Cultivating a Jewish Eco- Education Framework: The Toronto Heschel School’s Teaching and Learning Garden

Over the last century, global food systems have increasingly shifted towards a scientific, input-based industrial paradigm whose adverse ecological impacts are well documented. In response, global agricultural movements, such as the agroecology movement, have sought an integration of contemporary science and indigenous agricultural knowledges. Scholars in the field of Jewish ecology similarly propose that biblical Hebrew scripture may provide a framework for thinking about, and acting upon, issues of ecological sustainability in agriculture. In educational settings too, learning about ecology is increasingly approached in an intimate and tangible way in the form of school garden programs. In this work, we highlight the case of the Toronto Heschel School, a Canadian Jewish day school for children in which a Teaching and Learning Garden fosters student learning on ecology and their Jewish identity in tandem. Reporting the thematic results of qualitative interviews with two educators and five alumni from the Heschel School, this study highlights key similarities and differences between this school’s garden program and those taking place in secular school settings. Like secular school gardens, the Heschel program implements experiential, interdisciplinary learning activities within a scientific ecological knowledge (SEK) framework. That said, the Heschel program supplements and deepens these SEK activities with traditional ecological knowledge (TEK) rooted in Judaic traditional teachings. The resulting educational outcomes appear at once universally applicable while specifically relevant to the Jewish identities of learners.Au cours du dernier siècle, les systèmes alimentaires mondiaux ont eu tendance à évoluer dans la direction d’une approche scientifique fondée sur un paradigme industriel dont les impacts écologiques néfastes sont bien documentés. En réponse à ce problème, les mouvements agricoles mondiaux, dont le mouvement agroécologique, ont cherché à intégrer la science contemporaine et les connaissances agricoles autochtones. En particulier, certains spécialistes du domaine de l’écologie juive croient que la Bible hébraïque puisse fournir, à son tour, un cadre théorique et pratique permettant de favoriser la réflexion et l’action eu égard aux problèmes liés au développement agroécologique durable. En milieu scolaire, les éducateurs tendent à enseigner l’écologie de manière concrète et dans un cadre intime, et ce en recourant à des programmes centrés sur les jardins pédagogiques. Dans le présent article, nous examinerons le cas de l’école Heschel de Toronto, une école juive canadienne qui a recours à un jardin pédagogique dans le but d’amener les élèves à poursuivre un apprentissage axé sur l’écologie et l’identité juive. En se basant sur des entrevues qualitatives réalisées avec deux éducateurs et cinq anciens élèves de l’école Heschel, notre étude mettra en évidence les similitudes et les différences principales entre le programme de jardin de l’école Heschel et les programmes des écoles laïques. À l’instar des jardins pédagogiques laïques, le programme de l’école Heschel propose des activités éducatives qui encouragent une forme d’apprentissage de type expérientiel et interdisciplinaire fondée sur des savoirs écologiques scientifiques (SES). Toutefois, le programme de l’école Heschel se distingue des programmes laïques en complétant et en approfondissant cet apprentissage en recourant à des savoirs écologiques traditionnels (SET) ancrés dans la tradition juive. Or, il semblerait que les résultats scolaires qui en découlent soient, à la fois, universellement applicables et spécifiquement pertinents eu égard à l’identité juive des apprenants visés.  &nbsp

The P323L substitution in the SARS-CoV-2 polymerase (NSP12) confers a selective advantage during infection

Background The mutational landscape of SARS-CoV-2 varies at the dominant viral genome sequence and minor genomic variant population. During the COVID-19 pandemic, an early substitution in the genome was the D614G change in the spike protein, associated with an increase in transmissibility. Genomes with D614G are accompanied by a P323L substitution in the viral polymerase (NSP12). However, P323L is not thought to be under strong selective pressure. Results Investigation of P323L/D614G substitutions in the population shows rapid emergence during the containment phase and early surge phase during the first wave. These substitutions emerge from minor genomic variants which become dominant viral genome sequence. This is investigated in vivo and in vitro using SARS-CoV-2 with P323 and D614 in the dominant genome sequence and L323 and G614 in the minor variant population. During infection, there is rapid selection of L323 into the dominant viral genome sequence but not G614. Reverse genetics is used to create two viruses (either P323 or L323) with the same genetic background. L323 shows greater abundance of viral RNA and proteins and a smaller plaque morphology than P323. Conclusions These data suggest that P323L is an important contribution in the emergence of variants with transmission advantages. Sequence analysis of viral populations suggests it may be possible to predict the emergence of a new variant based on tracking the frequency of minor variant genomes. The ability to predict an emerging variant of SARS-CoV-2 in the global landscape may aid in the evaluation of medical countermeasures and non-pharmaceutical interventions

