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Policy-makers need to rethink the connections between the economy and health. The World Health Organization Council on the Economics of Health for All has called for human and planetary health and well-being to be moved to the core of decision-making to build economies for health. Doing so involves valuing and measuring what matters, more and better health financing, innovation for the common good and rebuilding public sector capacity. We build on this thinking to argue that breastfeeding should be recognized in food and well-being statistics, while investments in breastfeeding should be considered a carbon offset in global financing arrangements for sustainable food, health and economic systems. Breastfeeding women nourish half the world's infants and young children with immense quantities of a highly valuable milk. This care work is not counted in gross domestic product or national food balance sheets, and yet ever-increasing commercial milk formula sales are counted. Achieving global nutrition targets for breastfeeding would realize far greater reductions in greenhouse gas emissions than decarbonizing commercial milk formula manufacturing. New metrics and financing mechanisms are needed to achieve the health, sustainability and equity gains from more optimal infant and young child feeding. Properly valuing crucial care and environmental resources in global and national measurement systems would redirect international financial resources away from expanding carbon-emitting activities, and towards what really matters, that is, health for all. Doing so should start with considering breastfeeding as the highest quality, local, sustainable first-food system for generations to come. [ABSTRACT FROM AUTHOR]

One of the greatest challenges in business consulting is to help clients quickly grasp how the products and services you offer will improve their organizations. As businesswomen whose adult lives have been spent implementing behavioral solutions in large companies and complex organizations, we have amassed experience and advice for those who seek to help others achieve sustainable improvements through behaviorally based solutions. It starts with getting them to understand and believe in what you are proposing. This paper outlines advice and strategies gained over three decades of marketing and implementing behavioral solutions in large organizations. [ABSTRACT FROM AUTHOR]

Despite increasing evidence about the value and importance of breastfeeding, less than half of the world's infants and young children (aged 0–36 months) are breastfed as recommended. This Series paper examines the social, political, and economic reasons for this problem. First, this paper highlights the power of the commercial milk formula (CMF) industry to commodify the feeding of infants and young children; influence policy at both national and international levels in ways that grow and sustain CMF markets; and externalise the social, environmental, and economic costs of CMF. Second, this paper examines how breastfeeding is undermined by economic policies and systems that ignore the value of care work by women, including breastfeeding, and by the inadequacy of maternity rights protection across the world, especially for poorer women. Third, this paper presents three reasons why health systems often do not provide adequate breastfeeding protection, promotion, and support. These reasons are the gendered and biomedical power systems that deny women-centred and culturally appropriate care; the economic and ideological factors that accept, and even encourage, commercial influence and conflicts of interest; and the fiscal and economic policies that leave governments with insufficient funds to adequately protect, promote, and support breastfeeding. We outline six sets of wide-ranging social, political, and economic reforms required to overcome these deeply embedded commercial and structural barriers to breastfeeding. [ABSTRACT FROM AUTHOR]

The article discusses the support being given by the Leg Clubs to National Health Service (NHS) nurses. Topics include research by N. McIntyre et al on behalf of the Lindsay Leg Club Foundation on the preventative care offered in Leg Clubs via the Well Leg regimen, possible impact of the expansion of Leg Clubs on healthcare trusts, and the Leg Club Foundation's commitment to person-centred care.

Background: The in-hospital stay following childbirth is a critical time for education and support of new mothers to establish breastfeeding. The WHO/UNICEF 'Ten Steps to Successful Breastfeeding (Ten Steps)' was launched globally in 1989 to encourage maternity services to educate and support mothers to breastfeed. The strategy is effective, however its uptake within health systems and facilities has been disappointing. We aimed to understand midwives' and nurses' experiences of implementing the Ten Steps in an Indonesian hospital. Methods: This qualitative study was conducted in an Indonesian hospital which has been implementing the Ten Steps since the hospital's establishment in 2012. Fourteen midwives and nurses participated in a focus group in January 2020. Data were analyzed using thematic analysis. Results: We identified five themes that represented midwives' and nurses' experiences of implementing the Ten Steps in this Indonesian maternity unit: 1) Human rights of child and mother, 2) Dependency on precarious leadership, 3) Lack of budget prioritization, 4) Fragmented and inconsistent implementation of the Ten Steps across the health system, and 5) Negotiating with family, community and culture. The results highlighted a dependency on local hospital champions and a lack of budget prioritization as barriers to implementation, as well as health system gaps which prevented the enablement of mothers and families to establish and maintain breastfeeding successfully in Indonesian maternity services. Conclusions: As Indonesia has one of the largest populations in South East Asia, it is an important market for infant milk formula, and health services are commonly targeted for marketing these products. This makes it especially important that the government invest strongly in Ten Steps implementation. Continuity of care within and across the health system and leadership continuity are key factors in reinforcing its implementation. The study findings from this Indonesian maternity care facility re-emphasize WHO recommendations to integrate the Ten Steps into national health systems and increase pre-service education on breastfeeding for health care professionals. [ABSTRACT FROM AUTHOR]

Objective: The mother–child breastfeeding dyad is a powerful force for achieving healthy, secure and sustainable food systems. However, food system reports exclude breastfeeding and mother's milk. To help correct this omission and give breastfeeding women greater visibility in food systems dialogue and action, we illustrate how to estimate mother's milk production and incorporate this into food surveillance systems, drawing on the pioneering experience of Norway to show the potential value of such analysis. Design: The estimates use data on the proportion of children who are breastfed at each month of age (0–24 months), annual number of live births and assumptions on daily human milk intake at each month. New indicators for temporal and cross-country comparisons are considered. Setting: It is assumed that a breastfeeding mother on average produces 306 l of milk during 24 months of lactation. Participants: The annual number of live births is from Statistics Norway. Data for any breastfeeding at each month of age, between 0 and 24 months, are from official surveys in 1993, 1998–1999, 2006–2007, 2013 and 2018–2019. Results: Estimated total milk production by Norwegian mothers increased from 8·2 to 10·1 million l per year between 1993 and 2018–2019. Annual per capita production increased from 69 to 91 l per child aged 0–24 months. Conclusions: This study shows it is feasible and useful to include human milk production in food surveillance systems as an indicator of infant and young child food security and dietary quality. It also demonstrates significant potential for greater milk production. [ABSTRACT FROM AUTHOR]

