Communication about sexual health and decision making with adolescents in foster care

This study uses original data to identify predictors of communication between child welfare workers in a Midwestern state and the adolescents they serve who are residing in foster care regarding their sexual health and decision making. Quantitative analysis was used to identify statistically significant models of communication between child welfare workers and adolescents residing in foster care regarding their sexual health and decision making. The comfort level of child welfare workers around discussing sexual health issues with adolescents residing in foster care was found to be a significant predictor in five out of six regression models

Service Learning and Community-Based Research: Implementation, Benefits, Challenges, and Future Directions

Rationale: Service learning and community engagement are a natural fit for many disciplines. Service learning projects provide students with an opportunity to apply course content to real world situations (Harder, 2010), developing projects that will benefit clients, agencies, and communities. Service learning is used across a variety of disciplines including social work (Hostetter, Sullenberger, & Wood, 2013) nursing (Murray, 2013) and business (Payne, Campbell, Bal, & Piercy, 2011). Working in a group within a service learning context provides a multitude of benefits including greater interest, motivation, and engagement; improved communication skills; real-life application of course content; and skills acquisition (Murray, 2013; Payne et al., 2011; Postlethwait, 2012). Panel Purpose: The purpose of this panel is to describe how four faculty members incorporated service learning into their social work courses. This panel is unique in that three of the four faculty began conducting service learning projects while at the same institution and are now integrating service learning into their respective university settings in a variety of ways. Goals: Five goals exist for this panel. By the end of the Panel participants will understand (1) how to implement student-led community-based research projects, (2) how to build partnerships with diverse stakeholders/agency settings, (3) benefits and challenges of student-led research within a community-based agency, (4) how to use projects to support agency change, and (5) future directions in service learning. Specifically, the panel will provide the audience with information on how to incorporate student-led community-based research projects into their courses. First, the discussion will focus on how to prepare for a community-based research project. The panelists will describe how to: (a) develop an assignment that is consistent with learning outcomes and meets the need of the partner agency, (b) create a project that is feasible to complete in one semester and results in a high quality project, (c) manage and plan for difficult group dynamics, and (d) incorporate measures of student learning and engagement into a service learning course. Second, the panelists will describe the art of building relationships and engaging diverse stakeholders/agencies in the community-based research project, highlighting key strategies. Next, the panelists will discuss the benefits, challenges, and lessons learned from implementing service learning into their courses. For example, one panelist will describe the challenges of partnering with a rural agency, while another panelist will highlight how agency politics influence students’ abilities to conduct agency-based research. Lastly, the panelists will discuss how to use service learning to support community change and explore future directions for service learning. Participant Engagement will occur through questions designed to elicit discussion related to the five Panel goals. Participants will also be asked to share their experiences with the various topics covered during the panel

The Intersections of Biological Diversity and Cultural Diversity: Towards Integration

There is an emerging recognition that the diversity of life comprises both biological and cultural diversity. In the past, however, it has been common to make divisions between nature and culture, arising partly out of a desire to control nature. The range of interconnections between biological and cultural diversity are reflected in the growing variety of environmental sub-disciplines that have emerged. In this article, we present ideas from a number of these sub-disciplines. We investigate four bridges linking both types of diversity (beliefs and worldviews, livelihoods and practices, knowledge bases and languages, and norms and institutions), seek to determine the common drivers of loss that exist, and suggest a novel and integrative path forwards. We recommend that future policy responses should target both biological and cultural diversity in a combined approach to conservation. The degree to which biological diversity is linked to cultural diversity is only beginning to be understood. But it is precisely as our knowledge is advancing that these complex systems are under threat. While conserving nature alongside human cultures presents unique challenges, we suggest that any hope for saving biological diversity is predicated on a concomitant effort to appreciate and protect cultural diversity

Clinical outcomes of patients with estimated low or intermediate surgical risk undergoing transcatheter aortic valve implantation

