live up to expectations. The production was shambolic, critics were disdainful, and the film was a dud at the box office. The Blue Bird is largely forgotten nowadays, but the story of the film's production and reception sheds valuable light on the economics and politics of cross-bloc filmmaking. It also provides insight into the importance of cinema as an instrument of public diplomacy at the height of détente.Peer reviewe

Mycotoxin control in low- and middle-income countries

An estimated 500 million of the poorest people in sub-Saharan Africa, Latin America, and Asia are exposed to mycotoxins at levels that substantially increase mortality and morbidity (Pitt et al., 2012). The problem is not newly recognized. Shortly after the discovery of aflatoxins, the impact on child health was brought into immediate focus. After the reporting of several deaths in children in Africa due to consumption of aflatoxin- contaminated meal, a decision was made in 1966 by the FAO/WHO/ UNICEF Protein Advisory Group to set a limit of 30 ppb aflatoxin in protein supplements made from groundnuts (Anonymous, 1966). In contrast to the situation today, in 1966 throughout most of Africa the proportion of calories from maize was modest, with a greater proportion coming from sorghum, millet, and cassava. Executive summary The International Agency for Research on Cancer (IARC) of the World Health Organization convened a Working Group Meeting in Lyon from 30 June to 3 July 2014. This IARC Working Group Report provides a systematic, independent review of the scientific evidence base on the adverse health effects from aflatoxin and fumonisin exposure through consumption of contaminated maize and groundnuts. An evaluation is provided of interventions, available on an individual and a community level, to reduce human exposure and disease. Therefore, this Report provides an authoritative basis for action at an international level, enabling decision-makers to invest with confidence in effective strategies to save lives. It also provides guidance on additional critical studies needed to yield further evidence of the merit of specific intervention approaches. The Working Group addressed current scientific knowledge in four key areas: the extent of exposures to aflatoxin and fumonisin; the effects on prenatal, infant, and child health; relevant mechanistic information; and effective intervention strategies in low-income settings. In the past, the focus has largely been on the impact of aflatoxin on cancer risk. Considering several recent studies, mainly in Africa, this Report also considers the potentially far greater burden of growth faltering after weaning (child stunting). Stunting in children results from chronic undernutrition, leading to adverse effects on survival, health, and development, entailing a large Executive summary. Mycotoxin control in low- and middle-income countries ix global population burden; in 2012, an estimated 162 million children younger than 5 years worldwide were stunted. Poor-quality diets and high rates of infection, both in pregnancy and in the first years of life, result in poor child growth, but the relative contributions to stunting are unknown. At the same time, provision of all of the established nutrition-specific interventions in the most affected regions would reduce the prevalence of stunting by only about 20% (Bhutta et al., 2013), illustrating the large knowledge gap in how to prevent stunting, including the potential impact of exposure to mycotoxins. This Report concludes that surveillance data on exposure to aflatoxins are generally lacking outside the developed countries. However, available data from measurements of contaminated crops and through the use of exposure biomarkers in exposed populations demonstrate that mycotoxin exposures can be high throughout Africa, as well as in Latin America and parts of Asia. More recently, among maize-consuming populations in these regions, the high concurrent exposure to aflatoxins and fumonisins has been documented. Notwithstanding the challenges, future mycotoxin monitoring programmes should be prioritized. Assessment of possible implementation within existing surveillance systems should be considered. In the short term, data from individual studies of sufficient quality should be added to the Global Environment Monitoring System (GEMS)/Food Contamination Database. Finally, a rapid screening approach aimed at the field/subsistence-farming level that is inexpensive and user-friendly and has a wide dynamic range should be developed. This could support a rapid alert system that informs responses and appropriate actions for food safety. Aflatoxins are a cause of human liver cancer and, in high doses, have caused deaths from aflatoxicosis. More recently, significant negative effects of aflatoxin on child growth have been reported, as well as immune modulation. These observations are consistent with impaired fetal development and immune system and gut function in animal models. Taken together, the few well-documented population-based studies and the mechanistic data in relevant animal models suggest that mycotoxin exposure contributes to stunting, independent of and with other risk factors. Further longitudinal studies of mycotoxin exposure and child stunting, including studies of the underlying mechanisms, merit investment. The Working Group assessed the question of effective interventions in low-income countries using studies where there was reliable direct or indirect evidence of improvement of health, including reduced mycotoxin biomarker levels. Using widely accepted criteria for evaluating evidence about public health interventions, some 15 interventions were placed into one of four categories: (1) sufficient evidence for implementation, (2) needs more field evaluation, (3) needs formative research, and (4) no evidence or ineffective. Recommendations on how to approach the necessary further investigation and potential scale-up were also considered. Four of the interventions were judged to be ready for implementation. The intervention for which the strongest evidence of improvement of health exists, but which is also the most difficult to achieve, was to increase dietary diversity. Other strategies deemed ready for implementation were sorting of the crop; a package of post-harvest measures, including improved storage; and, in Latin America for maize, optimized nixtamalization. Several interventions were considered that might be used in emergency situations of extremely high contamination (e.g. chemoprotectants, agents that can be put into the diet to ameliorate the effects of aflatoxin once ingested). As currently envisaged, the recommendations would be relevant for investment of public, nongovernmental organization, and private funds at the scale of the subsistence farmer, the smallholder, and through to a more advanced value chain