Pseudoendocrine sarcoma is a rare, recently described intermediate grade sarcoma of uncertain phenotype that most commonly affects the paraspinal location in older patients with a distinctive endocrine/paraganglioma-like morphology and unique CTNNB1 point mutation. While these tumors appear as epithelial or even benign endocrine tumors, these lack markers for such and are highlighted by nuclear expression of beta-catenin. This case is the first among the previously reported only twenty-five cases of this entity, including one original series and a few case reports, to correlate the radiologic imaging with the pathologic features. Furthermore, this case illustrates the oldest-to-date patient with this unique location as a palpable painful chest wall/paraspinal location, with new morphologic observations and, finally, this is only the second case to have this specific CTNNB1 hotspot point mutation for this rare entity. [ABSTRACT FROM AUTHOR]

Purpose The study's purpose was to measure the impact of anti-reflux needleless connector usage in prevention of intraluminal thrombotic occlusions among central venous catheters, as represented by alteplase usage, in a home infusion patient population. Methods An18-month before-and-after cohort study of a single home infusion intervention was conducted to compare occlusion outcomes with use of two types of needleless connectors—neutral and anti-reflux—in preventing catheter occlusions, which have been reported to occur in 28% of home infusion patients, resulting in treatment delays, increased nursing encounters and emergency room visits, and higher overall pharmacy costs for supplies and alteplase. Results A total of 552,707 patient therapy days were studied: 42.5% in the neutral needleless connector group (n = 235,004 therapy days) and 57.5% in the anti-reflux needleless connector group (n = 317,703 therapy days). The rate of alteplase usage with neutral versus anti-reflux needleless connectors was 4.4% versus 2.2% per 1,000 therapy days, with median alteplase use of 112 (95% CI, 89-169) units versus 82 (95% CI, 68-109) units (P < 0.001). Implementation of anti-reflux connectors reduced occlusions and alteplase usage by 48%. Conclusion Statistical evidence demonstrated that use of anti-reflux needleless connectors with central venous access devices reduced the need for alteplase in the study population. Since 10% of patient occlusions were within 7 days after home infusion admission, future research may indicate that placement of anti-reflux needleless connectors at the time of in-hospital insertion can improve patient outcomes. This quality improvement measure reduced central catheter occlusions, alteplase costs, and the number of required nursing and emergency room visits. [ABSTRACT FROM AUTHOR]

Identifying and promoting resilience factors may offer novel strategies for optimizing the recovery of patients following orthopedic surgery. Prior research has suggested that self-efficacy, positive affect, vigor, and vitality may function as resilience factors in the face of chronic pain. The present study examines these resilience factors in a prospective, cognitive-affective-behavioral pathway to recovery. Patients (n = 110) undergoing unilateral, total knee replacement surgery completed self-report assessments of study variables. Self-efficacy was assessed 2 ½ weeks prior to surgery, positive affect the day after surgery, vitality and vigor one-month following surgery, and post-operative pain at one- and three-months following surgery. Control variables included gender, pain, and depressive symptoms prior to surgery. Path analysis revealed significant coefficients from pre-operative self-efficacy to positive affect during hospitalization (β =.246, p =.017), as well as to vitality (β =.323, p =.001) and vigor (β =.387, p <.001) at one-month following surgery. Both indicators of energy predicted better post-operative recovery (one-month: vitality β = -.254, p =.016; vigor β = -.329, p =.002); three-months: vitality β = -.192, p =.047, vigor β = -.201, p =.044). Findings support a cognitive-affective-behavioral pathway to recovery. [ABSTRACT FROM AUTHOR]

Disease‐tolerant cultivars maintain yield in the presence of disease. When disease intensity is high, they can improve a grower's net return compared to less tolerant cultivars. Many authors report a trade‐off, whereby higher fully protected yields are correlated with a lower disease tolerance. We analyse the question for breeders: to what extent should they breed for tolerance when it compromises maximizing fully protected yield? Field trials with 147 progeny from five parental crosses of wheat were used to measure yield and tolerance under a range of disease intensities from Septoria tritici blotch (STB; causal organism Zymoseptoria tritici) at a range of sites and seasons. The data define the variation for these traits from which breeders can select. A simple data‐driven descriptive model was used to calculate the combination of tolerance and fully protected yield that maximizes actual yield for any given level of disease—quantified by loss of healthy canopy area duration (HAD‐loss). This model was combined with data on the year‐to‐year variability of HAD‐loss in the UK to calculate the tolerance and fully protected yield that maximizes the mean actual yield. We found that even when an effective fungicide treatment programme is applied, breeding for tolerance increases the mean actual yield. Some commercially available cultivars were found to have a level of tolerance that leads to yields close to the maximum yield in the presence of disease, others had a lower tolerance leading to suboptimal yields. [ABSTRACT FROM AUTHOR]

Background: Governments must protect and apply maximum feasible resourcing to the protection, promotion and support of breastfeeding in order to meet their international legal obligations with respect to the human rights of women and children. However, governments across the world have consistently failed in these duties. Breastfeeding has been notably absent from mainstream feminist advocacy on sexual and reproductive health rights ('SRH rights'). Why is there this lack of focus on breastfeeding in feminist advocacy in this area? This review seeks to identify the extent to which the protection, promotion and support of breastfeeding is visible within the SRH rights and the gender responsive budgeting literature. Method: A cross-disciplinary single scoping literature review of online and other databases was conducted to yield final samples of eighty-seven publications from the SRH rights literature and forty-four publications from the gender responsive budgeting literature. These publications were searched for references to breastfeeding. Results: Only 21% of the sexual and reproductive health rights literature and just one gender responsive budgeting publication sampled referenced the protection, promotion and support of breastfeeding. Where breastfeeding was mentioned in the publications reviewed it was, in general, brief and on the periphery of discussion. Conclusions: Reviews of the SRH rights literature and the gender budgeting literature both reveal an overwhelming absence of meaningful analysis on breastfeeding. The lack of attention to breastfeeding in the gender advocacy space represents a lost opportunity to advocate for the alleviation of the economic and social constraints imposed on breastfeeding women and caregivers. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding has positive impacts on the health, environment, and economic wealth of families and countries. The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative (BFHI) in 1991 as a global program to incentivize maternity services to implement the Ten Steps to Successful Breastfeeding (Ten Steps). These were developed to ensure that maternity services remove barriers for mothers and families to successfully initiate breastfeeding and to continue breastfeeding through referral to community support after hospital discharge. While more than three in four births in Australia take place in public hospitals, in 2020 only 26% of Australian hospitals were BFHI-accredited. So what is the social return to investing in BFHI accreditation in Australia, and does it incentivize BFHI accreditation? This study aimed to examine the social value of maintaining the BFHI accreditation in one public maternity unit in Australia using the Social Return on Investment (SROI) framework. This novel method was developed in 2000 and measures social, environmental and economic outcomes of change using monetary values. Method: The study was non-experimental and was conducted in the maternity unit of Calvary Public Hospital, Canberra, an Australian BFHI-accredited public hospital with around 1000 births annually. This facility provided an opportunity to illustrate costs for maintaining BFHI accreditation in a relatively affluent urban population. Stakeholders considered within scope of the study were the mother-baby dyad and the maternity facility. We interviewed the hospital's Director of Maternity Services and the Clinical Midwifery Educator, guided by a structured questionnaire, which examined the cost (financial, time and other resources) and benefits of each of the Ten Steps. Analysis was informed by the Social Return on Investment (SROI) framework, which consists of mapping the stakeholders, identifying and valuing outcomes, establishing impact, calculating the ratio and conducting sensitivity analysis. This information was supplemented with micro costing studies from the literature that measure the benefits of the BFHI. Results: The social return from the BFHI in this facility was calculated to be AU$ 1,375,050. The total investment required was AU$ 24,433 per year. Therefore, the SROI ratio was approximately AU$ 55:1 (sensitivity analysis: AU$ 16–112), which meant that every AU$1 invested in maintaining BFHI accreditation by this maternal and newborn care facility generated approximately AU$55 of benefit. Conclusions: Scaled up nationally, the BFHI could provide important benefits to the Australian health system and national economy. In this public hospital, the BFHI produced social value greater than the cost of investment, providing new evidence of its effectiveness and economic gains as a public health intervention. Our findings using a novel tool to calculate the social rate of return, indicate that the BHFI accreditation is an investment in the health and wellbeing of families, communities and the Australian economy, as well as in health equity. [ABSTRACT FROM AUTHOR]

This article looks at the impact of the COVID-19 crisis in the United Kingdom. COVID-19 is a health issue but one that would have significant economic and constitutional implications for the UK. Moreover, the asymmetric responses across the UK put pressure on the very fabric of the country, as the four nations – Scotland, England, Wales and Northern Ireland – pursued differing policies in response to COVID-19 and within England certain regions perceived themselves to have been treated unfairly. All of these issues reinforced and magnified the implications of the issue that had overshadowed British politics for years: Brexit. [ABSTRACT FROM AUTHOR]

Background: Infant sleep is of great interest to new parents. There is ongoing debate about whether infants fed with breastmilk substitutes sleep longer than those exclusively or partially breastfed, but what does this mean for the mother? What expectations are realistic for mothers desiring to exclusively breastfeed as recommended by health authorities? There are both biological and social influences on infant and maternal sleep. More accurate information on average maternal sleep hours for diverse feeding practices may help guide realistic expectations and better outcomes for mothers, infants and families. Methods: Using a unique time use dataset purposefully designed to study the time use of new mothers, this study investigated whether the weekly duration of maternal sleep, sleep disturbance, unpaid housework, and free time activities differed by detailed feeding method. The study collected 24/7 time use data from 156 mothers of infants aged 3, 6 and/or 9 months between April 2005 and April 2006, recruited via mother's groups, infant health clinics, and childcare services throughout Australia. Sociodemographic and feeding status data were collected by questionnaire. Statistical analysis used linear mixed modelling and residual maximum likelihood analysis to compare effects of different infant feeding practices on maternal time use. Results: There were no significant differences in time spent asleep between lactating and non lactating mothers, though lactating mothers had more time awake at night. Lactating mothers spent more time (8.5 h weekly) in childcaring activity (p = 0.007), and in employment (2.7 vs. 1.2 h, p < 0.01), but there were no significant differences in free time. Those not breastfeeding spent more time in unpaid domestic work. Exclusive breastfeeding was associated with reduced maternal sleep hours (average 7.08 h daily). Again, free time did not differ significantly between feeding groups. Exclusively breastfeeding mothers experienced reduced sleep hours, but maintained comparable leisure time to other mothers by allocating their time differently. Domestic work hours differed, interacting in complex ways with infant age and feeding practice. Conclusions: Optimal breastfeeding may require realistic maternal sleep expectations and equitable sharing of paid and unpaid work burdens with other household members in the months after the birth of an infant. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding has positive impacts on the health, environment, and economic wealth of families and countries. The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative (BFHI) in 1991 as a global program to incentivize maternity services to implement the Ten Steps to Successful Breastfeeding (Ten Steps). These were developed to ensure that maternity services remove barriers for mothers and families to successfully initiate breastfeeding and to continue breastfeeding through referral to community support after hospital discharge. While more than three in four births in Australia take place in public hospitals, in 2020 only 26% of Australian hospitals were BFHI-accredited. So what is the social return to investing in BFHI accreditation in Australia, and does it incentivize BFHI accreditation? This study aimed to examine the social value of maintaining the BFHI accreditation in one public maternity unit in Australia using the Social Return on Investment (SROI) framework. This novel method was developed in 2000 and measures social, environmental and economic outcomes of change using monetary values. Method: The study was non-experimental and was conducted in the maternity unit of Calvary Public Hospital, Canberra, an Australian BFHI-accredited public hospital with around 1000 births annually. This facility provided an opportunity to illustrate costs for maintaining BFHI accreditation in a relatively affluent urban population. Stakeholders considered within scope of the study were the mother-baby dyad and the maternity facility. We interviewed the hospital's Director of Maternity Services and the Clinical Midwifery Educator, guided by a structured questionnaire, which examined the cost (financial, time and other resources) and benefits of each of the Ten Steps. Analysis was informed by the Social Return on Investment (SROI) framework, which consists of mapping the stakeholders, identifying and valuing outcomes, establishing impact, calculating the ratio and conducting sensitivity analysis. This information was supplemented with micro costing studies from the literature that measure the benefits of the BFHI. Results: The social return from the BFHI in this facility was calculated to be AU$ 1,375,050. The total investment required was AU$ 24,433 per year. Therefore, the SROI ratio was approximately AU$ 55:1 (sensitivity analysis: AU$ 16–112), which meant that every AU$1 invested in maintaining BFHI accreditation by this maternal and newborn care facility generated approximately AU$55 of benefit. Conclusions: Scaled up nationally, the BFHI could provide important benefits to the Australian health system and national economy. In this public hospital, the BFHI produced social value greater than the cost of investment, providing new evidence of its effectiveness and economic gains as a public health intervention. Our findings using a novel tool to calculate the social rate of return, indicate that the BHFI accreditation is an investment in the health and wellbeing of families, communities and the Australian economy, as well as in health equity. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to explore the importance of problem posing in learning mathematics at the compulsory education level. Despite acknowledging that children have a natural disposition to pose questions, no curricular provision currently exists for the conceptualisation and operationalisation of mathematical problem posing within Scotland's Curriculum for Excellence. In order to provide evidence to support any curricular change, integrative systematic review and narrative synthesis of quantitative and qualitative studies was conducted. Results suggest that problem posing can offer an array of valuable didactic benefits for pupils such as deeper conceptual knowledge, enhanced problem‐solving skills and an increase in the enjoyment of mathematics. Evidence from the qualitative synthesis provides some tentative guidance on considerations regarding the integration of problem posing to the curriculum. This study argues that in order to improve future learning experiences, mathematical problem posing should be embedded in all Scottish classrooms. Furthermore, problem posing is determined to be effective in the pedagogical development of prospective primary and secondary mathematics practitioners. [ABSTRACT FROM AUTHOR]