Para-infectious brain injury in COVID-19 persists at follow-up despite attenuated cytokine and autoantibody responses

To understand neurological complications of COVID-19 better both acutely and for recovery, we measured markers of brain injury, inflammatory mediators, and autoantibodies in 203 hospitalised participants; 111 with acute sera (1–11 days post-admission) and 92 convalescent sera (56 with COVID-19-associated neurological diagnoses). Here we show that compared to 60 uninfected controls, tTau, GFAP, NfL, and UCH-L1 are increased with COVID-19 infection at acute timepoints and NfL and GFAP are significantly higher in participants with neurological complications. Inflammatory mediators (IL-6, IL-12p40, HGF, M-CSF, CCL2, and IL-1RA) are associated with both altered consciousness and markers of brain injury. Autoantibodies are more common in COVID-19 than controls and some (including against MYL7, UCH-L1, and GRIN3B) are more frequent with altered consciousness. Additionally, convalescent participants with neurological complications show elevated GFAP and NfL, unrelated to attenuated systemic inflammatory mediators and to autoantibody responses. Overall, neurological complications of COVID-19 are associated with evidence of neuroglial injury in both acute and late disease and these correlate with dysregulated innate and adaptive immune responses acutely

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

Regulating Traditional Medicine Professionals in the Public Interest: A Case Study of Chinese Medicine and Acupuncture Regulation in Ontario, Canada

Many complementary and alternative medicine (CAM) interventions, such as acupuncture and herbal medicines, are rooted in traditional medicine (TM) systems indigenous to particular cultures and lands. The World Health Organization has recommended that nations take steps to regulate both TM and CAM practitioners worldwide, with the aim of enhancing their ‘safety, quality and effectiveness’. Several United Nations bodies have moreover recommended that nations take steps to protect TM knowledge, and prevent further misappropriation of TM practices. However, to date, very few studies have investigated or discussed how regulators may address the unique complexities of regulating TM practitioners and TM-rooted practices. This PhD dissertation – a qualitative case study of traditional Chinese medicine and acupuncture regulation in the province of Ontario, Canada: a) explores the range of factors that distinguish the regulation of traditional medicine practices and professionals from biomedical professionals; and b) considers how the ‘public interest’ may be conceptualized to appropriately address these distinguishing factors in regulatory context. Data for the study was generated from several sources, including mixed methods survey, documentary review, and 32 key informant interviews. Analytic approaches included thematic and critical discourse analyses using the principle of ‘regulatory equity’ as a guiding concept. Postcolonial, multiculturalism, and boundary work theories, as well as legal principles of disparate impact discrimination and reasonable accommodation, were applied across the study. This body of work points to ways in which regulatory structures in Western liberal democracies may systemically privilege biomedical and non-immigrant practitioners by examining state risk discourses and the construction of regulatory boundaries for acupuncture; the issue of English-language fluency for immigrant practitioners; and the negotiation of safety, quality and epistemology in acupuncture standard-setting across professions. In this light, a series of strategies is proposed to assist regulators in negotiating equitable approaches to CAM and TM regulation. Emphasizing a broad conception of the ‘public interest,’ these strategies prioritize protection of traditional knowledge frameworks, while seeking to accommodate biomedical practitioners’ safe and skilled adoption of TM-rooted health care approaches.Ph.D

Evaluating the international standards gap for the use of acupuncture needles by physiotherapists and chiropractors: A policy analysis.

BackgroundAcupuncture needles have become an increasingly-popular treatment tool used by multiple health professions. However, the World Health Organization (WHO)'s 1999 training guidelines for acupuncture address only medical doctors and licensed acupuncturists, leaving a gap as to appropriate training standards for other professions.Aims and methodsWith reference to an extensive document analysis, and interviews with seventeen acupuncture educators from across several professions in Ontario, Canada, this work uses a critical qualitative policy analytic approach to: a) present a comprehensive account of statutory training requirements for acupuncture-needling physiotherapists and chiropractors in the United States, Canada, and Australia; and b) evaluate competing stakeholder discourses pertaining to recent related controversies.ResultsA wide range of educational requirements are evident across the jurisdictions under study (most below the 200-hour WHO guideline for physicians); and there is considerable disagreement among stakeholders as to what constitutes sufficient training in various forms of acupuncture, including 'dry needling'. Organizations defending brief post-graduate training for needling physiotherapists and chiropractors are generally associated with these two professions, and contend that their 'dry needling' practices differ substantially from traditional acupuncture. Characterizing such brief training as insufficient, opportunistic and unsafe, and 'dry needling' as a subset of acupuncture practice, are the voices of all acupuncture educators interviewed, as well as professional organizations representing physicians, licensed acupuncturists, and some physiotherapists and chiropractors.Discussion and conclusionCritiquing claims on both sides of the debate, this work calls for the development of independent, international safety-geared training guidelines that explicitly address the recent, evidence-informed trend towards biomedicalized acupuncture needling. Findings also suggest a need for additional research regarding the current shift towards overlapping-rather than exclusive-health professional practice scopes in industrialized countries