Aims Transcatheter aortic valve implantation (TAVI) is an established treatment alternative to surgical aortic valve replacement in high-risk and inoperable patients and outcomes among patients with estimated low or intermediate risk remain to be determined. The aim of this study was to assess clinical outcomes among patients with estimated low or intermediate surgical risk undergoing TAVI. Methods and results Between August 2007 and October 2011, 389 consecutive patients underwent TAVI and were categorized according to the Society of Thoracic Surgeons (STS) score into low (STS 8%; n = 94, 24.2%) groups for the purpose of this study. Significant differences were found between the groups (low risk vs. intermediate risk vs. high risk) for age (78.2 ± 6.7 vs. 82.7 ± 5.7 vs. 83.7 ± 4.9, P < 0.001), body mass index (28.1 ± 6.1 vs. 26.5 ± 4.9 vs. 24.4 ± 4.6, P < 0.001), chronic renal failure (34 vs. 67 vs. 90%, P < 0.001), all-cause mortality at 30 days (2.4 vs. 3.9 vs. 14.9%, P = 0.001), and all-cause mortality at 1 year (10.1 vs. 16.1 vs. 34.5%, P = 0.0003). No differences were observed with regards to cerebrovascular accidents and myocardial infarction during 1-year follow-up. Conclusion In contemporary practice, TAVI is not limited to inoperable or STS-defined high-risk patients and should be guided by the decision of an interdisciplinary Heart Team. Compared with patients at calculated high risk, well-selected patients with STS-defined intermediate or low risk appear to have favourable clinical outcome

Assessing the contribution of recreational sea angling to the English economy

Sea angling has been shown to be a high value activity with significant expenditure by individuals on their sport. Deriving estimates of the economic contribution of recreational sea angling is important in a number of related policy contexts, from tourism management and economic development policy, to the sustainable management of inshore fish stocks. This paper reveals some of the challenges in understanding the economic effects associated with recreational sea angling, and provides estimates of the economic value of recreational sea angling in England. The results were derived from research undertaken in England in 2011- 13, which was conducted as part a wide ranging government-funded study, Sea Angling 2012, that estimated sea angler catches, spending and activity. Recreational sea angling made a significant contribution to the economy, supporting just over £2 billion of total spending, and 23,600 jobs in England in 2012-13. The implications of these results are discussed in the context of the management of recreational sea angling in England

Qualitative meta-synthesis of user experience of computerised therapy for depression and anxiety

Objective: Computerised therapies play an integral role in efforts to improve access to psychological treatment for patients with depression and anxiety. However, despite recognised problems with uptake, there has been a lack of investigation into the barriers and facilitators of engagement. We aimed to systematically review and synthesise findings from qualitative studies of computerised therapies, in order to identify factors impacting on engagement. Method: Systematic review and meta-synthesis of qualitative studies of user experiences of computer delivered therapy for depression and/or anxiety. Results: 8 studies were included in the review. All except one were of desktop based cognitive behavioural treatments. Black and minority ethnic and older participants were underrepresented, and only one study addressed users with a comorbid physical health problem. Through synthesis, we identified two key overarching concepts, regarding the need for treatments to be sensitive to the individual, and the dialectal nature of user experience, with different degrees of support and anonymity experienced as both positive and negative. We propose that these factors can be conceptually understood as the ‘non-specific’ or ‘common’ factors of computerised therapy, analogous to but distinct from the common factors of traditional face-to-face therapies. Conclusion: Experience of computerised therapy could be improved through personalisation and sensitisation of content to individual users, recognising the need for users to experience a sense of ‘self’ in the treatment which is currently absent. Exploiting the common factors of computerised therapy, through enhancing perceived connection and collaboration, could offer a way of reconciling tensions due to the dialectal nature of user experience. Future research should explore whether the findings are generalisable to other patient groups, to other delivery formats (such as mobile technology) and other treatment modalities beyond cognitive behaviour therapy. The proposed model could aid the development of enhancements to current packages to improve uptake and support engagement

Implementation of corticosteroids in treating COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK:prospective observational cohort study

BACKGROUND: Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. METHODS: We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. FINDINGS: Between June 17, 2020, and April 14, 2021, 47 795 (75·2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86·6%] of 12 909 vs 36 415 [72·4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0·79 [95% CI 0·70–0·89], p=0·0001, for 70–79 years; 0·52 [0·46–0·58], p80 years), independent of patient demographics and illness severity. 84 (54·2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27·5% in the week before June 16, 2020, to 75–80% in January, 2021. INTERPRETATION: Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. FUNDING: UK National Institute for Health Research and UK Medical Research Council

Procalcitonin Is Not a Reliable Biomarker of Bacterial Coinfection in People With Coronavirus Disease 2019 Undergoing Microbiological Investigation at the Time of Hospital Admission

Abstract Admission procalcitonin measurements and microbiology results were available for 1040 hospitalized adults with coronavirus disease 2019 (from 48 902 included in the International Severe Acute Respiratory and Emerging Infections Consortium World Health Organization Clinical Characterisation Protocol UK study). Although procalcitonin was higher in bacterial coinfection, this was neither clinically significant (median [IQR], 0.33 [0.11–1.70] ng/mL vs 0.24 [0.10–0.90] ng/mL) nor diagnostically useful (area under the receiver operating characteristic curve, 0.56 [95% confidence interval, .51–.60]).</jats:p

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients