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Context: In contrast to the mental and physical health needs of veterans, veterans’ social care needs remain relatively neglected by policymakers and researchers. Objective: To inform UK veterans policy and practice by drawing together the expectedly limited international research base on veterans in care homes. Method: An international scoping review of peer-reviewed and grey research literature was conducted, informed by Levac et al.’s (2010) six-stage process. Findings: Thirty-three papers were found to meet the inclusion/exclusion criteria. The papers’ contents typically fell into one or more of the following themes: social connection, care preferences and autonomy, and military-related physical and mental health needs. Limitations: Very little (n = 1) UK-situated research was found, with the majority of retrieved papers (n = 24) being US-based, impeding transferability and relevancy of the findings to a UK context. Implications: Veterans’ social care needs were found to be a largely underexplored area of research, especially in the UK. There is a pressing need for UK veterans’ policymakers to redress existing imbalances in the focus of policy and research by raising the status and importance of the social care needs of UK veterans, as has been achieved on the mental and physical health fronts.

Online video game communities can provide a sense of belonging and support for marginalized people, while at the same time, can be rife with prejudice and discrimination. This study aimed to assess the prevalence of both positive and negative comments about sexual orientation and gender identity during online gaming, and to test the hypothesis that LGBTQ+ people witness or experience more prejudice than do heterosexual and cisgender persons. An online survey, distributed on social media sites and a psychology subject pool, included rating scales and open-ended questions on game-related conversations. Respondents (N = 185) provided negative examples made by others more frequently than positive ones and attributed serious comments to themselves versus jokes and offhand comments to others. Across all respondent gender identities, the targets of the negative comments by others were almost always LGBTQ+ persons. These results bolster critiques of online gaming environments as hostile to members of marginalized groups. [ABSTRACT FROM AUTHOR]

Introduction: Since 2009, nurses have relocated to Japan from Indonesia, the Philippines, and Vietnam under the auspices of the Economic Partnership Agreement (EPA). We asked why some migrant nurses remain in Japan whereas others leave. Method: We applied the methodology of Constructivist Grounded Theory. All participants were internationally educated nurses (IENs) currently or formerly working in Japan after passing the National Nursing Examination. Results: Difficulty in mastering the Japanese language was established as one of the main themes. Initial coding elicited two explanatory sub-categories: lack of confidence in communication and effects of language difficulty on workplace relationships. One explains how practical experience in the workplace affected nurses' confidence in communication. The other explains how levels of Japanese language attainment shaped relationships with colleagues. Discussion: These findings suggest a need to regulate the working conditions of foreign nurses, and a need for training schemes to optimize IEN retention. [ABSTRACT FROM AUTHOR]

Book details Krätli, S and Koehler-Rollefson, I Pastoralism – Making Variability Work Rome: FAO; 2021. 58 pages, ISBN 9789251347539

Abstract As the “new rangeland paradigm” took shape in the 1990s, climatic variability in pastoral ecosystems was often discussed as “uncertainty”, and the essential mobility of pastoral systems was argued to be possible only with flexible land access rights. These context-specific principles have increasingly been globalized in analyses of diverse pastoral systems. While new understandings of the role of uncertainty and flexibility in pastoral systems have been unquestionably beneficial for particular contexts, uncertainty has been problematically embraced as intrinsically central to pastoral systems. This paper combines a critical review of the literature and field work in Tajikistan’s Rasht Valley to bring into clear relief differences between variability and uncertainty, on the one hand, and mobility and flexibility, on the other. This allows us to see that livestock mobility is a strategy to cope with environmental variability in all pastoral contexts. Flexibility, however, is a strategy to cope with environmental uncertainty that is only present in a subset of pastoral contexts. Importantly, flexibility is not a required precondition for mobility. These realizations carry important implications for governance in pastoral settings. Due to the many challenges of building flexibility into property systems, pastoral land governance should be developed by looking for predictability, and efforts to maintain flexibility should be judicious and empirically well-justified.

