Self-expansion is positively associated with Fitbit-measured daily steps across 4-weeks.

The growth of the self-concept through increasing perspectives, identities, resources, and efficacy is known as self-expansion and typically involves novelty, challenge, interest, and/or excitement. Self-expansion is positively associated with health factors including self-reported physical activity (PA). This study is the first to investigate self-expansion and daily PA, and with a PA monitor. Fifty community participants completed baseline questionnaires, wore a Fitbit One and completed daily self-report questionnaires for 28 days, and completed follow-up questionnaires. Daily surveys included questions about both general and PA-specific self-expansion. Across the 4 weeks, steps taken was positively correlated with both general (all maximum likelihood r = 0.17) and PA-specific self-expansion (maximum likelihood rs of 0.15 and 0.16), and PA-specific self-expansion was positively correlated (maximum likelihood rs of 0.38 and 0.50) with aerobic activity. Future research should investigate this relationship in a larger more diverse sample and test whether PA-specific self-expansion can be utilized as an acceptable, feasible, and effective intervention to increase daily steps and other forms of PA

Trickle or treat: the dynamics of nutrient export from polar glaciers

Cold-based polar glacier watersheds contain well-defined supraglacial, ice-marginal, and proglacial elements that differ in their degree of hydrologic connectivity, sources of water (e.g., snow, ice, and/or sediment pore water), meltwater residence times, allochthonous and autochthonous nutrient, and sediment loads. We investigated 11 distinct hydrological units along the supraglacial, ice marginal, and proglacial flow paths that drain Joyce Glacier in the McMurdo Dry Valleys of Antarctica. We found that these units play unique and important roles as sources and/or sinks for dissolved inorganic nitrogen and dissolved inorganic phosphorus and for specific fractions of dissolved organic matter (DOM) as waters are routed from the glacier into nutrient-poor downstream ecosystems. Changes in nutrient export from the glacial system as a whole were observed as the routing and residence times of meltwater changed throughout the melt season. The concentrations of major ions in the proglacial stream were inversely proportional to discharge, such that there was a relatively constant “trickle” of these solutes into downstream ecosystems. In contrast, NO3− concentrations generally increased with discharge, resulting in delivery of episodic pulses of dissolved inorganic nitrogen-rich water (“treats”) into those same ecosystems during high discharge events. DOM concentrations or fluorescence did not correlate with discharge rate, but high variability in DOM concentrations or fluorescence suggests that DOM may be exported downstream as episodic treats, but with spatial and/or temporal patterns that remain poorly understood. The strong, nutrient-specific responses to changes in hydrology suggest that polar glacier drainage systems may export meltwater with nutrient compositions that vary within and between melt seasons and watersheds. Because nutrient dynamics identified in this study differ between glacier watersheds with broadly similar hydrology, climate, and geology, we emphasize the need to develop conceptual models of nutrient export that thoroughly integrate the biogeochemical an

Understanding the experiences of Black women medical students and residents: A narrative review.

Few research studies examine medical students and residents with intersectional identities. In the emerging literature, data on Black women’s experiences may be misrepresented and misinterpreted as studies aggregate data for women, students of color, and Black/African American men. As such, these studies do not account for the nuanced experiences of gendered racism that Black women students and residents may encounter during their medical education. Using Crenshaw’s intersectionality as an analytical lens, we conducted a narrative review to highlight how Black women medical students and residents are rendered invisible in the current literature on medical education. The results generated 13 citations specifically discussing Black women medical students and residents. This study underscores the importance of diversifying medical education

Understanding the Experiences of Black Women Medical Students and Residents: A Narrative Review..

