A Japanese Canadian Nurse Reflects on Cultural Competency, Humility, and Safety in Caring for an Indigenous Patient

The effects of colonization in Canada continue to cause mistrust of the healthcare system among some Indigenous people. A Canadian registered nurse of Japanese and European descent reflects upon his final clinical placement as a student nurse, where he cared for an older Indigenous woman in North Central Saskatchewan. The concepts of cultural competence, humility and safety were applied by reflecting upon the history of Indigenous people in Canada, as well as through the nurse’s life experiences with Indigenous people. The nurse’s own family history of Japanese Canadian internment during the Second World War was contemplated, and the discrimination facing his family after WW2.  Lessons learned from reflecting on cultural competence, cultural humility, and cultural safety in clinical experiences will have implications for the health care system, the profession of nursing, patient outcomes, and my future nursing practice. Necessary changes still needed in the healthcare system in light of recent racial encounters are discussed. &nbsp

Nonequilibrium Josephson-like effects in wide mesoscopic S-N-S junctions

Mesoscopic superconducting-normal-metal-superconducting (S-N-S) junctions with a large separation between the superconducting electrodes (i.e. wide junctions) exhibit nonequilibrium supercurrents, even at temperatures for which the equilibrium Josephson effect is exponentially small. The second harmonic of the Josephson frequency dominates these currents, as observed in recent experiments. A simple description of these effects, in the spirit of the Resistively-Shunted-Junction model, is suggested here. It is used to calculate dc I-V characteristics, and to examine the effects of various types of noise and of external microwave radiation (Shapiro steps). It is found that the nonequilibrium supercurrents are excited when the junction is driven by a dc bias or an ac bias, or even by external noise. In the case of junctions which are also long in the direction perpendicular to the current flow, thermodynamic phase fluctuations (thermal noise) alone can drive the quasiparticles out of local equilibrium. Magnetic flux is then predicted to be trapped in units of Phi_0 /2 = hc/4e.Comment: 10 pages, to appear in a special issue of Superlattices & Microstructure

Prevalence and Predictors of Giving Birth in Health Facilities in Bugesera District, Rwanda

Background The proportion of births attended by skilled health personnel is one of two indicators used to measure progress towards Millennium Development Goal 5, which aims for a 75% reduction in global maternal mortality ratios by 2015. Rwanda has one of the highest maternal mortality ratios in the world, estimated between 249–584 maternal deaths per 100,000 live births. The objectives of this study were to quantify secular trends in health facility delivery and to identify factors that affect the uptake of intrapartum healthcare services among women living in rural villages in Bugesera District, Eastern Province, Rwanda. Methods Using census data and probability proportional to size cluster sampling methodology, 30 villages were selected for community-based, cross-sectional surveys of women aged 18–50 who had given birth in the previous three years. Complete obstetric histories and detailed demographic data were elicited from respondents using iPad technology. Geospatial coordinates were used to calculate the path distances between each village and its designated health center and district hospital. Bivariate and multivariate logistic regressions were used to identify factors associated with delivery in health facilities. Results Analysis of 3106 lifetime deliveries from 859 respondents shows a sharp increase in the percentage of health facility deliveries in recent years. Delivering a penultimate baby at a health facility (OR = 4.681 [3.204 - 6.839]), possessing health insurance (OR = 3.812 [1.795 - 8.097]), managing household finances (OR = 1.897 [1.046 - 3.439]), attending more antenatal care visits (OR = 1.567 [1.163 - 2.112]), delivering more recently (OR = 1.438 [1.120 - 1.847] annually), and living closer to a health center (OR = 0.909 [0.846 - 0.976] per km) were independently associated with facility delivery. Conclusions The strongest correlates of facility-based delivery in Bugesera District include previous delivery at a health facility, possession of health insurance, greater financial autonomy, more recent interactions with the health system, and proximity to a health center. Recent structural interventions in Rwanda, including the rapid scale-up of community-financed health insurance, likely contributed to the dramatic improvement in the health facility delivery rate observed in our study

Policies for an Ageing Workforce Work-life balance, working conditions and equal opportunities 2019

