Indigenous Knowledge and Maple Syrup: A Case Study of the Effects of Colonization in Ontario

For many Indigenous communities throughout the province of Ontario on Turtle Island, maple syrup (MS) practices are culturally and spiritually significant; however, since the arrival of European settlers, these MS practices have substantially declined. This research utilizes the decline of maple syrup practices and related Indigenous Knowledge (IK) as a case study to exemplify the damaging impacts colonialism has had on the culture of Indigenous peoples living within Ontario. Over a period of two months, I spoke with seven Indigenous individuals throughout Ontario about their experiences and opinions regarding the relationship between colonialism and MS practices. Accordingly, colonialism has impacted and contributed to the decline in MS practices and IK in two main interlocking ways: 1) direct colonial acts, such as residential schools, the Indian Act and the introduction of reserves; and 2) the continuing impacts of colonial processes, including settler colonialism, effects of capitalism, health ramifications and the colonized mind. However, as will be outlined in this paper, even in the face of this adversity caused by colonialism, all seven participants of this research are optimistic about the resurgence of MS practices by Indigenous populations

Help to Overcome Problems Effectively for Cancer Survivors: Development and Evaluation of a Digital Self-Management Program

Background People living with cancer face numerous psychosocial challenges, including cancer-related fatigue, fear of recurrence, and depression. There is a lack of digital interventions tailored to the needs of people living with all types of cancer. We developed a 6-week, digital, peer-delivered, self-management program: iHOPE (Help to Overcome Problems Effectively; where ‘i’ indicates the digital version of the program). The program is underpinned by positive psychology and cognitive behavioral therapy to meet these psychosocial challenges. Objective This study aimed to assess the feasibility of the iHOPE program among people living with cancer. Program adherence and satisfaction along with changes in psychological distress and positive well-being were measured. Methods A pre-post, acceptability, and feasibility design was used. People living with cancer (N=114) were recruited via a national cancer charity in the United Kingdom and were given access to the iHOPE program. Demographic and other participant characteristics were recorded. Participants completed digital measures at baseline and the end of the 6-week program for depression, anxiety, cancer-related fatigue, cancer worry or fear of cancer recurrence, positive mental well-being, hope, gratitude, and health status. The website’s system recorded data on the usage of the program. Satisfaction with the program was also measured. Results A total of 114 participants completed the baseline questionnaires. Of these, 70 people (61.4%) participated in all 6 sessions. The mean number of sessions undertaken was 5.0 (SD 1.5). Moreover, 44.7% (51/114) of participants completed at least three sessions and end-of-program outcome measures. A total of 59 participants completed the satisfaction questionnaire, where ≥90% (54/58) of participants reported that the program was easy to navigate and was well managed by the peer facilitators, and that they found the social networking tools useful. Preliminary efficacy testing among the 51 participants who completed baseline and postprogram outcome measures showed that postprogram scores decreased for depression, anxiety, cancer-related fatigue, and fear of recurrence (all P&lt;.001) and increased for positive mental well-being (P&lt;.001), hope (both P&lt;.001), and gratitude (P=.02). Conclusions The feasibility evidence is promising, showing that the peer-delivered digital iHOPE program is acceptable and practical. Implementation of the iHOPE program on a wider scale will incorporate further research and development to maximize the completion rates of the measures. Initial effectiveness data suggest positive impacts on important cancer-related quality of life and mental well-being outcomes. A randomized controlled trial design with a longer follow-up is needed to confirm the potential of the iHOPE program for improving mental and physical health outcomes for cancer survivors. </jats:sec

Why volunteer? What stimulates involvement in a stem peer learning facilitation program?

