Food Resilience Toolkit

This toolkit is intended to help community leaders and technical support professionals assess and build food system resilience in their regions. The toolkit is available in English and Spanish and in written and video format. In the introduction, we explore the concept of resilience and the Community Capitals framework and suggest possible indicators of food system resilience. In Chapter 2, we outline four tools for assessing community advantages and challenges and developing plans to address them. These tools are: asset mapping, focus groups, nominal groups, and strategic planning. While many research techniques can be deployed for resilience building, we have found these four to be especially useful in building purpose-driven, directed initiatives that are responsive to community needs and assets. Chapter 3 explores the role of policy in building (or obstructing) resilience, and in responding to shocks. We take a birds-eye view of disaster experiences in both Vermont and Puerto Rico and review how political actors responded differently in each region. We use the Multiple Streams Approach as a lens for understanding how policy decisions happen and where there are opportunities to advocate for change. In the final chapter, we offer lessons from our own resilience research efforts in Puerto Rico and Vermont. We connect our findings with food system resilience indicators and community capitals to offer real-world examples of strengths and vulnerabilities in the face of crisis

Food Resilience Toolkit

This toolkit is intended to help community leaders and technical support professionals assess and build food system resilience in their regions. The toolkit is available in English and Spanish and in written and video format. In the introduction, we explore the concept of resilience and the Community Capitals framework and suggest possible indicators of food system resilience. In Chapter 2, we outline four tools for assessing community advantages and challenges and developing plans to address them. These tools are: asset mapping, focus groups, nominal groups, and strategic planning. While many research techniques can be deployed for resilience building, we have found these four to be especially useful in building purpose-driven, directed initiatives that are responsive to community needs and assets. Chapter 3 explores the role of policy in building (or obstructing) resilience, and in responding to shocks. We take a birds-eye view of disaster experiences in both Vermont and Puerto Rico and review how political actors responded differently in each region. We use the Multiple Streams Approach as a lens for understanding how policy decisions happen and where there are opportunities to advocate for change. In the final chapter, we offer lessons from our own resilience research efforts in Puerto Rico and Vermont. We connect our findings with food system resilience indicators and community capitals to offer real-world examples of strengths and vulnerabilities in the face of crisis

Caja de herramientas: Desarrollando resiliencia en el sistema alimentario

En esta caja de herramientas encontrarán guías y estudios sobre evaluación y desarrollo de la resiliencia de los sistemas agroalimentarios. La meta de este trabajo es que personas de la comunidad, líderes y profesionales puedan utilizar este material para que a través de la colaboración se pueda catalizar un cambio positivo en los sistemas agroalimentarios de sus regiones. Además, con el fin de lograr que este material educativo sea accesible se ha desarrollado tanto en manuscrito como videos, en los idiomas del inglés y español. En el Capítulo 1, se explora el concepto de resiliencia, el marco de los capitales comunitarios y se sugieren posibles indicadores de resiliencia en los sistemas agroalimentarios. Mientras en el Capítulo 2, se describen cuatro herramientas para evaluar las ventajas y desafíos de una comunidad. Estas herramientas son: mapeo de activos, grupos focales, grupos nominales y planificación estratégica. Estas cuatro son especialmente útiles para construir iniciativas dirigidas y orientadas a un propósito que respondan a las necesidades y activos de la comunidad. En el Capítulo 3, se explora el rol de la política pública entorno al desarrollo o la obstrucción hacia la resiliencia y como se desenvuelve esta ante amenazas que pueden llevar a una crisis. Para este caso se seleccionó investigar cómo los representantes de política pública respondieron ante las experiencias de desastres naturales en Vermont y Puerto Rico. Además, se utilizó el Enfoque de Flujos Múltiples como un lente para comprender cómo ocurren las decisiones políticas en estas situaciones y dónde hay oportunidades para abogar por el cambio. En el capítulo final, se presentan las lecciones que el equipo de trabajo investigó en Puerto Rico y Vermont. Por consiguiente, se conectaron los hallazgos con los indicadores de resiliencia del sistema agroalimentario y los capitales comunitarios para ofrecer ejemplos reales de fortalezas y vulnerabilidades frente a una crisis

Integrating the Patient’s Voice Into the Research Agenda for Treatment of Chemosensory Disorders

