Food insecurity in Detroit: exploring the relationship between patient-reported food insecurity and proximity to healthful grocery stores

Objective: The objective of the current study was to determine if patients of a large health care system in Detroit who self-identify as food insecure live further away from healthy grocery stores compared with food secure patients. Second, we explored whether food insecurity and distance to healthy grocery stores are related to ecological measures of vehicle availability in the area of residence. Design: A secondary data analysis that uses baseline data from a pilot intervention/feasibility study. Setting: Detroit, Michigan, USA. Participants: Patients of Henry Ford Health System were screened for food insecurity to determine eligibility for a pilot intervention/feasibility study (i.e. Henry’s Groceries for Health), conducted through a collaboration with Gleaners Community Foodbank of Southeastern Michigan. Only patients residing in Detroit city limits (including Highland Park and Hamtramck) were included in the secondary analysis. Of the 1,100 patients included in the analysis, 336 (31 %) were food insecure. Results: After accounting for socio-demographic factors associated with food insecurity, we did not find evidence that food insecure patients lived further away from healthier grocery stores, nor was this modified by ecological measures of vehicle access. However, some neighbourhoods were identified as having a significantly higher risk of food insecurity. Conclusions: Food insecure patients in Detroit are perhaps limited by social and political determinants and not their immediate neighbourhood geography or physical access to healthy grocery stores. Future research should explore the complexity in linkages between household socio-economic factors, socio-cultural dynamics and the neighbourhood food environment

Evidence and rationale for the World Health Organization recommended standards for Japanese encephalitis surveillance

<p>Abstract</p> <p>Background</p> <p>Japanese encephalitis (JE) is the most important form of viral encephalitis in Asia. Surveillance for the disease in many countries has been limited. To improve collection of accurate surveillance data in order to increase understanding of the full impact of JE and monitor control programs, World Health Organization (WHO) Recommended Standards for JE Surveillance have been developed. To aid acceptance of the Standards, we describe the process of development, provide the supporting evidence, and explain the rationale for the recommendations made in the document.</p> <p>Methods</p> <p>A JE Core Working Group was formed in 2002 and worked on development of JE surveillance standards. A series of questions on specific topics was initially developed. A literature review was undertaken and the findings were discussed and documented. The group then prepared a draft document, with emphasis placed on the feasibility of implementation in Asian countries. A field test version of the Standards was published by WHO in January 2006. Feedback was then sought from countries that piloted the Standards and from public health professionals in forums and individual meetings to modify the Standards accordingly.</p> <p>Results</p> <p>After revisions, a final version of the JE surveillance standards was published in August 2008. The supporting information is presented here together with explanations of the rationale and levels of evidence for specific recommendations.</p> <p>Conclusion</p> <p>Provision of the supporting evidence and rationale should help to facilitate successful implementation of the JE surveillance standards in JE-endemic countries which will in turn enable better understanding of disease burden and the impact of control programs.</p

word~river literary review (2012)

wordriver is a literary journal dedicated to the poetry, short fiction, and creative nonfiction of adjunct, part-time and fulltime instructors teaching under a semester or yearly contract in our universities, colleges, and community colleges worldwide. Graduate student teachers who have used up their teaching assistant time and are teaching with adjunct contracts for the remainder of their graduate program are also eligible. We’re looking for work that demonstrates the creativity and craft of adjunct/part-time instructors in English and other disciplines. We reserve first publication rights and onetime anthology publication rights for all work published. We do not accept simultaneous submissions.https://digitalscholarship.unlv.edu/word_river/1003/thumbnail.jp

Justice Through a Multispecies Lens

The bushfires in Australia during the Summer of 2019–2020, in the midst of which we were writing this exchange, violently heightened the urgency of the task of rethinking justice through a multispecies lens for all of the authors in this exchange, and no doubt many of its readers. As I finish this introduction, still in the middle of the Australian summer, more than 10 million hectares (100,000 km2 or 24.7 million acres) of bushland have been burned and over a billion individual animals killed. This says nothing of the others who will die because their habitat and the relationships on which they depend no longer exist. People all around the world are mourning these deaths and the destruction of unique ecosystems. As humans on this planet, and specifically as political theorists facing the prospect that such devastating events will only become more frequent, the question before us is whether we can rethink what it means to be in ethical relationships with beings other than humans and what justice requires, in ways that mark these deaths as absolute wrongs that obligate us to act, and not simply as unfortunate tragedies that leave us bereft

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

On the development and implementation of ecosystem management plans for water resources in the Great Lakes: A case study of the RAP initiative.

