A Sunday Afternoon

This garment was a collaborative project that explored the integration of 2D and 3D design and the communication of tacit knowledge between co-designers. This garment was inspired from the 1884 painting by George Seurat, A Sunday Afternoon on the Island of La Grande Jatte

Kinship Diversion in the District of Columbia: A Review of Local Practice to Inform National Policy

This article addresses a practice commonly known in the child welfare community as “kinship diversion,” where a child welfare agency informally places children with relatives as an alternative to foster care. While evidence predominantly shows that abused and neglected children have better outcomes when they are placed with relatives when they cannot remain safely at home, serious concerns about these children’s safety and well-being arise when the placement with relatives is informal. Indeed, it is often not understood that these same relatives can be approved as foster parents and can receive essential financial assistance and supportive services to help safely raise these children, who often have significant needs. By contrast, kinship diversion does not protect abused and neglected children from harm nor does it help stabilize the family unit financially or emotionally. As such, the safety of diverted abused and neglected children is imperiled because child protection agencies do not oversee or manage what happens to them. Using the practices of the District of Columbia child protection agency as an example of how kinship diversion is implemented by child welfare agencies nationally, this article provides recommendations for identifying and implementing best practices in this area to protect diverted children

Beliefs About Medication and Uptake of Preventive Therapy in Women at Increased Risk of Breast Cancer: Results From a Multicenter Prospective Study

Introduction Uptake of preventive therapies for breast cancer is low. We examined whether women at increased risk of breast cancer can be categorized into groups with similar medication beliefs, and whether belief group membership was prospectively associated with uptake of preventive therapy. Patients and Methods Women (n = 732) attending an appointment to discuss breast cancer risk were approached; 408 (55.7%) completed the Beliefs About Medicines and the Perceived Sensitivity to Medicines questionnaires. Uptake of tamoxifen at 3 months was reported in 258 (63.2%). The optimal number of belief groups were identified using latent profile analysis. Results Uptake of tamoxifen was 14.7% (38/258). One in 5 women (19.4%; 78/402) reported a strong need for tamoxifen. The model fit statistics supported a 2-group model. Both groups held weak beliefs about their need for tamoxifen for current and future health. Group 2 (38%; 154/406 of the sample) reported stronger concerns about tamoxifen and medicines in general, and stronger perceived sensitivity to the negative effects of medicines compared with group 1 (62%; 252/406). Women with low necessity and lower concerns (group 1) were more likely to initiate tamoxifen (18.3%; 33/180) than those with low necessity and higher concerns (group 2) (6.4%; 5/78). After adjusting for demographic and clinical factors, the odds ratio was 3.37 (95% confidence interval, 1.08-10.51; P = .036). Conclusion Uptake of breast cancer preventive therapy was low. A subgroup of women reported low need for preventive therapy and strong medication concerns. These women were less likely to initiate tamoxifen. Medication beliefs are targets for supporting informed decision-making

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Visitor behavior in zoo exhibits with underwater viewing: An evaluation of six exhibits in the western United States

The design of zoo and aquarium exhibits has a strong influence on visitor behavior in exhibit enclosures. Furthermore, zoo exhibits with underwater viewing draw large crowds. The intent of this study was to formulate significant design criteria, through post-occupancy evaluation, to be used for the design of successful underwater exhibits in zoos. This study was conducted to reveal factors significantly influencing viewing time and visitor behavior in zoo exhibits with underwater viewing. At four zoo facilities, 331 visitor groups were observed and asked to participate in a short survey at six zoo exhibits. Chi-square analysis and analysis of variance (ANOVA) were used to evaluate observation and survey results. The size of the underwater viewing window, animal size, animal aquatic activity, presence of infant animals, visitor group type and crowding levels had a significant impact on visitor behavior. Recommendations for the future design of underwater zoo exhibits are discussed

A Sunday Afternoon

This garment was a collaborative project that explored the integration of 2D and 3D design and the communication of tacit knowledge between co-designers. This garment was inspired from the 1884 painting by George Seurat, A Sunday Afternoon on the Island of La Grande Jatte.</p