World-wide some 658 million people were infected with coronavirus disease 2019 (COVID-19) and millions suffer from chemosensory impairment associated with long COVID. Current treatments for taste and smell disorders are limited. Involving patients has the potential to catalyze the dynamic exchange and development of new ideas and approaches to facilitate biomedical research and therapeutics. We assessed patients\u27 perceptions of the efficacy of treatments for chemosensory impairment using an online questionnaire completed by 5,815 people in the US Logistic regression determined variables predictive of reported treatment efficacy for patients aged 18 to 24, 25 to 39, 40 to 60, and 60+ yrs. who were treated with nasal steroids, oral steroids, zinc, nasal rinse, smell training, theophylline, platelet-rich plasma, and Omega 3. The most consistent predictor was age, with the majority of those 40 to 60 and 60+ reporting that nasal steroids, oral steroids, zinc, nasal rinse, and smell training were only slightly effective or not effective at all. Many of these treatment strategies target regeneration and immune response, processes compromised by age. Only those under 40 reported more than slight efficacy of steroids or smell training. Findings emphasize the need to include patients of all ages in clinical trials. Older adults with olfactory impairment are at increased risk for Alzheimer\u27s disease (AD). We speculate that olfactory impairment associated with long COVID introduces the potential for a significant rise in AD. Long COVID-associated chemosensory impairment increases the urgency for translational and clinical research on novel treatment strategies. Suggestions for high-priority areas for epidemiological, basic, and clinical research on chemosensory impairment follow

Which factors explain variation in intention to disclose a diagnosis of dementia? A theory-based survey of mental health professionals

Background: For people with dementia, patient-centred care should involve timely explanation of the diagnosis and its implications. However, this is not routine. Theoretical models of behaviour change offer a generalisable framework for understanding professional practice and identifying modifiable factors to target with an intervention. Theoretical models and empirical work indicate that behavioural intention represents a modifiable predictor of actual professional behaviour. We identified factors that predict the intentions of members of older people's mental health teams (MHTs) to perform key behaviours involved in the disclosure of dementia. Design: Postal questionnaire survey. Participants: Professionals from MHTs in the English National Health Service. Methods: We selected three behaviours: Determining what patients already know or suspect about their diagnosis; using explicit terminology when talking to patients; and exploring what the diagnosis means to patients. The questionnaire was based upon the Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), and exploratory team variables. Main outcomes: Behavioural intentions. Results: Out of 1,269 professionals working in 85 MHTs, 399 (31.4%) returned completed questionnaires. Overall, the TPB best explained behavioural intention. For determining what patients already know, the TPB variables of subjective norm, perceived behavioural control and attitude explained 29.4% of the variance in intention. For the use of explicit terminology, the same variables explained 53.7% of intention. For exploring what the diagnosis means to patients, subjective norm and perceived behavioural control explained 48.6% of intention. Conclusion: These psychological models can explain up to half of the variation in intention to perform key disclosure behaviours. This provides an empirically- supported, theoretical basis for the design of interventions to improve disclosure practice by targeting relevant predictive factors. Trial Registration: ISRCTN15871014

Dietary levels of pure flavonoids improve spatial memory performance and increase hippocampal brain-derived neurotrophic factor.

Evidence suggests that flavonoid-rich foods are capable of inducing improvements in memory and cognition in animals and humans. However, there is a lack of clarity concerning whether flavonoids are the causal agents in inducing such behavioral responses. Here we show that supplementation with pure anthocyanins or pure flavanols for 6 weeks, at levels similar to that found in blueberry (2% w/w), results in an enhancement of spatial memory in 18 month old rats. Pure flavanols and pure anthocyanins were observed to induce significant improvements in spatial working memory (p = 0.002 and p = 0.006 respectively), to a similar extent to that following blueberry supplementation (p = 0.002). These behavioral changes were paralleled by increases in hippocampal brain-derived neurotrophic factor (R = 0.46, p<0.01), suggesting a common mechanism for the enhancement of memory. However, unlike protein levels of BDNF, the regional enhancement of BDNF mRNA expression in the hippocampus appeared to be predominantly enhanced by anthocyanins. Our data support the claim that flavonoids are likely causal agents in mediating the cognitive effects of flavonoid-rich foods

Social comparison processes in organizations

We systematically analyze the role of social comparison processes in organizations. Specifically, we describe how social comparison processes have been used to explain six key areas of organizational inquiry: (1) organizational justice, (2) performance appraisal, (3) virtual work environments, (4) affective behavior in the workplace, (5) stress, and (6) leadership. Additionally, we describe how unique contextual factors in organizations offer new insight into two widely studied sub-processes of social comparison, acquiring social information and thinking about that information. Our analyses underscore the merit of integrating organizational phenomena and social comparison processes in future research and theory

Electronic self-reporting of adverse events for patients undergoing cancer treatment: the eRAPID research programme including two RCTs

