The Learning Healthcare System: How an Adult Education Lens Can Be Used to Inform a Paradigm Shift in US Healthcare Landscape

Adult education researchers and practitioners have an unprecedented opportunity to inform and learn with the health care system as it embraces learning as a process to provide the best care at lower cost

Co-seismic deformation of deep slabs based on summed CMT data

We assess the co-seismic deformation inferred from earthquake moment tensor solutions for subducting slabs at depths greater than 50 km globally. We rotate each moment tensor into a local slab reference frame, then sum tensors within 50 km depth bins to approximate long term deformation characteristics. This builds upon previous analyses by using the up-to-date global Centroid Moment Tensor catalog, incorporating a more complete slab geometry, and focusing on the 3-D aspects of slab deformation. Results show a general consistency with Isacks and Molnar (1969), who found that most slabs can be divided into intermediate-extensional, intermediate-extensional-deep-compressional, and intermediate to deep-compressional categories. Exceptions to these three categories can be related to slab bending in the top 100 km, plate convergence that is oblique to the trench normal direction, and regions of higher focal mechanism heterogeneity. The regions of higher focal mechanism heterogeneity appear where there are along-strike changes in slab geometry and/or evidence of double-seismic zones. We find that the sense of deformation in the intermediate strain axis direction is opposite to that of the down-dip direction, in agreement with Kuge and Kawakatsu (1993). By quantitative comparison to numerical models of global mantle flow, we show that these observations are consistent with deformation of viscous slabs responding to their own negative buoyancy and an upper to lower mantle viscosity increas

The Evolution of Satellite III DNA Subfamilies among Primates

We demonstrate that satellite III (SatIII) DNA subfamilies cloned from human acrocentric chromosomes arose in the Hominoidea superfamily. Two groups, distinguished by sequence composition, evolved nonconcurrently, with group 2 evolving 16–23 million years ago (MYA) and the more recent group 1 sequences emerging ∼4.5 MYA. We also show the relative order of emergence of each group 2 subfamily in the various primate species. Our results show that each SatIII subfamily is an independent evolutionary unit, that the rate of evolution is not uniform between species, and that the evolution within a species is not uniform between chromosomes

A peer-led, school-based social network intervention for young people in the UK, promoting sexual health via social media and conversations with friends: intervention development and optimisation of STASH

BACKGROUND: The quality of school-based sex and relationships education (SRE) is variable in the UK. Digitally-based interventions can usefully supplement teacher-delivered lessons and positively impact sexual health knowledge. Designed to address gaps in core SRE knowledge, STASH (Sexually Transmitted infections And Sexual Health) is a peer-led social network intervention adapted from the successful ASSIST (A Stop Smoking in Schools Trial) model, and based on Diffusion of Innovation theory. This paper describes how the STASH intervention was developed and refined. METHODS: Drawing on the Six Steps in Quality Intervention Development (6SQuID) framework, we tested a provisional programme theory through three iterative stages -: 1) evidence synthesis; 2) intervention co-production; and 3) adaptation - which incorporated evidence review, stakeholder consultation, and website co-development and piloting with young people, sexual health specialists, and educators. Multi-method results were analysed in a matrix of commonalities and differences. RESULTS: Over 21 months, intervention development comprised 20 activities within the three stages. 1) We identified gaps in SRE provision and online resources (e.g. around sexual consent, pleasure, digital literacy), and confirmed critical components including the core ASSIST peer nomination process, the support of schools, and alignment to the national curriculum. We reviewed candidate social media platforms, ruling out all except Facebook on basis of functionality restrictions which precluded their use for our purposes. 2) Drawing on these findings, as well as relevant behaviour change theories and core elements of the ASSIST model, we co-developed new content with young people and other stakeholders, tailored to sexual health and to delivery via closed Facebook groups, as well as face-to-face conversations. 3) A pilot in one school highlighted practical considerations, including around peer nomination, recruitment, awareness raising, and boundaries to message sharing. From this, a revised STASH intervention and programme theory were co-developed with stakeholders. CONCLUSIONS: STASH intervention development required extensive adaptation from the ASSIST model. Although labour intensive, our robust co-development approach ensured that an optimised intervention was taken forward for feasibility testing. Evidencing a rigorous approach to operationalising existing intervention development guidance, this paper also highlights the significance of balancing competing stakeholder concerns, resource availability, and an ever-changing landscape for implementation. TRIAL REGISTRATION: ISRCTN97369178