Understanding the mechanisms generating diversity in mating signals is critical to understanding the process of speciation. One mechanism of mating signal diversification occurs when phenotypes that experience divergent ecological selection also affect the production of mating signals, resulting in a coupling between ecological diversification and mating signal diversification. Here, we present evidence that rapid diversification in bill size has resulted in the diversification of some components of song structure in a young adaptive radiation of seed-eating finches (red crossbill, Loxia curvirostra complex). Specifically, we find that larger-billed ecotypes sing songs with lower minimum frequencies, lower syllable repetition rates and greater vocal deviation (i.e. lower performance) than smaller-billed ecotypes for pure tonal syllables. In contrast, bill size was not correlated with maximum frequency or frequency bandwidth, and we found no relationship between bill size and any song parameters in buzzy syllables. Furthermore, we found no evidence for a relationship between the degree of bill size divergence and the potential for song discrimination between sympatric ecotypes. Because bill size is correlated with some features of pure tonal syllables (which appear to be most important for courtship in crossbills) in crossbill song, our results suggest that there was an early-evolving link between ecological and mating signal diversification that may have influenced the rapid evolution of reproductive isolation between sympatric ecotypes. [ABSTRACT FROM AUTHOR]

Up to December 2019, 9 (4.34%) of 207 paediatric patients with diabetes using CGMDs had developed reactions to the devices. Https://doi.org/10.1093/ced/llac076 Dear Editor, Glucose monitoring in diabetes can be performed using traditional blood glucose monitoring devices (GMDs), which measure capillary glucose, or with newer continuous glucose monitoring devices (CGMDs), which measure interstitial fluid glucose.[1] In March 2022, The National Institute for Health and Care Excellence (NICE) recommended CGMDs for all adults and children with Type 1 diabetes and extended its use to patients with Type 2 diabetes on intensive insulin therapy.[2] These devices reduce the need for finger pricks and allow better glycaemic control.[2] CGMDs can be of two types: real-time CGMDs (e.g. Dexcom and Medtronic) and intermittently scanned or flash CGMDs (e.g. Freestyle® Libre).[1] There have been increasing reports of cutaneous reactions to medical devices, including CGMDs, in the literature.[3] These reactions are mostly to the sensor of the CGMD, which is held in place on the skin for days to weeks with adhesive,[3] causing irritant or allergic contact dermatitis. [Extracted from the article]

Researchers have shown that a drawing activity is a useful way to detect students' attitudes and stimulate discussion on age-related subjects. This study adopted a drawing activity to investigate 105 college students' attitudes towards aging in general compared to notions of their aging self. Results highlighted two double standards. First, undergraduate students in the present study perceived aging in general or older people as "the other" who do not age successfully, while constructing a successful ideal regarding their own aging or future selves. If the current generation of college students in deed does view older people as somehow 'different' from themselves, it is then possible that they will distance themselves from older people or treat them less favorably. A second finding revealed gender difference regarding the image of later life. Specifically, college students in this study perceived older women more negatively and facing more physical challenges of aging while at the same time positively viewed older women as having more support from family and social relationships. Implications of current study focus on ways faculty can alter college students' biases along with enhancing students' interests in working in the field of aging. [ABSTRACT FROM AUTHOR]

