Animal data suggest that jet fuels such as JP-8 are associated with hearing deficits when combined with noise and that the effect is more pronounced than with noise exposure alone. Some studies suggest peripheral dysfunction while others suggest central auditory dysfunction. Human data are limited in this regard. The aim of this study was to investigate the possible chronic adverse effects of JP-8 combined with noise exposure on the peripheral and central auditory systems in humans. Fifty-seven participants who were current (...) personnel from the Royal Australian Air Force were selected. Based on their levels of exposure to jet fuels, participants were divided into three exposure groups. Groups were also categorised based on their noise exposure levels. All participants were evaluated by tympanometry, pure-tone audiometry, distortion product otoacoustic emissions, auditory brainstem response, words-in-noise, compressed speech, dichotic digit test, pitch pattern sequence test, duration pattern sequence test and adaptive test of temporal resolution. All auditory tests were carried out after the participants were away from the Air Force base for a minimum of two weeks, thus two weeks without jet fuel and noise exposure. Jet fuel exposure was significantly associated with hearing thresholds at 4 and 8 kHz; average hearing thresholds across frequencies in the better ear; DPOAEs at 2.8, 4 and 6 kHz; ABR wave V latency in the right ear; compressed speech and words-in-noise. Further analyses revealed that participants with low exposure level to jet fuels showed significantly better results for the aforementioned procedures than participants with moderate and high exposure levels. All results were controlled for the covariates of age and noise exposure levels. The results suggest that jet fuel exposure, when combined with noise exposure, has an adverse effect on audibility in humans. Taking all the test results into consideration, jet fuel exposure combined with noise exposure specifically seems to affect the peripheral hearing system in humans. (shrink)

The HealthyFood program offers members up to 25% cash back monthly on healthy food purchases. In this randomized controlled trial, we tested the efficacy of financial incentives combined with text messages in increasing healthy food purchases among HF members. Members receiving the lowest cash back level were randomized to one of six arms: Arm 1 : 10% cash back, no weekly text, standard monthly text; Arm 2: 10% cash back, generic weekly text, standard monthly text; Arm 3: 10% cash back, (...) personalized weekly text, standard monthly text; Arm 4: 25% cash back, personalized weekly text, standard monthly text; Arm 5: 10 + 15%NET cash back, personalized weekly text, standard monthly text; and, Arm 6: 10 + 15%NET cash back, personalized weekly text, unbundled monthly text. In the 10 + 15%NET cash back, the cash back amount was the baseline 10% plus 15% of the net difference between healthy and unhealthy spending. The generic text included information on HF and healthy eating, while the personalized text had individualized feedback on purchases. The standard monthly text contained the cash back amount. The unbundled monthly text included the amount lost due to unhealthy purchases. The primary outcome was the average monthly percent healthy food spending. Secondary outcomes were the percent unhealthy food spending, and the percent healthy and unhealthy food items. Of the members contacted, 20 opted out, and 2841 met all inclusion criteria. There were no between-arm differences in the examined outcomes. The largest mean difference in percent healthy spending was between Arm 1 and Arm 2, and the largest mean difference in percent unhealthy spending was also between Arm 1 and Arm 2, but no differences were statistically significant after correction for multiple comparisons. None of the tested financial incentive structures or text strategies differentially affected food purchasing. Notably, more than doubling the cash back amount and introducing a financial disincentive for unhealthy purchases did not affect purchasing. These findings speak to the difficulty of changing shopping habits and to the need for innovative strategies to shift complex health behaviors. NCT02486588 Increasing Engagement with a Healthy Food Benefit. The trial was prospectively registered on July 1, 2015. (shrink)

Pulmonary rehabilitation has demonstrated patients’ physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit. A 12-week community-based PR will be implemented in (...) primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea, fatigue, cough and sputum, impact of the disease, emotional state, number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion. Other clinical outcomes will be peripheral and respiratory muscle strength, muscle thickness and cross sectional area, exercise capacity, balance and physical activity. Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted. This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases. The trial was registered in the ClinicalTrials.gov U.S. National Library of Medicine, on 10th January, 2019. (shrink)