The "ecosystem approach" to water resource management is deceptively simple: one must recognize the interrelationships among water, land, air, and all living things and undertake resource planning in such a way that the integrity of the natural system is preserved. Significant features of the ecosystem approach include its watershed boundaries, its holistic orientation, and its assumption that humans should be viewed as part of, rather than apart from, the natural system. A theme of environmental ethics and education underlies the approach. Although it seems straightforward, the ecosystem approach has important implications for water management. In 1985, the International Joint Commission challenged government agencies to utilize the ecosystem approach to develop Remedial Action Plans to rehabilitate forty-two "hotspots" across the Great Lakes Basin. This initiative represented a first effort to implement the ecosystem approach in the Great Lakes. The research questions were: what does ecosystem management mean in the context of the RAP process, and how can one increase the likelihood of successful implementation of ecosystem management plans? The research proposition suggests that there are three preconditions to ecosystem management: participation; decision making; and legitimacy. Each precondition has subcomponent measures. The participation subcomponents were intergovernmental and interdisciplinary participation. The decision making subcomponents were use of consensual decision making, development of a common vision of the desired future state of the resource, and dispute resolution. The legitimacy subcomponents were political support, public participation, and funding. Comparative case studies of Green Bay, Wisconsin; Saginaw Bay, Michigan; and Hamilton Harbour, Ontario were undertaken. Thirty-five RAP participants were chosen for on-site indepth interviews. Data were arrayed by respondent, question, and case, and were analyzed for content. Each RAP achieved the preconditions to a varying degree. Overall, the Green Bay RAP is distinguished by its science and high quality participants. The Hamilton Harbour RAP stands out for its conceptualization of the ecosystem approach, and its commitment to consensual decision making. To date, Saginaw Bay RAP has not achieved the ideals of the ecosystem approach.Ph.D.Natural Resource PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/105753/1/9208610.pdfDescription of 9208610.pdf : Restricted to UM users only

Food insecurity in Detroit: exploring the relationship between patient-reported food insecurity and proximity to healthful grocery stores

OBJECTIVE: The objective of the current study was to determine if patients of a large health care system in Detroit who self-identify as food insecure live further away from healthy grocery stores compared with food secure patients. Second, we explored whether food insecurity and distance to healthy grocery stores are related to ecological measures of vehicle availability in the area of residence. DESIGN: A secondary data analysis that uses baseline data from a pilot intervention/feasibility study. SETTING: Detroit, Michigan, USA. PARTICIPANTS: Patients of Henry Ford Health System were screened for food insecurity to determine eligibility for a pilot intervention/feasibility study (i.e. Henry\u27s Groceries for Health), conducted through a collaboration with Gleaners Community Foodbank of Southeastern Michigan. Only patients residing in Detroit city limits (including Highland Park and Hamtramck) were included in the secondary analysis. Of the 1,100 patients included in the analysis, 336 (31 %) were food insecure. RESULTS: After accounting for socio-demographic factors associated with food insecurity, we did not find evidence that food insecure patients lived further away from healthier grocery stores, nor was this modified by ecological measures of vehicle access. However, some neighbourhoods were identified as having a significantly higher risk of food insecurity. CONCLUSIONS: Food insecure patients in Detroit are perhaps limited by social and political determinants and not their immediate neighbourhood geography or physical access to healthy grocery stores. Future research should explore the complexity in linkages between household socio-economic factors, socio-cultural dynamics and the neighbourhood food environment

Gender analysis and social change: Testing the water

Copyright © 2006 Policy and Society Associates (APSS)This paper uses preliminary findings from an ARC-funded Linkage grant to speculate on the requirements for producing gender analysis as a change process. Gender analysis, commonly associated with gender mainstreaming, is a methodology aimed at ensuring that all projects, programs and policies are gender-inclusive and gendersensitive. In the Linkage study existing models of gender analysis taken from Canada and The Netherlands are being tested for their usefulness in selected agencies in South Australia and Western Australia. The goal is to design gender analysis processes appropriate to specific Australian contexts. This paper reflects on the challenges and obstacles encountered in the project to date. It focuses in particular on the importance of creating space for extended debate and discussion of the concepts and issues relevant to gender equality and social change. The authors describe this space as “somewhere in the middle”.Carol Bacchi, Joan Eveline, Jennifer Binns, Catherine Mackenzie and Susan Harwoo