The purpose of this study was to enhance our understanding of the relationship between collaborative talk and metacognitive talk during group mathematical problem-solving. Research suggests that collaborative talk may mediate the use of metacognitive talk, which in turn is associated with improved learning outcomes. However, our understanding of the role of group work on the individual use of metacognition during problem-solving has been limited because research has focused on either the individual or the group as a collective. Here, primary students (aged nine to 10) were video-recorded in a naturalistic classroom setting during group mathematical problem-solving sessions. Student talk was coded for metacognitive, cognitive and social content, and also for collaborative content. Compared with cognitive talk, we found that metacognitive talk was more likely to meet the criteria to be considered collaborative, with a higher probability of being both preceded by and followed by collaborative talk. Our results suggest that collaborative metacognition arises from combined individual and group processes. [ABSTRACT FROM AUTHOR]

Electronic assessment is gaining popularity in clinically based elements of pre-registration nurse education. In this study, the authors explored student nurse and mentor experiences during transition from a paper to an electronic system. Mixed research methods used included survey questionnaires and focus groups. Student nurses and their mentors (both n=5) discussed and rated their confidence and skills in information technology and their experience of an electronic assessment document before and after two successive clinical placements. Students’ self-reported confidence increased after both placements; mentors’ confidence fell after the first placement. Students reported the fewest needs for additional support, while mentors expressed anxieties about system navigation and time required. The main barrier was lack of access to computers connected to the internet in the practice environment. Nevertheless, students and mentors were receptive to the change. Training and support was seen as essential. Serious challenges in up-scaling this system for complete student cohorts lie in wait if computer availability is not addressed. [ABSTRACT FROM AUTHOR]

The article explores the democratic legitimacy of the European Union (EU) economic governance. Topics discussed include the response of the European Parliament to the withdrawal of Great Britain from the EU, the treaty reforms and strategies considered by the EU to address the Eurozone debt crisis, and the establishment and accomplishments of the Interparliamentary Conference on Stability, Economic Coordination and Governance.

This paper examines law, science, and policy issues behind the 2016 federal genetically modified organism (GMO) food labeling law. It argues in favor of the FDA's approach of regulating GMOs based on product characteristics rather than on the process by which they were created. Because GMO labeling addresses subjective personal preferences rather than objective concerns, it should be voluntary rather than mandatory. For thousands of years, humans have genetically modified plants and animals to improve characteristics like flavor, nutrient content, production yield, shelf life, and pest resistance. Older agricultural methods modified DNA indirectly, but genetic engineering can now be used to modify DNA directly, resulting in more efficient improvements in the characteristics of our foods. Most consumers have only a minimal understanding of genetics and genetic engineering and many express reservations about modifying foods in the laboratory. Although scientists have concluded that genetic engineering does not in itself cause health or environmental problems, a majority of Americans say that all GMO foods should be labeled. When Vermont and other states enacted GMO food labeling laws, Congress feared a patchwork of conflicting local laws and quickly passed a federal mandatory GMO labeling statute. The federal statute has strong preemption clauses that nullify most state GMO labeling laws. But the new law's scope is arguably narrow and ambiguous, and even labeling proponents deem it unacceptable. The new GOP administration's focus on reducing federal regulation may provide an opportunity to revisit and revise or repeal the federal GMO labeling statute. In the bigger picture, scientists need to better educate both legislators and citizens about complex technical fields like genetics in order to facilitate better-informed policy choices. [ABSTRACT FROM AUTHOR]

Objective: The marketing of infant/child milk-based formulas (MF) contributes to suboptimal breast-feeding and adversely affects child and maternal health outcomes globally. However, little is known about recent changes in MF markets. The present study describes contemporary trends and patterns of MF sales at the global, regional and country levels.Design: Descriptive statistics of trends and patterns in MF sales volume per infant/child for the years 2008-2013 and projections to 2018, using industry-sourced data.Setting: Eighty countries categorized by country income bracket, for developing countries by region, and in countries with the largest infant/child populations.Subjects: MF categories included total (for ages 0-36 months), infant (0-6 months), follow-up (7-12 months), toddler (13-36 months) and special (0-6 months).Results: In 2008-2013 world total MF sales grew by 40·8 % from 5·5 to 7·8 kg per infant/child/year, a figure predicted to increase to 10·8 kg by 2018. Growth was most rapid in East Asia particularly in China, Indonesia, Thailand and Vietnam and was led by the infant and follow-up formula categories. Sales volume per infant/child was positively associated with country income level although with wide variability between countries.Conclusions: A global infant and young child feeding (IYCF) transition towards diets higher in MF is underway and is expected to continue apace. The observed increase in MF sales raises serious concern for global child and maternal health, particularly in East Asia, and calls into question the efficacy of current regulatory regimes designed to protect and promote optimal IYCF. The observed changes have not been captured by existing IYCF monitoring systems. [ABSTRACT FROM AUTHOR]

Objective. The severe pain and disability associated with osteoarthritis often motivate individuals to undergo arthroplastic surgery. However, a significant number of surgical patients continue to experience pain following surgery. Prior research has implicated both the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) in the sensitization of pain receptors and chronic pain conditions. This study uses a prospective, observational, cohort design to examine whether physiological stress responses before and after surgery could predict post-operative pain severity. Subjects. Participants included 110 patients undergoing total knee arthroplasty. Methods. Physiological indices of stress included the measurement of catecholamine and cortisol levels in 15-hour urine samples collected prior to and 1 month following surgery, as well as in-hospital heart rate and blood pressure (before and after surgery), which were abstracted from medical records. Patients completed the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [Bellamy et al., J Orthop Rheumatol 1, 95 (1988)] 2.5 weeks prior to surgery and at a 3-month follow-up. Results. Contrary to expectations, lower stress hormone levels at baseline were related to more severe post-operative pain. Data at later time points, however, supported our hypothesis: cardiovascular tone shortly before surgery and urinary levels of epinephrine 1 month following surgery were positively related to pain severity 3 months later. Conclusion. Results suggest that the occurrence of post-operative pain can be predicted on the basis of stress physiology prior to and following arthroplastic surgery. [ABSTRACT FROM AUTHOR]