Domestic violence is one of the most common forms of violence against women. Domestic violence during pregnancy is associated with adverse perinatal and maternal outcomes. We aimed to assess whether domestic violence was associated with mode of delivery, low birthweight and preterm birth in two sites in Nepal. In this prospective cohort study we consecutively recruited 2004 pregnant women during antenatal care at two hospitals between June 2015 and September 2016. The Abuse Assessment Screen was used to assess fear and (...) violence. Having ever experienced either fear or violence was defined as any domestic violence. Obstetric outcomes were obtained from hospital records for 1381 women, selecting singleton pregnancies only. Mode of delivery was assessed as birth by cesarean section or not. A birthweight of less than 2500 g was defined as low birthweight and preterm birth as birth before completion of 37 weeks gestation. Descriptive and multiple logistic regression analyses were performed to assess associations. Twenty percent of the women reported any domestic violence. Among all 1381 women, 37.6% gave birth by cesarean section. Of those women who delivered by cesarean section, 84.7% had an emergency cesarean section. Less than 10% of the babies were born prematurely and 13.5% were born with low birthweight. We found no significant association between exposure to any domestic violence during pregnancy and risk of a low birthweight baby or birth by cesarean section. However, having experienced both violence and fear was significantly associated with giving birth to a preterm infant [aOR 2.33 ]. Domestic violence is common in Nepal. This is a potential risk factor for severe morbidity and mortality in newborns. We found that the risk of having a preterm baby was higher for pregnant women who experienced both fear and violence. This should be recognized by the health sector. In this study, no significant differences were found in the rate of cesarean section nor low birthweight for women who had experienced any domestic violence compared to those who did not. (shrink)

India is home to 243 million adolescents. Two million of them belong to Scheduled Tribes living in underserved, rural areas. Few studies have examined the health of tribal adolescents. We conducted a cross-sectional survey to assess the health, nutrition and wellbeing of adolescent girls in rural Jharkhand, eastern India, a state where 26% of the population is from Scheduled Tribes. We aimed to identify priorities for community interventions to serve adolescents and their families. Between June 2016 and January 2017, interviewers (...) visited all households in 50 purposively sampled villages of West Singhbhum district, Jharkhand. They aimed to interview all girls aged 10–19. Interviewers conducted face-to-face interviews with girls to administer a survey about physical and mental health, disability, nutrition, sexual and reproductive health, gender norms, decision-making, education and violence. Interviewers also measured girls’ height, weight, and Mid-Upper Arm Circumference. Interviewers collected data from 3324 of an estimated 4068 girls residing in the study area. Their mean age was 14.3. 82% were from Scheduled Tribes. 89% of younger girls aged 10–14 and 46% of older girls aged 15–19 were in school or college. Girls dropped out of school because they were required for household work or work on the family farm or business. Over a third reported symptoms of anaemia in the past month, but less than a fifth had a blood test. The prevalence of thinness was 14% for younger girls and 6% for older girls. 45% of girls were stunted. 40% reported emotional violence in the past year, 14% physical violence, and 0.7% sexual violence. 12% had problems associated with depression or anxiety. 30% aged 15–19 had heard of contraception. Among married girls and their husbands, only 10% had ever used methods to prevent or delay pregnancy. Our study identified several priorities to improve adolescent girls’ health, nutrition and wellbeing in largely tribal areas of Jharkhand: reducing violence, early marriage and undernutrition, as well as improving mental health, knowledge about contraception and school retention. (shrink)

Among the many features that go hand in hand with the recent onset of populism in many countries, an interesting phenomenon is surely the shift of public discourse in the direction of social media. Is there any-thing special about communication in social media that is particularly suitable for the development of such movements and ideas? In what fol-lows, I provide an attempt to read Facebook comments as showing an anaphoric structure. This analysis permits me to give emphasis on a number (...) of interesting features that such communications exhibit. Final-ly, I try also to highlight some of the main implications of this model in comparison with ordinary communication. (shrink)

Wittgenstein’s Investigations proposed an egalitarian view about language games, emphasizing their plurality (“language has no downtown”). Uses of words depend on the game one is playing, and may change when playing another. Furthermore, there is no privileged game dictating the rules for the others: games are as many as purposes. This view is pluralist and egalitarian, but it says little about the connection between meaning and use, and about how a set of rules is responsible for them in practice. Brandom’s (...) Making It Explicit attempted a straightforward answer to these questions, by developing Wittgensteinian insights: the primacy of social practice over meanings; the idea that meaning is use; the idea of rule–following to understand participation in social practices. Nonetheless, Brandom defended a non–Wittgensteinian conception of discursive practice: language has a “downtown”, the game of “giving and asking for reasons”. This is the idea of a normative structure of language, consisting of advancing claims and drawing inferences. By means of assertions, speakers undertake “commitments” that can be challenged/defended in terms of reasons (those successfully justified can gain “entitlement”). This game is not one among many: it is indispensable to the very idea of discursive practice. In this paper, my aim will be that of exploring the main motivations and implications of both perspectives. (shrink)

We present a framework for epistemic logic, modeling the logical aspects of System 1 and System 2 cognitive processes, as per dual process theories of reasoning. The framework combines non-normal worlds semantics with the techniques of Dynamic Epistemic Logic. It models non-logically-omniscient, but moderately rational agents: their System 1 makes fast sense of incoming information by integrating it on the basis of their background knowledge and beliefs. Their System 2 allows them to slowly, step-wise unpack some of the logical consequences (...) of such knowledge and beliefs, by paying a cognitive cost. The framework is applied to three instances of limited rationality, widely discussed in cognitive psychology: Stereotypical Thinking, the Framing Effect, and the Anchoring Effect. (shrink)