There is an acknowledged need for strategies to enhance participation, learning and graduate capabilities for students engaged in STEM disciplines given the central importance of these skills to the future economy. The STIMulate program provides support for learning across maths, science and IT to all QUT coursework students regardless of course of study or campus. Central to the success of the program is the provision of face-to-face peer support by a team of high-achieving, experienced student volunteers; the Peer Learning Facilitators (PLFs). Understanding the motivations and expectations of the diverse team of STIMulate student volunteers is necessary to appropriately manage the program. A survey instrument was adapted from the Volunteer Functions Inventory (Clary, Snyder, Ridge, Copeland, Stukas, Haugen & Meine, 1998) to assess three drivers of participation - autonomy, mastery and purpose, and provided to all commencing PLFs at the initial 2016 training session. Principal Component Analysis (PCA) identified three classifications of motivators for beginning PLFs: relationships and experiences (most important criteria), intrinsic motivators and extrinsic motivators (least important criteria). The findings of this work represent an important first step towards enhancing evidence-based practice for the management, reward and recognition of student volunteers engaged in academic support programs

Economic impacts of the COVID-19 pandemic on families of children with autism and other developmental disabilities

BackgroundTo control the spread of the coronavirus disease (COVID-19), many jurisdictions throughout the world enacted public health measures that had vast socio-economic implications. In emergency situations, families of children with developmental disabilities (DDs), including autism, may experience increased difficulty accessing therapies, economic hardship, and caregiver stress, with the potential to exacerbate autism symptoms. Yet, limited research exists on the economic impacts of the COVID-19 pandemic on families of children with autism or another DD compared to families of children from the general population.ObjectivesTo assess impact of the COVID-19 pandemic related to parental employment and economic difficulties in families of children with autism, another DD, and in the general population, considering potential modification by socioeconomic disadvantage before the pandemic and levels of child behavioral and emotional problems.MethodsThe Study to Explore Early Development (SEED) is a multi-site, multi-phase, case-control study of young children with autism or another DD as compared to a population comparison group (POP). During January-July 2021, a COVID-19 Impact Assessment Questionnaire was sent to eligible participants (n=1,789) who had enrolled in SEED Phase 3 from September 2017-March 2020. Parents completed a questionnaire on impacts of the pandemic in 2020 and completed the Child Behavior Checklist (CBCL) to measure behavioral and emotional health of their child during this time. Multiple logistic regression models were built for employment reduction, increased remote work, difficulty paying bills, or fear of losing their home. Covariates include group status (autism, DD, POP), household income at enrollment, child’s race and ethnicity, and binary CBCL Total Problems T-score (&lt;60 vs. ≥60). Unadjusted and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated.ResultsThe study included 274 children with autism, 368 children with another DD, and 385 POP children. The mean age of 6.1 years (standard deviation, 0.8) at the COVID-19 Impact Assessment did not differ between study groups. Parents of children with autism were less likely to transition to remote work (aOR [95% CI] = 0.6 [0.4, 1.0]) and more likely to report difficulty paying bills during the pandemic (1.8 [1.2, 2.9]) relative to parents of POP children. Lower income was associated with greater employment reduction, difficulty paying bills, and fear of losing their home, but inversely associated with transitioning to remote work. Parents of non-Hispanic (NH) Black children experienced greater employment reduction compared to parents of NH White children (1.9 [1.1, 3.0]). Parents from racial and ethnic minority groups were more likely to experience difficulty paying bills and fear losing their home, relative to NH White parents. Caregivers of children with CBCL scores in the clinical range were more likely to fear losing their home (2.1 [1.3, 3.4]).ConclusionThese findings suggest that families of children with autism, families of lower socio-economic status, and families of racial and ethnic minority groups experienced fewer work flexibilities and greater financial distress during the pandemic. Future research can be used to assess if these impacts are sustained over time