The negative perception of behavior analysis by the public, and conveyed in mass media, is well-recognized by the professional community of behavior analysts. Several strategies for correcting this perception have been deployed in the field by organizational behavior management practitioners, in particular, with encouraging results. These strategies include (a) reframing behaviorism in a more resonant format, (b) pushing direct outcome comparisons between behavior analysis and its rivals, and (c) playing up the 'warm and fuzzy' side of behavior analysis (see Freedman , in this issue, for a thorough description of these strategies). This article outlines three additional strategies that the author believes will position behavior analysis as a 'contemporary science of what works in behavior change.' These new strategies are (a) creating a cohesive, easily understandable framework; (b) personally communicating a more contemporary, sophisticated message; and (c) using technology to achieve scale. [ABSTRACT FROM AUTHOR]

The article discusses the vernacular translation of the Benedictine Rule during the English reform. Topics discussed include the history of monasticism, the value of translating Latin texts into vernacular, and the relevant features of surviving manuscripts of the vernacular Rule including the feminized and masculine versions.

A focus on market-based green growth strategies to pursue sustainability goals neglects the pursuit of understanding how human health is interwoven with the health of eco-systems to deliver sustainability goals. The article argues that clarifying the difference between green and sustainable public sector food procurement, with political continuity that supports and enables policymakers and practitioners to take an incremental approach to change, makes an important contribution to delivering more sustainable food systems and better public health nutrition. Five European case studies demonstrate the reality of devising and implementing innovative approaches to sustainable public sector food procurement and the effects of cultural and political framings. How legislation is enacted at the national level and interpreted at the local level is a key driver for sustainable procurement. Transition is dependent on political will and leadership and an infrastructure that can balance the economic, environmental and social drivers to effect change. The development of systems and indicators to measure change, reforms to EU directives on procurement, and the relationship between green growth strategies and sustainable diets are also discussed. The findings show the need to explore how consistent definitions for green public procurement and sustainable public procurement can be refined and standardized in order to support governments at all levels in reviewing and analyzing their current food procurement strategies and practices to improve sustainability. [ABSTRACT FROM AUTHOR]

The article offers the author's insights on the five impulses of the Gospel of Mark's Joseph Smith Translation (JST) which are considered potential trajectories for the Latter Days Saints (LDS) biblical interpretation. Topics discussed include the impulse of amplifying unique tendencies of Mark in JST findings by scholars such as the portrayal of disciples, the function of women in the JST as compared in Mark, and an impulse to modernize in the JST.

The present studies examine whether information contained in medical records can be used to predict outcomes following two orthopedic procedures: repair of hip fracture and total knee replacement. Study I reports the acute, in-hospital recovery data from the medical records of 119 hip fracture patients. Study 2 is a prospective, longitudinal investigation of 3-month postoperative recovery of 110 total knee replacement patients. Patients characterized by a greater number of post-traumatic stress risk factors experienced poorer outcomes following orthopedic surgery. Our results suggest that patients at risk for negative outcomes can be identified by information readily available to medical personnel. [ABSTRACT FROM AUTHOR]

Research concerning the impact of trauma history on individuals' ability to cope with subsequent events is mixed. While many studies find that trauma history increases vulnerability for conditions such as post-traumatic stress disorder and chronic pain, others reveal that there are benefits associated with moderate levels of stress (e.g. development of coping skills). Objective: The present study investigated whether the experience of prior traumatic stressors would serve as a risk or resilience factor based on physical and emotional outcomes among patients recovering from total knee replacement surgery (TKR). Design: 110 patients undergoing unilateral, TKR completed surveys before surgery, as well as one and three months following the procedure. Results: Contrary to hypotheses, patients who reported more prior traumas experienced less severe pain and functional limitations at one- (β = −.259,p = .006) and three-month follow-up assessments (β = −.187,p = .04). A similar pattern emerged when specific types of traumas (e.g. interpersonal) were examined in relation to physical recovery. Further, patients’ trauma history was negatively related to symptoms of post-traumatic stress three-months following surgery (e.g. Avoidance:β = −.200,p = .037). Conclusion: Trauma history represents a source of resilience, rather than vulnerability, within the context of arthroplastic surgery. [ABSTRACT FROM PUBLISHER]

Background Cardiac rehabilitation and secondary prevention are evidence-based strategies to reduce the risk of recurrent cardiac events but are underutilised. New approaches are required to improve uptake. Methods A new cardiac rehabilitation needs assessment tool (CRNAT), for use by cardiology ward nurses, was developed and refined in collaboration with stakeholders through action research. The tool documented patients’ risk factors, initiated a discussion about secondary prevention and linked patients to post-discharge follow-up. The initial version of the tool was developed through consultation with cardiac rehabilitation specialist staff (n=3), reviewed by ward nurses (n=4) and general practitioners (GP) (n=8), and piloted in patients (n=8). Review was undertaken at six months post implementation through patient (n=66) and GP (n=10) surveys, with additional patient feedback through focus groups (n=8 patients) and phone interviews (n=14). At 12 months, ward nurses (n=21) were surveyed. Results The CRNAT was well regarded by patients and GPs and stakeholder feedback resulted in only minor changes to the tool's content. Feedback from ward nurses led to important changes to the process of administering the tool to streamline its use in an inpatient setting. Conclusions Feedback from end users is important when developing a new clinical tool to ensure it meets their requirements. [ABSTRACT FROM AUTHOR]