Freedom is one of the most important moral and political ideals. Questions concerning degrees of overall freedom are therefore of the utmost moral and political concern. To answer these questions we need to know how to measure degrees of overall freedom. This paper offers a novel defence of the partly evaluative approach to freedom measurement against a recent critique of it. According to the partly evaluative approach, the question of how free one is depends partly on the specific value of (...) the freedoms one possesses and partly on their physical extension. According to the critique, because of its reference to freedoms’ specific value, the partly evaluative approach fails to capture freedoms’ non-specific value, which is what it should capture. In this paper I argue that this critique is unfounded, by showing that even measures of more mundane things, which nevertheless, like freedom, present us with a commensuration problem, sometimes involve evaluative considerations similar to the ones that the partly evaluative approach invokes. (shrink)

Society is at a crossroads. Interconnected systems, radical transparency, and rapidly increasing sophistication in skills, communications, and technologies provide a unique context for fostering social innovation at a planetary scale. We argue that unprecedented rates of systemic social change are possible for co-creating a future where humans and all life can thrive. Yet, this requires innovation in the conceptions, practice, teaching, and researching of social innovation itself to reimagine what it is and can be. As a multidisciplinary group of academics, (...) practitioners, and educators, we integrate our perspectives on social innovation and humanistic management to suggest the notion of systemic social innovation. We introduce the concept of “transformative collaboration” as central to facilitating systemic social innovation and propose a multilevel model for accelerating systems change. We then develop an integrated framework for conceptualizing systemic social innovation. Four levels of social impact are identified, and these levels are bracketed with a call for transforming individual consciousness at the micro level and new collective mindsets at the macro level. Blooom is presented as a case study to illustrate transformative collaboration, demonstrate the role of mindset shift in practice, and introduce four key ingredients to systemic social innovation. Finally, a call to action is issued for social innovation practice, teaching, and research. Most importantly, we seek to inspire and accelerate systemic social innovation that enables the flourishing of every human being and all life on earth. (shrink)

Morbidity of birth asphyxia has been estimated to be 42 million disability-adjusted life years. The study sought to assess the impact of the use and completion of partograph during labour on reducing birth asphyxia at the St Anthony’s Hospital, Dzodze, in the Volta Region of Ghana. A retrospective study design using a quantitative approach was adopted for the study. A simple random sampling technique was used to select a total of 200 folders of labouring women who were admitted and delivered (...) at St Anthony’s Hospital, Dzodze, between 1st May 2015 and 30th April 2016. A structured checklist, which was developed by using labour and foetal monitoring parameters based on the standards of the World Health Organization partograph usage, was used to review all the 200 existing maternal records. The findings revealed that partographs were used by midwives at St Anthony’s Hospital with the majority of the maternal folders fully completed. The use and completion of partograph were found to be associated with less non-asphyxiated birth outcomes. Labours which were monitored with partograph were 4.29 times less likely to result in birth asphyxia [AOR 4.29 ], and those that were monitored with a completed partograph were 5.3 times less likely to result in birth asphyxia [AOR 5.31 ]. Midwives used partographs during labour at St Anthony’s Hospital. The use and completion of partograph were significantly associated with a reduced incidence of birth asphyxia at the hospital. Birth asphyxia could be reduced if partographs are used and completed by midwives during labour in all cases. (shrink)

Coping with a relative with a learning disability could be a stressful experience for family members. The present study is aimed at exploring the coping strategies adopted by families in trying to make meaning of their situation. A qualitative study design using focus group discussions was adopted. Ten FGD sessions were held with family members of persons with a learning disability. Findings revealed patterns of family coping to include problem-focused, emotion-focused, and spiritual/religious-focused. Also, coping responses to a learning disability varied (...) based on the level of information available to families about the condition of their relative. In some cases, interspousal relationship was strained due to stress. It was recommended that families of persons with a learning disability need social support and professional help from social workers to facilitate the adoption of more positive-oriented coping strategies by family members. (shrink)