At a time of rapid population ageing, a key means of sustaining current welfare states is to extend the length of working lives. In 2050, the share of people over the age of 75 years will be the same as the share over 65 years today. And just as not all are able to work to the age of 65 now, not everyone will be able to work to the age of 75 in 2050; even if future older workers will in all likelihood be healthier and have better working aids at their disposal. Extending average working lives by 10 years, and at the same time ensuring an adequate social safety net for those unable to work into their late 60s and 70s, is a major social policy challenge for the coming decades. And because people are much more likely to work late in life if they had stable careers before reaching 60, tackling this policy challenge means pulling on many more social policy levers than just pension policy. While being keenly aware of these issues and how they relate to the overall agenda of active ageing, Commissioner Thyssen also reminds us in her Foreword that marked increases in life expectancy – both past and in the future – represent enormous social progress. The Commissioner makes the point that older people too contribute to society. And more so with lifelong learning and investment in skills

Intrinsic aerobic capacity sets a divide for aging and longevity

<p><b>Rationale:</b> Low aerobic exercise capacity is a powerful predictor of premature morbidity and mortality for healthy adults as well as those with cardiovascular disease. For aged populations, poor performance on treadmill or extended walking tests indicates closer proximity to future health declines. Together, these findings suggest a fundamental connection between aerobic capacity and longevity.</p> <p><b>Objectives:</b> Through artificial selective breeding, we developed an animal model system to prospectively test the association between aerobic exercise capacity and survivability (aerobic hypothesis).</p> <p><b>Methods and Results:</b> Laboratory rats of widely diverse genetic backgrounds (N:NIH stock) were selectively bred for low or high intrinsic (inborn) treadmill running capacity. Cohorts of male and female rats from generations 14, 15, and 17 of selection were followed for survivability and assessed for age-related declines in cardiovascular fitness including maximal oxygen uptake (VO<sub>2max</sub>), myocardial function, endurance performance, and change in body mass. Median lifespan for low exercise capacity rats was 28% to 45% shorter than high capacity rats (hazard ratio, 0.06; P<0.001). VO<sub>2max</sub>, measured across adulthood was a reliable predictor of lifespan (P<0.001). During progression from adult to old age, left ventricular myocardial and cardiomyocyte morphology, contractility, and intracellular Ca<sup>2+</sup> handling in both systole and diastole, as well as mean blood pressure, were more compromised in rats bred for low aerobic capacity. Physical activity levels, energy expenditure (Vo<sub>2</sub>), and lean body mass were all better sustained with age in rats bred for high aerobic capacity.</p> <p><b>Conclusions:</b> These data obtained from a contrasting heterogeneous model system provide strong evidence that genetic segregation for aerobic exercise capacity can be linked with longevity and are useful for deeper mechanistic exploration of aging.</p&gt

Prospects for local co-governance

British local authorities and their partners are increasingly developing new ways of working together with local communities. The nature of this co-working, however, is complex, multi-faceted and little understood. This article argues for greater clarity of thinking on the topic, by analysing this co-working as a form of political co-governance, and drawing attention in particular to issues of scale and democracy. Using evidence from a study of 43 local authority areas, 16 authorities are identified where co-governance is practised, following three main types of approach: service-influencing, service-delivering and parish council developing. It is concluded that strengthening political co-governance is essential for a healthy democracy

Mechanistic insight into proton-coupled mixed valency

Stabilisation of the mixed-valence state in [Mo2(TiPB)3(HDOP)]2+ (HTiPB = 2,4,6-triisopropylbenzoic acid, H2DOP = 3,6-dihydroxypyridazine) by electron transfer (ET) is related to the proton coordinate of the bridging ligands. Spectroelectrochemical studies suggest that ET is slower than 109 s−1. The mechanism has been probed using DFT calculations, which show that proton transfer induces a larger dipole in the molecule resulting in ET

Scara1 deficiency impairs clearance of soluble Amyloid-β by mononuclear phagocytes and accelerates Alzheimer’s-like disease progression

In Alzheimer’s disease soluble amyloid beta (sAβ) causes synaptic dysfunction and neuronal loss. Receptors involved in clearance of sAβ are not known. Here we use shRNA screening and identify the scavenger receptor Scara1 as a receptor for sAβ expressed on myeloid cells. To determine the role of Scara1 in clearance of sAβ in vivo, we cross Scara1 null mice with PS1-APP mice, a mouse model of Alzheimer’s disease and generate PS1-APP- Scara1-deficient mice. Scara1 deficiency markedly accelerates Aβ accumulation leading to increased mortality. In contrast, pharmacological upregulation of Scara1 expression on mononuclear phagocytes increases Aβ clearance. This approach is a potential treatment strategy for Alzheimer’s disease