Abstract Background Cancer is treated using multiple modalities (e.g. surgery, radiotherapy and systemic therapies) and is frequently associated with adverse events that affect treatment delivery and quality of life. Regular adverse event reporting could improve care and safety through timely detection and management. Information technology provides a feasible monitoring model, but applied research is needed. This research programme developed and evaluated an electronic system, called eRAPID, for cancer patients to remotely self-report adverse events. Objectives The objectives were to address the following research questions: is it feasible to collect adverse event data from patients’ homes and in clinics during cancer treatment? Can eRAPID be implemented in different hospitals and treatment settings? Will oncology health-care professionals review eRAPID reports for decision-making? When added to usual care, will the eRAPID intervention (i.e. self-reporting with tailored advice) lead to clinical benefits (e.g. better adverse event control, improved patient safety and experiences)? Will eRAPID be cost-effective? Design Five mixed-methods work packages were conducted, incorporating co-design with patients and health-care professionals: work package 1 – development and implementation of the electronic platform across hospital centres; work package 2 – development of patient-reported adverse event items and advice (systematic and scoping reviews, patient interviews, Delphi exercise); work package 3 – mapping health-care professionals and care pathways; work package 4 – feasibility pilot studies to assess patient and clinician acceptability; and work package 5 – a single-centre randomised controlled trial of systemic treatment with a full health economic assessment. Setting The setting was three UK cancer centres (in Leeds, Manchester and Bristol). Participants The intervention was developed and evaluated with patients and clinicians. The systemic randomised controlled trial included 508 participants who were starting treatment for breast, colorectal or gynaecological cancer and 55 health-care professionals. The radiotherapy feasibility pilot recruited 167 patients undergoing treatment for pelvic cancers. The surgical feasibility pilot included 40 gastrointestinal cancer patients. Intervention eRAPID is an online system that allows patients to complete adverse event/symptom reports from home or hospital. The system provides immediate severity-graded advice based on clinical algorithms to guide self-management or hospital contact. Adverse event data are transferred to electronic patient records for review by clinical teams. Patients complete an online symptom report every week and whenever they experience symptoms. Main outcome measures In systemic treatment, the primary outcome was Functional Assessment of Cancer Therapy – General, Physical Well-Being score assessed at 6, 12 and 18 weeks (primary end point). Secondary outcomes included cost-effectiveness assessed through the comparison of health-care costs and quality-adjusted life-years. Patient self-efficacy was measured (using the Self-Efficacy for Managing Chronic Diseases 6-item Scale). The radiotherapy pilot studied feasibility (recruitment and attrition rates) and selection of outcome measures. The surgical pilot examined symptom report completeness, system actions, barriers to using eRAPID and technical performance. Results eRAPID was successfully developed and introduced across the treatments and centres. The systemic randomised controlled trial found no statistically significant effect of eRAPID on the primary end point at 18 weeks. There was a significant effect at 6 weeks (adjusted difference least square means 1.08, 95% confidence interval 0.12 to 2.05; p = 0.028) and 12 weeks (adjusted difference least square means 1.01, 95% confidence interval 0.05 to 1.98; p = 0.0395). No between-arm differences were found for admissions or calls/visits to acute oncology or chemotherapy delivery. Health economic analyses over 18 weeks indicated no statistically significant difference between the cost of the eRAPID information technology system and the cost of usual care (£12.28, 95% confidence interval –£1240.91 to £1167.69; p > 0.05). Mean differences were small, with eRAPID having a 55% probability of being cost-effective at the National Institute for Health and Care Excellence-recommended cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained. Patient self-efficacy was greater in the intervention arm (0.48, 95% confidence interval 0.13 to 0.83; p = 0.0073). Qualitative interviews indicated that many participants found eRAPID useful for support and guidance. Patient adherence to adverse-event symptom reporting was good (median compliance 72.2%). In the radiotherapy pilot, high levels of consent (73.2%) and low attrition rates (10%) were observed. Patient quality-of-life outcomes indicated a potential intervention benefit in chemoradiotherapy arms. In the surgical pilot, 40 out of 91 approached patients (44%) consented. Symptom report completion rates were high. Across the studies, clinician intervention engagement was varied. Both patient and staff feedback on the value of eRAPID was positive. Limitations The randomised controlled trial methodology led to small numbers of patients simultaneously using the intervention, thus reducing overall clinician exposure to and engagement with eRAPID. Furthermore, staff saw patients across both arms, introducing a contamination bias and potentially reducing the intervention effect. The health economic results were limited by numbers of missing data (e.g. for use of resources and EuroQol-5 Dimensions). Conclusions This research provides evidence that online symptom monitoring with inbuilt patient advice is acceptable to patients and clinical teams. Evidence of patient benefit was found, particularly during the early phases of treatment and in relation to self-efficacy. The findings will help improve the intervention and guide future trial designs. Future work Definitive trials in radiotherapy and surgical settings are suggested. Future research during systemic treatments could study self-report online interventions to replace elements of traditional follow-up care in the curative setting. Further research during modern targeted treatments (e.g. immunotherapy and small-molecule oral therapy) and in metastatic disease is recommended. Trial registration The systemic randomised controlled trial is registered as ISRCTN88520246. The radiotherapy trial is registered as ClinicalTrials.gov NCT02747264. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 1. See the NIHR Journals Library website for further project information