Stewardship Prompts to Improve Antibiotic Selection for Pneumonia

ImportancePneumonia is the most common infection requiring hospitalization and is a major reason for overuse of extended-spectrum antibiotics. Despite low risk of multidrug-resistant organism (MDRO) infection, clinical uncertainty often drives initial antibiotic selection. Strategies to limit empiric antibiotic overuse for patients with pneumonia are needed.ObjectiveTo evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO infection risk estimates could reduce empiric extended-spectrum antibiotics for non-critically ill patients admitted with pneumonia.Design, setting, and participantsCluster-randomized trial in 59 US community hospitals comparing the effect of a CPOE stewardship bundle (education, feedback, and real-time MDRO risk-based CPOE prompts; n = 29 hospitals) vs routine stewardship (n = 30 hospitals) on antibiotic selection during the first 3 hospital days (empiric period) in non-critically ill adults (≥18 years) hospitalized with pneumonia. There was an 18-month baseline period from April 1, 2017, to September 30, 2018, and a 15-month intervention period from April 1, 2019, to June 30, 2020.InterventionCPOE prompts recommending standard-spectrum antibiotics in patients ordered to receive extended-spectrum antibiotics during the empiric period who have low estimated absolute risk (&lt;10%) of MDRO pneumonia, coupled with feedback and education.Main outcomes and measuresThe primary outcome was empiric (first 3 days of hospitalization) extended-spectrum antibiotic days of therapy. Secondary outcomes included empiric vancomycin and antipseudomonal days of therapy and safety outcomes included days to intensive care unit (ICU) transfer and hospital length of stay. Outcomes compared differences between baseline and intervention periods across strategies.ResultsAmong 59 hospitals with 96 451 (51 671 in the baseline period and 44 780 in the intervention period) adult patients admitted with pneumonia, the mean (SD) age of patients was 68.1 (17.0) years, 48.1% were men, and the median (IQR) Elixhauser comorbidity count was 4 (2-6). Compared with routine stewardship, the group using CPOE prompts had a 28.4% reduction in empiric extended-spectrum days of therapy (rate ratio, 0.72 [95% CI, 0.66-0.78]; P &lt; .001). Safety outcomes of mean days to ICU transfer (6.5 vs 7.1 days) and hospital length of stay (6.8 vs 7.1 days) did not differ significantly between the routine and CPOE intervention groups.Conclusions and relevanceEmpiric extended-spectrum antibiotic use was significantly lower among adults admitted with pneumonia to non-ICU settings in hospitals using education, feedback, and CPOE prompts recommending standard-spectrum antibiotics for patients at low risk of MDRO infection, compared with routine stewardship practices. Hospital length of stay and days to ICU transfer were unchanged.Trial registrationClinicalTrials.gov Identifier: NCT03697070

Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19

Importance: Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality. // Objective: To evaluate whether systemic anticancer treatments (SACTs), tumor subtypes, patient demographic characteristics (age and sex), and comorbidities are associated with COVID-19 mortality. // Design, Setting, and Participants: The UK Coronavirus Cancer Monitoring Project (UKCCMP) is a prospective cohort study conducted at 69 UK cancer hospitals among adult patients (≥18 years) with an active cancer and a clinical diagnosis of COVID-19. Patients registered from March 18 to August 1, 2020, were included in this analysis. // Exposures: SACT, tumor subtype, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities were investigated. // Main Outcomes and Measures: The primary end point was all-cause mortality within the primary hospitalization. // Results: Overall, 2515 of 2786 patients registered during the study period were included; 1464 (58%) were men; and the median (IQR) age was 72 (62-80) years. The mortality rate was 38% (966 patients). The data suggest an association between higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher COVID-19–related mortality (OR, 1.58; 95% CI, 1.11-2.25). No association between higher mortality and receiving chemotherapy in the 4 weeks before COVID-19 diagnosis was observed after correcting for the crucial confounders of age, sex, and comorbidities. An association between lower mortality and receiving immunotherapy in the 4 weeks before COVID-19 diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86). // Conclusions and Relevance: The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection. This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers. Important differences in outcomes among patients with hematological and lung cancers were observed

Benchmarking of the biomechanical characteristics of normal and degraded articular cartilage to facilitate mathematical modelling