Changes in depressive symptoms, perceived stres, and food security among study participants with metabolic syndrome during a COVID-19-mandated research pause

Introduction: This study explored how food security, perceived stress and mental health of persons with metabolic syndrome (MetS) changed in the COVID-19 pandemic. Methods: An online survey was administered to persons enrolled in a 2-year lifestyle intervention trial to reverse metabolic syndrome at baseline; the survey was repeated during the COVID-19 pandemic. Outcomes were a change in depressive symptoms, perceived stress, and food security as measured by the Patient Health Questionnaire-8, Cohen Stress Scale, and USDA 10-item Food Security Screener. Changes in outcomes were analyzed with measures of association, paired t-test, repeated measures and independent t-test. Results: Participants (n = 132; MetS diagnosis) were mostly female (67%), White (70%), middle-aged, well-educated, with median income of $86,000. Perceived stress was significantly higher at baseline than follow-up (18.5 ± 6.4 vs. 14.9 ± 7.2; P Conclusion: A high-risk sample for COVID-19 did not experience increased stress or food insecurity, but demonstrated increased depressive symptoms after the onset of COVID-19 pandemic, with some baseline susceptibility noted

Brexit, trade and UK advanced manufacturing sectors: a Midlands’ perspective

The paper examines how Brexit has impacted on Original Equipment Manufacturers (OEMs) and suppliers in the UK Midlands, and to what extent such firms are reconfiguring their supply chains with the increase in trade barriers with Brexit. To do this, the paper aims to add to macro studies in the area by using a mixed-methods approach that combines descriptive quantitative analysis of secondary data with a complementary qualitative research analysis based on a novel interview dataset. The latter is generated from 14 semi-structured interviews conducted in late 2021 with senior managers and directors in advanced manufacturing firms across the East and West Midlands regions of the UK. A key finding of this paper is that the imposition of new non-tariff barriers through Brexit has proved particularly challenging to smaller firms in manufacturing supply chains. The findings of our research highlight the need for policy support for smaller firms engaging in EU-wide supply chains, particularly around skillsets and access to talent, cost reduction for exports and facilitating trade

Daily Dietary Intake Patterns Improve after Visiting a Food Pantry among Food-Insecure Rural Midwestern Adults.

Emergency food pantries provide food at no cost to low-resource populations. The purpose of this study was to evaluate single-day dietary intake patterns before and after visiting a food pantry among food-secure and food-insecure pantry clients. This observational cohort study comprised a paired, before-and-after design with a pantry visit as the intervention. Participants (n = 455) completed a demographic and food security assessment, and two 24-h dietary recalls. Adult food security was measured using the U.S. Household Food Security Survey Module. Dietary intake patterns were assessed using Automated Self-Administered 24-h Recall data and classified by Healthy Eating Index (HEI-2010) scores, dietary variety, number of eating occasions, and energy intake. Paired t-tests and Wilcoxon signed-rank tests compared outcomes before and after a pantry visit. Mean dietary variety increased after the pantry visit among both food-secure (p = 0.02) and food-insecure (p \u3c 0.0001) pantry clients. Mean energy intake (p = 0.0003), number of eating occasions (p = 0.004), and HEI-2010 component scores for total fruit (p \u3c 0.001) and whole fruit (p \u3c 0.0003) increased among food-insecure pantry clients only. A pantry visit may improve dietary intake patterns, especially among food-insecure pantry clients