Background: Few research studies examine medical students and residents with intersectional identities. In the emerging literature, data on Black women’s experiences may be misrepresented and misinterpreted as studies aggregate data for women, students of color, and Black/African American men. As such, these studies do not account for the nuanced experiences of gendered racism that Black women students and residents may encounter during their medical education. Methods: Using Crenshaw’s intersectionality as an analytical tool, we conducted a narrative review to highlight how Black women medical students and residents are rendered invisible in the current literature on medical education. Results: The results generated 13 citations specifically discussing Black women medical students and residents, with only six studies being empirical research. Conclusion: We conclude that 13 articles is inadequate for understanding the experiences of these populations. Without centering Black women or using an intersectional lens, researchers could invalidate the lived experiences of this population and create barriers to the political resources Black women learners need to be successful. Moreover, the lack of intention behind addressing the needs of Black women can be viewed as complicity in the oppressive structures that serve to subjugate them

A snapshot of the practicality and barriers to COVID-19 interventions: Public health and healthcare workers' perceptions in high and low- and middle-income countries.

BACKGROUND: In response to the COVID-19 pandemic, governments have implemented a range of non-pharmaceutical interventions (NPIs) and pharmaceutical interventions (PIs) to reduce transmission and minimise morbidity and mortality, whilst maintaining social and economic activities. The perceptions of public health workers (PHWs) and healthcare workers (HCWs) are essential to inform future COVID-19 strategies as they are viewed as trusted sources and are at the forefront of COVID-19 response. The objectives of this study were to 1) describe the practicality of implementing NPIs and PIs and 2) identify potential barriers to implementation, as perceived by HCWs and PHWs. METHODS: We conducted a cross-sectional study of PHWs and HCWs perceptions of the implementation, practicality of, and barriers to implementation of NPIs and PIs using an online survey (28/9/2020-1/11/2020) available in English, French and Portuguese. We used descriptive statistics and thematic analysis to analyse quantitative and qualitative responses. RESULTS: In total, 226 respondents (67 HCWs and 159 PHWs) from 52 countries completed the survey and 222 were included in the final analysis. Participants from low and middle-income countries (LMICs) accounted for 63% of HCWs and 67% of PHWs, with the remaining from high-income (HICs). There was little difference between the perceptions of PHWs and HCWs in HICs and LMICs, with the majority regarding a number of common NPIs as difficult to implement. However, PHWs in HICs perceived restrictions on schools and educational institutions to be more difficult to implement, with a lack of childcare support identified as the main barrier. Additionally, most contact tracing methods were perceived to be more difficult to implement in HICs than LMICs, with a range of barriers reported. A lack of public support was the most commonly reported barrier to NPIs overall across both country income and professional groups. Similarly, public fear of vaccine safety and lack of vaccine supply were the main reported barriers to implementing a COVID-19 vaccine. However, PHWs and HCWs in LMICs perceived a lack of financial support and the vaccine being manufactured in another country as additional barriers. CONCLUSION: This snapshot provides insight into the difficulty of implementing interventions as perceived by PHWs and HCWs. There is no one-size-fits-all solution to implementing interventions, and barriers in different contexts do vary. Barriers to implementing a vaccine programme expressed here by HCWs and PHCWs have subsequently come to the fore internationally

An evaluation of a pilot of daily testing of SARS-CoV-2 contacts in acute hospital and ambulance trusts in England

OBJECTIVES: Healthcare worker (HCW) SARS-CoV-2 contacts in England have been required to quarantine, creating staff shortages. We piloted daily contact testing (DCT) to assess its feasibility as an alternative. STUDY DESIGN: Observational service evaluation. METHODS: We conducted an observational service evaluation of seven-day daily contact testing using antigen lateral flow devices, (LFDs) at four acute hospital trusts and one ambulance trust in England. Mixed methods were employed, utilising aggregate and individual-level test monitoring data, semi-structured interviews, and a survey of eligible contacts. RESULTS: In total, 138 HCWs were identified as contacts of a confirmed SARS-CoV-2 case. Of these, 111 (80%) consented to daily LFD testing, of whom 82 (74%) completed the required programme without interruption, and 12 (11%) completed with interruption. Fifty-eight (52%) participants and two (7·4%) non-participants completed the survey. In total, 28 interviews were conducted with participants, site and infection control leads, and union representatives. One participant tested positive on LFD and polymerase chain reaction (PCR) test. Three participants tested positive on PCR but not LFD. DCT was well-accepted by trusts and staff. Participants reported no relaxation of their infection prevention and control behaviours. No incidents of transmission were detected. An estimated 729 potential days of work absence were averted. CONCLUSIONS: DCT can be acceptably operated in a healthcare setting, averting quarantine-related work absences in HCW SARS-CoV-2 contacts