Assisted reproductive technology treatment tends to involve significant physical and emotional commitments that can impact maternal, infant, and family health and well-being. An in-depth understanding of experiences is necessary to provide adequate support for women and their families during pregnancy and transition to parenthood following ART treatment. The aim of this study was to explore first-time mothers’ experiences of pregnancy and transition to parenthood following successful ART treatment in Taiwan. Twelve first-time mothers who conceived and gave live birth using ART (...) treatment were purposively selected from a fertility centre in Taipei, Taiwan. Women’s experiences in pregnancy and in their transition to motherhood were explored using semi-structured in-depth interviews. All interviews were recorded, transcribed, and analysed using the Colaizzi strategy. The mothers’ accounts reflected three main themes: ‘being different from mothers who became pregnant naturally’, ‘ensuring health and safety of the foetus’, and ‘welcoming new lives with excitement’. The difference mothers felt about themselves was evident in four subthemes: becoming pregnant after a long wait, feeling vulnerable during pregnancy, relying on family’s assistance and support, and worrying about the impact of ART on health. The theme on ‘ensuring health and safety of the foetus’ encompassed three subthemes: activities to protect the unborn baby, monitoring foetal movement constantly to maintain peace of mind, and receiving foetal reduction for the sake of the pregnancy. Narratives around ‘welcoming new lives with excitement’ reflected four subthemes: overcoming hardship for worthwhile results, realising one’s life and dreams, proving to be fertile enough to give birth, and return to normal life track. Findings indicate the need for educational and psychosocial interventions to support women and their families physically and psychologically during ART treatment. The stigma related to infertility and the psychosocial support from family are aspects to consider while planning intervention programmes. (shrink)

Bowel necrosis is a commonly observed condition in elderly patients with longstanding diabetes. In such condition, intestinal resection is usually performed for the removal of the gangrenous part. Post-surgical dietary management after bowel resection poses several challenges for the health care team. The case presented in this study is that of an elderly diabetic male who developed acute renal failure as a result of neglect in post-surgical feeding after intestinal resection. After the intervention by a trained dietitian, a transitional diet (...) was planned and successfully executed, resulting in reversal of acute renal failure, dehydration, and post-surgical stress. Several complications including hepatic dysfunction and mouth ulcers were resolved through well-planned transitional diet. The patient was finally discharged in a stable health condition and was regularly followed up for any nutritional or medical issues. Neglects in nutritional care of patients can have severe implications including development of medical complications, resulting in increased length of hospital stay, augmenting the disease stress of the patient and family, and finally the preventable drainage of several human and monetary resources. Therefore, recognition of nutritional intervention as an important part of in-hospital health care may have social as well as economic impacts. (shrink)

Proper utilization of antenatal and postnatal care services plays an important role in reducing the maternal mortality ratio and infant mortality rate. This paper assesses the utilization of health care services during pregnancy, delivery and post-delivery among rural women in Uttar Pradesh and examines its determinants. Data from a baseline survey of UP Community Mobilization project was utilized. A cross-sectional sample of currently married women who delivered a baby 15 months prior to the survey was included. Information was collected from (...) 2208 women spread over five districts of UP. Information on socio-demography characteristics, utilization of antenatal care, delivery and postnatal care services was collected. To examine the determinants of utilization of maternal health services, the variables included were three ANC visits, institutional delivery and PNC within 42 days of delivery. Separate multilevel random intercept logistic regressions were used to account for clustering at a block and gram panchayat level after adjusting for covariates. Eighty-three percent of women had any ANC. Of them, 61% reported three or more ANC visits. Although 68% of women delivered in a health facility, 29% stayed for at least 48 h. Any PNC within 42 days after delivery was reported by 26% of women. In the adjusted analysis, women with increasing number of contacts with the health worker during the antenatal period, women exposed to mass-media and non-marginalized women were more likely to have at least three ANC visits during pregnancy. Non-marginalized women and women with at least three ANC visits were more likely than their counterparts to deliver in an institution. Contacts with health worker during pregnancy, marginalization, at least three ANC visits and institutional delivery were the strong determinants for utilization of PNC services. Self-help group membership had no association with the utilization of maternal health services. Utilization of maternal health services was low. Contact with the health worker and marginalization emerged as important factors for utilization of services. Although not associated with the utilization, SHGs can be used for delivering health care messages within and beyond the group. (shrink)

In this paper I suggest that the “missile” and the “targeting” metaphors in research on nanoparticle-based drug delivery play different roles. I argue that the “missile” plays a marginal scientific role and a more important role in communication, while “targeting” has become an organizing metaphor for the research field. The reason, I suggest, is that targeting is the main _ explanandum _ of the field and that this metaphor continues to be relevant even as nanomedicine matures towards tackling more complex (...) problems. Finally, I discuss recent suggestions of new complexity-oriented metaphors, and I suggest that the significant role of simplifying models and the genuine need for such models may explain why complexity metaphors have not caught on among researchers. (shrink)

Benjamin et al. Nature Human Behavior 2, 6–10 proposed decreasing the significance level by an order of magnitude to improve the replicability of psychology. This modest, practical proposal has been widely criticized, and its prospects remain unclear. This article defends this proposal against these criticisms and highlights its virtues.

We consider definable topological spaces of dimension one in o-minimal structures, and state several equivalent conditions for when such a topological space \ \) is definably homeomorphic to an affine definable space with the induced subspace topology). One of the main results says that it is sufficient for X to be regular and decompose into finitely many definably connected components.