In order to validate the appropriate functional characteristics of cartilage, we need to systematically study and understand what constitutes normality and degradation in cartilage. This thesis provides an important step in this direction. To understand the mechanical repercussions of disruption to the matrix properties, cartilage is often artificially degraded using common enzymes. Although the process of artificial degradation does not provide an accurate representation of osteoarthritis, it can provide insight into the biomechanical properties of single matrix components by examining the behaviour of the tissue following its removal. Through histological analysis utilising the optical absorbance measurements of Safranin O stain, this work has demonstrated that for a given time and enzyme concentration, the action of Trypsin on proteoglycans is highly variable and is dependent on: * The initial distribution and concentration of proteoglycans at different depths * The intrinsic sample depth * The location in the joint space, and * The medium type. These findings provide initial data towards a mathematical model which researchers can use to optimise Trypsin treatment of articular cartilage, and therefore model degeneration in vitro with a better degree of certainty. The variability noted in the distribution and concentration of proteoglycans, and most likely the collagen network, creates a large variation in the compressive and tensile stiffness of all samples, and total failure strain energy. The average values for each of these tests indicate that a loss of proteoglycan through Trypsin treatment results in decreased compressive stiffness, increased tensile stiffness, and little change to the failure strains or total failure strain energy. Conversely, disruption to the collagen network shows increased compressive and tensile stiffness, as well as failure strain and total failure strain energy. Due to the large variation in the results for each treatment group, the average values for the treated samples fall within the range of results for normal cartilage. These values cannot therefore be used as dependable parameters to benchmark cartilage, since the parameters for artificially degraded cartilage are within the normal levels. The Yeoh and Polynomial hyperelastic laws were found to best represent the material characteristics of cartilage across the range of tested samples, regardless of differences in health and strength. The results presented here provide important insight into the biomechanical outcomes of artificial degradation and provide direction for future research in this area

New Directions for the Characterisation of Cartilage Health in Vivo

This paper outlines the motivation and preliminary investigations into the possibility of a new method of characterising cartilage health in vivo. Current in vivo indentation techniques, which rely on stiffness measurements alone, are unable to adequately distinguish between healthy and degraded tissue. By considering the tangential strain in the articular surface during an indentation test, it is hypothesised that a simple and more sensitive indicator of cartilage integrity may be possible. The present study investigates the effects of low levels of degradation on the tangential surface strain under the indenter. Preliminary results suggest that this technique is highly sensitive, and can discriminate between degeneration and the natural variations across the joint. From these investigations we propose that the relationship between indentation and the surrounding strain field might be able to distinguish between healthy soft tissue and degraded tissue in vivo, important information not available from the current techniques. This study forms the basis of a series of further experimental and modelling investigations to develop these ideas with the goal of creating a more effective diagnostic method for the surgeon

Feasibility of ranking articular cartilage conditions with non-destructive near-infrared spectroscopy with extension to the Mankin grading system

Grading osteoarthritic tissue has, until now, been a laboratory process confined to research activities. This thesis establishes a scientific protocol that extends osteoarthritic tissue ranking to surgical practice. The innovative protocol, which now incorporates the structural degeneration of collagen, enhances the traditional Modified Mankin ranking system, enabling its application to real time decision during surgery. Because it is fast and without time consuming laboratory process, it would potentially enable the cataloguing of tissues in osteoarthritic joints in all compartments of diseased joints during surgery for epistemological study and insight into the manifestation of osteoarthritis across age, gender, occupation, physical activities and race

[Expert] Guide on the Side: One University's Response to Support for Learning in STEM-Based Disciplines

Increasing demand for STEM graduates and a competitive higher education sector have highlighted a critical need to safeguard the learner experience through the provision of accessible and curriculum-aligned support for learning. The anticipated and actual demand for STEM skills is underscored by the requirement for universities to ensure a sustainable pipeline of skilled, confident and job-ready graduates. However, when the focus is on the end-product (graduate employability), what then is the place and value in the learner experience of the “hard” skills, that is mastery of the discipline?A competitive higher education market, in conjunction with the widening participation agenda, has seen an increase in the number of students embarking on degrees in traditional STEM areas, as well as those where STEM concepts underpin their confidence within the discipline (e.g., Nursing, Education). Simultaneously, the move from prerequisites to assumed knowledge requirements for university courses has resulted in students being frequently underprepared for these courses. On this basis, it is essential that universities provide integrated and accessible support for all learners. In this chapter we outline Queensland University of Technology’s response to this issue. We discuss relevant contextual factors that have informed the iterative design and implementation of an institution-wide approach to support learning in STEM disciplines. This approach is grounded in the provision of curriculum-aligned, scaffolded support for learning delivered by STEM discipline experts in the co-curricular space