Reflexive adaptation for resilient water services: lessons for theory and practice

‘Adaptive management’ concern attempts to manage complex social-ecological and socio-technical systems in nimble ways to enhance their resilience. In this paper, three forms of adaptive management are identified, ‘scientific’ forms focused on collation of scientific data in response to management experiments, but more recent developments adding processes of collaboration as well as emphasising the need for reflexivity, that is, conscious processes of opening up debates to different perspectives and values. While reflexive adaptive management has been increasingly discussed in theory, there is a lack of examples of what its application means in practice. As a response, this paper examines an ‘Adaptive Planning Process’ (APP), seeking to apply reflexive adaptive management as a means to improve climate resilience in the UK water sector. The APP’s three inter linked workshops – Aspiration, Scenario and Roadmapping – were co-developed and trialled in a water utility. By describing and justifying the choices made in the development of the APP, the paper aims to reveal some of the challenges that arise when trying to design processes that achieve reflexive adaptation. The paper concludes that, if applied to planning for climate change, reflexive adaptation has the potential to explore multiple value positions, highlight different potential futures and acknowledge (and hence, partly address) power differentials, and therefore to offer the possibility of real change. On the basis of the trial, we argue that through tapping the depth and breadth of internal knowledge the APP process created the potential for decision making to be joined up across different parts of the utility, and hence offering new strategies and routes for addressing uncertainties and delivering more resilient water services

Decentralising NCD management in rural southern Africa: evaluation of a pilot implementation study

Background The prevalence of non-communicable diseases, and associated morbidity and mortality, is increasing rapidly in low and middle-income countries where health systems often have limited access and lower quality of care. The intervention was to decentralise uncomplicated non-communicable disease (NCD) care from a hospital to nurse practitioners in health centres in a poor rural district in Eswatini, southern Africa. The objective of this study was to assess the feasibility and impact of decentralised care for NCDs within nurse-led clinics in order improve access and inform healthcare planning in Eswatini and similar settings. Methods In collaboration with the Eswatini Ministry of Health, we developed and implemented a package of interventions to support nurse-led delivery of care, including: clinical desk-guide for hypertension and diabetes, training modules, treatment cards and registries and patient leaflets. Ten community clinics in the Lubombo Region of Eswatini were randomly selected to be trained to deliver NCD care for a period of 18 months. Observational data on follow-up rates, blood pressure (BP), glucose etc. were recorded and evaluated. We compared blood pressure and blood glucose measurements between the first and fourth visits and fitted a linear mixed effects model. Results One thousand one hundred twenty-five patients were recruited to the study. Of these patients, 573 attended for at least 4 appointments. There was a significant reduction in mean BP among hypertensive patients after four visits of 9.9 mmHg systolic and 4.7 mmHg diastolic (p = 0.01), and a non-significant reduction in fasting blood glucose among diabetic patients of 1.2 mmol/l (p = 0.2). Key components of NCD care were completed consistently by nurses throughout the intervention period, including a trend towards patients progressing from monotherapy to dual therapy in accordance with prescribing guidelines. Conclusions The findings suggest that management of diabetes and hypertension care in a rural district setting can be safely delivered by nurses in community clinics according to a shared care protocol. Improved access is likely to lead to improved patient compliance with treatment