OBJECTIVES:. Acute respiratory distress syndrome is treated by utilizing a lung protective ventilation strategy. Obesity presents with additional physiologic considerations, and optimizing ventilator settings may be limited with traditional means. Transpulmonary pressure (PL) obtained via esophageal manometry may be more beneficial to titrating positive end-expiratory pressure (PEEP) in this population. We sought to determine the feasibility and impact of implementation of a protocol for use of esophageal balloon to set PEEP in obese patients in a community ICU. DESIGN:. Retrospective cohort study of obese (body mass index [BMI] ≥ 35 kg/m2) patients undergoing individualized PEEP titration with esophageal manometry. Data were extracted from electronic health record, and Wilcoxon signed rank test was performed to determine whether there were differences in the ventilatory parameters over time. SETTING:. Intensive care unit in a community based hospital system in Newark, Delaware. PATIENTS:. Twenty-nine mechanically ventilated adult patients with a median BMI of 45.8 kg/m2 with acute respiratory distress syndrome (ARDS). INTERVENTION:. Individualized titration of PEEP via esophageal catheter obtained transpulmonary pressures. MEASUREMENTS AND MAIN RESULTS:. Outcomes measured include PEEP, oxygenation, and driving pressure (DP) before and after esophageal manometry at 4 and 24 hr. Clinical outcomes including adverse events (pneumothorax and pneumomediastinum), increased vasopressor use, rescue therapies (inhaled pulmonary vasodilators, extracorporeal membrane oxygenation, and new prone position), continuous renal replacement therapy, and tracheostomy were also analyzed. Four hours after PEEP titration, median PEEP increased from 12 to 20 cm H2O (p < 0.0001) with a corresponding decrease in median DP from 15 to 13 cm H2O (p = 0.002). Subsequently, oxygenation improved as median Fio2 decreased from 0.8 to 0.6 (p < 0.0001), and median oxygen saturation/Fio2 (S/F) ratio improved from 120 to 165 (p < 0.0001). One patient developed pneumomediastinum. No pneumothoraces were identified. Improvements in oxygenation continued to be seen at 24 hr, compared with the prior 4 hr mark, Fio2 (0.6–0.45; p < 0.004), and S/F ratio (165–211.11; p < 0.001). Seven patients required an increase in vasopressor support after 4 hours. Norepinephrine and epinephrine were increased by 0.05 (± 0.04) µg/kg/min and 0.02 (± 0.01) µg/kg/min on average, respectively. CONCLUSIONS:. PL-guided PEEP titration in obese patients can be used to safely titrate PEEP and decrease DP, resulting in improved oxygenation.

Purpose: The neutron shielding properties of the concrete structures of a proposed proton therapy facility were evaluated with help of the Monte Carlo technique. The planned facility’s design omits the typical maze-structured entrances to the treatment rooms to facilitate more efficient access and, instead, proposes the use of massive concrete/steel doors. Furthermore, straight conduits in the treatment room walls were used in the design of the facility, necessitating a detailed investigation of the neutron radiation outside the rooms to determine if the design can be applied without violating existing radiation protection regulations. This study was performed to investigate whether the operation of a proton therapy unit using such a facility design will be in compliance with radiation protection requirements. Methods: A detailed model of the planned proton therapy expansion project of the University of Texas, M. D. Anderson Cancer Center in Houston, Texas, was produced to simulate secondary neutron production from clinical proton beams using the MCNPX Monte Carlo radiation transport code. Neutron spectral fluences were collected at locations of interest and converted to ambient dose equivalents using an in-house code based on fluence to dose-conversion factors provided by the International Commission on Radiological Protection. Results and Conclusions: At all investigated locations of interest, the ambient dose equivalent values were below the occupational dose limits and the dose limits for individual members of the public. The impact of straight conduits was negligible because their location and orientation were such that no line of sight to the neutron sources (ie, the isocenter locations) was established. Finally, the treatment room doors were specially designed to provide spatial efficiency and, compared with traditional maze designs, showed that while it would be possible to achieve a lower neutron ambient dose equivalent with a maze, the increased spatial (and financial) requirements may offset this advantage.