This introduction to a special issue on the economics of breastfeeding draws attention to the lack of economic justice for women. Human milk is being bought and sold. Commodifying and marketing human milk and breastfeeding risk reinforcing social and gender economic inequities. Yet there are potential benefits for breastfeeding, and some of the world's poorest women might profit. How can we improve on the present situation where everyone except the woman who donates her milk benefits? Breastfeeding is a global food production system with unsurpassed capacity to promote children's food security and maternal and child health, but it is side-lined by trade negotiators who seek instead to expand world markets for cow's milk-based formula. Regulators focus on potential risks of feeding donated human milk, rather than on health risks of exposing infants and young children to highly processed bovine milk. Similarly, policymakers aspire to provide universal health care access that may be unaffordable when two thirds of the world's children are not optimally nourished in infancy, resulting in a global double burden of infectious and chronic disease. Universal breastfeeding requires greater commitment of resources, but such investment remains lacking despite the cost effectiveness of breastfeeding protection, support and promotion in and beyond health services. Women invest substantially in breastfeeding but current policy - epitomised by the G20 approach to the ‘gender gap' - fails to acknowledge the economic value of this unpaid care work. Economic incentives for mothers to optimally breastfeed are dwarfed by health system and commercial incentives promoting formula feeding and by government fiscal policies which ignore the resulting economic costs. ‘The market' fails to protect breastfeeding, because market prices give the wrong signals. An economic approach to the problem of premature weaning from optimal breastfeeding may help prioritise global maternity protection as the foundation for sustainable development of human capital and labour productivity. It would remove fiscal subsidies for breast milk substitutes, tax their sale to recoup health system costs, and penalise their free supply, promotion and distribution. By removing widespread incentives for premature weaning, the resources would be available for the world to invest more in breastfeeding. [ABSTRACT FROM AUTHOR]

Background: Surgical robotics has been shown to improve the accuracy of bone preparation and soft tissue balance in unicondylar knee arthroplasty (UKA). However, although extensive data have emerged with regard to a CT scan-based haptically constrained robotic arm, little is known about the accuracy of a newer alternative, an imageless robotic system. Questions/purposes: We assessed the accuracy of a novel imageless semiautonomous freehand robotic sculpting system in performing bone resection and preparation in UKA using cadaveric specimens. Methods: In this controlled study, we compared the planned and final implant placement in 25 cadaveric specimens undergoing UKA using the new tool. A quantitative analysis was performed to determine the translational, angular, and rotational differences between the planned and achieved positions of the implants. Results: The femoral implant rotational mean error was 1.04° to 1.88° and mean translational error was 0.72 to 1.29 mm across the three planes. The tibial implant rotational mean error was 1.48° to 1.98° and the mean translational error was 0.79 to 1.27 mm across the three planes. Conclusions: The image-free robotic sculpting tool achieved accurate implementation of the surgical plan with small errors in implant placement. The next step will be to determine whether accurate implant placement translates into a clinical and functional benefit for the patient. [ABSTRACT FROM AUTHOR]

Although service improvement projects have been incorporated into some postregistration nurse education modules in the UK, they have not been generally available to pre-registration students. This paper reports on the implementation and evaluation of a pilot project in pre-registration nurse education at one university in eastern England. It concludes that the nursing students found the project to be a useful addition to their course. Supportive reactions were obtained from nurse managers, mentors and academics. A need to improve communication with clinical areas through the use of web-based materials was highlighted. [ABSTRACT FROM AUTHOR]

Introduction: There are currently no routinely used imaging modalities for the proximal lacrimal system. Optical Coherence Tomography (OCT) is a safe and non-invasive method of high resolution cross-sectional imaging of tissue microstructures using infra-red radiation. In this study we investigate whether OCT may be used to image the punctum and proximal canaliculus. Methods: A cohort of healthy subjects with normal ocular anatomy and no symptoms of epiphora were prospectively invited to enrol. Spectral OCT images of the lower punctae were captured with a Topcon 3D Optical Coherence Tomography 2000 machine. Measurements were made of the maximal punctal diameter, canalicular diameter and canalicular depth. Our data for depth of the vertical canaliculus was compared to the widely quoted figure of 2 mm using a two-tailed t-test to check for a statistically significant difference at p < 0.05. Results: Thirty-six punctae of 18 subjects were scanned. The punctum was recognisable on the OCT image in all cases. The mean depth, width and cross- sectional area of the visualised canaliculi were 0.753 mm (SD 0.216), 0.110 mm (SD 0.067) and 9.49 × 10−3 mm2, respectively. The mean width of the punctum was 0.247 mm (SD 0.078). Discussion: We have demonstrated the first in-vivo high resolution images of normal punctal and vertical canalicular anatomy using spectral OCT. There is currently no other practical way to accurately image punctal and proximal canalicular morphology in vivo. OCT is a convenient and readily available tool in most eye clinics with resolution ideally suited for imaging of the punctum and proximal canaliculus. [ABSTRACT FROM AUTHOR]

Cutaneous VCL::ALK fusion spindle (ovoid) cell tumor is unique. Recently emerged RAS::MAP tyrosine kinase fusion sarcomas more commonly involve subcutis, skeletal muscle and even bone. We share our experience with a novel cutaneous VCL::ALK spindle cell tumor. An 11‐year‐old male presented with a back pedunculated pink–red papule thought to be a pyogenic granuloma. Biopsy histopathology revealed an epithelial collarette with pedunculated tumor extending to deep dermis/subcutis interface. The combination of spindled and epithelioid cells, an ovoid myopericytoid appearance within myxoid to collagenous stroma, low to moderate MIB1 and focal S100 protein without SOX10 immunostaining, were suggestive of a novel RAS::MAPK tyrosine kinase fusion sarcoma that is well described. ALK immunostain being positive, a next‐generation sequencing comprehensive fusion panel was performed to reveal a VCL::ALK fusion. While epithelioid fibrous histiocytoma shares this fusion and similar dermal location and collarette pedunculation, this and other entities were excluded by older patient age, deeper dermal involvement, ovoid‐to‐spindled morphology, central pericytoid vasculature, myxoid stroma, moderate cellularity with low to moderate MIB1 expression, superficial ulceration, and focal S100 protein expression. Complete excision was performed with favorable follow‐up to date. This novel VCL::ALK fusion spindle (ovoid) cell tumor of the dermis is best considered as part of the recently emerged RAS::MAP tyrosine kinase fusion sarcomas. [ABSTRACT FROM AUTHOR]