A mixed-methods survey of physiotherapists who practice acupuncture and dry needling in Ontario, Canada: practice characteristics, motivations, and professional outcomes

Abstract Background Physiotherapists (PTs) across the globe are increasingly incorporating filiform needling techniques (e.g., acupuncture, dry needling) into their clinical toolkits; and, the evidence base for these complementary therapies is becoming progressively more robust. However, to date, little is known about needling PTs themselves. Methods Using a cross-sectional survey design, PTs authorized to perform needling therapies in Ontario, Canada were recruited for anonymous participation (n = 2061) in an online survey. The survey asked providers about their demographics and practice characteristics, rationale for and views about therapeutic needling, and their related clinical and professional outcomes. The response rate was 20.7% (n = 426), and 22.3% (n = 95) of respondents provided textual responses to an open-ended qualitative question. Results While study respondents’ demographic features appear similar to their broader professional population, Ontario’s needling PTs are less likely to work in public sector settings. Most completed training in medical acupuncture rather than dry needling, and typically used needling in over one-third of patient visits. Almost all endorsed needling as an effective musculoskeletal treatment, the primary factor informing their adoption of the practice. While many viewed traditional Chinese medical theories as a useful explanatory framework, most relied on biomedical epistemology to drive their needling work. A majority of respondents reported that the inclusion of needling within their clinical toolkits had improved their likelihood of achieving excellent clinical results, helped support patient recruitment and retention, and heightened their professional satisfaction. While a few reported earning a higher income as a result, most reported that their clinical use of needling in addition to other PT modalities reduced their physical fatigue after a day’s work. Conclusions This study represents a first scholarly investigation into the motivations, training backgrounds and practice patterns of PTs who use acupuncture or dry needling. Additional research from other jurisdictions is needed to evaluate the transferability of study findings

Supportive but “worried”: perceptions of naturopaths, homeopaths and Chinese medicine practitioners through a regulatory transition in Ontario, Canada

Abstract Background In line with recent World Health Organization recommendations, many jurisdictions are taking steps to regulate practitioners of traditional, complementary and alternative medicine (TCAM). Previous studies have examined TCAM practitioners’ generally-supportive views about professional regulation; however, little research has been conducted on TCAM practitioners’ experiences and perspectives amidst an active regulatory process. In 2006 and 2007, the province of Ontario, Canada announced it would grant self-regulatory status to three TCAM practitioner groups - homeopaths, naturopaths and Chinese medicine practitioners/acupuncturists. Methods In 2011 and 2012, part-way through each group’s regulatory process, we surveyed all practitioners from these three groups (n = 1047) that could be identified from public registries and professional associations. The data presented here are derived from the sub-sample of homeopaths (n = 234), naturopaths (n = 273) and Chinese medicine practitioners/acupuncturists (n = 181) who provided answers to an open-ended question about their opinions of the regulatory process at the end of the survey. An inductive, thematic analysis of qualitative survey responses was conducted. Results Survey responses affirmed a pro-regulatory stance across all groups, but revealed considerable ‘worry’ amongst practitioners as to how the regulations might be implemented. Four primary ‘worry-related’ themes emerged: a) regulation’s potential administrative and financial burden on practitioners; b) scope-related concerns; c) implementation of fair registration standards; and d) whether regulation might erode the groups’ distinctive worldviews. Some occupationally-specific concerns appeared related to each group’s particular stage of professionalization. Other ‘worries’ may be related to the relative marginality of TCAM practitioner groups within biomedically-dominant national health care systems, and the possibility that inter-professional hierarchies may be emerging between particular TCAM groups. Specific concerns around overlapping practice scopes between TCAM and other professions raised questions about the implementation of non-monopolistic regulatory models such as Ontario’s. Conclusions Overall, this study will help inform regulators and TCAM practitioner groups to navigate the unique challenge of regulating health care providers long excluded from national health care systems, who frequently work from within paradigms distinct from mainstream biomedicine