This article adds to on-going debates about food provisioning in England and the relative positioning of supermarkets vis-à-vis other sources of fresh food. Arguing that traditional food markets have been neglected in the agri-food literature, the paper investigates the suggestion that they are at 'a critical juncture', with many in decline and others being (re-)gentrified for a wealthier type of customer. Theoretically, the article argues that the 'internal' and 'external' spaces and places of traditional food markets are tightly interwoven. It draws on database analysis and detailed findings from interviews with market managers, traders and shoppers conducted on markets in contrasting regions of England in the cities of Newcastle and Cambridge. The findings provide new insights by examining the connective spaces and places that link market actors and consumers as fresh food moves across the geographical regions and through the marketplace. Taking a relational view, the paper challenges the suggestion that traditional food markets are at 'a critical juncture', arguing that there are unique points of difference on how the traditional food market adapts to rapid retail change, according to its geography, history and the spatial and temporal tensions between traditional and modernised fresh food provisioning systems, and suggests the need for further in-depth research. [ABSTRACT FROM AUTHOR]

Abstract: Previous research comparing the Fed's Greenbook forecasts with a median forecast from a private-sector panel has found that the Fed's forecasts are superior. These comparisons potentially miss information from other parts of the distribution of forecast errors. We compare the Fed's forecast errors to the upper and lower quartiles from the Survey of Professional Forecasters’ forecast errors and find that errors in the lower quartile are significantly smaller. We further investigate whether the forecasters who produced those forecast errors can be identified ex-ante and find that while possible the practicality of this finding is limited due to forecaster turnover. [Copyright &y& Elsevier]

Abstract: Background: C-type natriuretic peptide (CNP) is a member of the natriuretic peptide family. Cardiac ANP and BNP expressions are firmly established, whereas CNP expression in the mammalian heart remains controversial. In the present report, we used a porcine model of the neonatal period with high expressions of cardiac ANP and BNP in order to elucidate the cardiac CNP expression profile. Methods: Plasma and cardiac tissue were obtained from newborn piglets during the first 72h of life. The chamber-specific CNP mRNA contents were quantified by real-time PCR analysis. The proCNP concentrations in plasma and cardiac tissue extracts were quantified by a porcine-specific radioimmunoassay. Results: Cardiac CNP mRNA contents (n =24) were low compared to sites of known expression, where porcine seminal vesicle CNP mRNA contents were 200-fold higher. In addition, plasma proCNP concentrations in the newborn piglets (n =44) were exceedingly low compared to proANP concentrations (5.3pmol/L (3.2–8.6) vs. 3438pmol/L (2790–5418), p <0.0001). The proCNP concentrations in atrial tissue extracts were barely detectable (≤0.06pmol/g) (n =2) compared to ventricular proANP (130pmol/g (101–159)) and atrial proANP (12,303pmol/g (10,623–15,412)). Conclusion: Our data show that the heart is not a major source of circulating proCNP in neonatal piglets. [Copyright &y& Elsevier]

The article discusses issues about the economic value of breastfeeding in trade policy worldwide in a period of trade and investment liberalisation as of January 2014. It examines whether international and national policies are sufficient in protecting optimal infant and young child feeding (IYCF). Also mentioned is the effectiveness of the International Code to regulate baby food product promotion and marketing, particularly in Australasia and China.

The article examines the symbolism of anointing in antiquity and both the immediate and broader contexts of Jesus' anointing in the Gospels. It focuses on the account given in Mark of his anointing at Bethany by a woman who is not named, but whose act Jesus declared would be spoken of for a memorial of her wherever this gospel shall be preached. A deeper examination of this account and its context is provided to explain what it means to be the Anointed One.

When a dissertation research project exploring the impact of mind-body practices on symptoms of depression and anxiety in pregnant women with a history of miscarriage failed to yield statistically significant results, I struggled with how to demonstrate that I had gleaned knowledge from this project of nearly 3 years. When a series of parallel pregnancy losses occurred in my own life, I realized that I am heavily situated within the context of my research and need to consider my data in a different sense; one that acknowledges my own self within this process while attempting to capture the lived experiences of others. The shift to autoethnography afforded me the opportunity to demonstrate that knowledge can be generated through multiple methodologies, with one approach not being privileged over another. As this dissertation moved from an empirical study to a qualitative, autoethnographic piece, I was able to identify themes surfacing from the literature, my own experiences and participation in a pregnancy loss support group. The themes discussed include: making meaning from the experience, granting personhood status and grieving and other emotional expression. [ABSTRACT FROM AUTHOR]

A literary critique is presented for the 20th-century English novel "Howards End," by E. M. Forster, focusing on its symbolic use of the color gray. Topics addressed include the cultural association of England's landscape and weather with the color gray, the color's signification of daily, monotonous living, and the associations of gray fog thematically representing obscurity and confusion.

The article discusses the best-practice strategies for support on breastfeeding in the workplace in Australia. It aims to explore the implications for absenteeism of infant feeding among employed women and maternal or child health, and identify the enablers of and barriers to combining breastfeeding with employment. It also examines the workplace factors and employment arrangements linked with breastfeeding for six months.

Phenotypic selection that is sustained over time underlies both anagenesis and cladogenesis, but the conditions that lead to such selection and what causes variation in selection are not well known. We measured the selection exerted by three species of predispersal seed predators of lodgepole pine ( Pinus contorta latifolia) in the South Hills, Idaho, and found that net selection on different cone and seed traits exerted by red crossbills ( Loxia curvirostra) and cone borer moths ( Eucosma recissoriana) over 10 years of seed crops was similar to that measured in another mountain range. We also found that the strength of selection increased as seed predation increased, which provides a mechanism for the correlation between the escalation of seed defenses and the density of seed predators. Red crossbills consume the most seeds and selection they exert accounts for much of the selection experienced by lodgepole pine, providing additional support for a coevolutionary arms race between crossbills and lodgepole pine in the South Hills. The third seed predator, hairy woodpeckers ( Picoides villosus), consumed less than one-sixth as many seeds as crossbills. Across the northern Rocky Mountains, woodpecker abundance and therefore selective impact appears limited by the elevated seed defenses of lodgepole pine. [ABSTRACT FROM AUTHOR]