Characterizing pathways of seafood access in small island developing states.

Ensuring healthy and sustainable food systems in increasing social, economic, and ecological change is a key global priority to protect human and environmental health. Seafood is an essential component of these food systems and a critical source of nutrients, especially in coastal communities. However, despite rapid transformations in aquatic food systems, and our urgent need to understand them, there is a dearth of data connecting harvested food production to actualized food consumption. Many analyses suggest institutional, legal, or technological innovations to improve food systems, but few have analyzed the pathways through which people already gain access to nutritious food. Here, using a random forest model and cluster analysis of a nationally representative data set from Kiribati, we operationalize access theory to trace the flows of consumptive benefit in a fisheries-based food system. We demonstrate that the market access mechanism is the key mechanism mediating seafood access in Kiribati, but importantly, the highest seafood consumption households showed lower market access, pointing to the importance of non-market acquisition (e.g., home production and gifting). We reveal six distinct household strategies that employ different sets of access mechanisms to ensure high levels of local seafood consumption in different contexts. We demonstrate the impacts of these strategies on the composition of household seafoods consumed, stressing the need to support these existing successful strategies. Finally, we point to key policy and management insights (e.g., improved infrastructure, shifts in species management) that may be more effective in reinforcing these existing pathways than commonly proposed food system interventions.

Traumatic Brain Injury Incidence in Adults with Intellectual and Developmental Disabilities.

BACKGROUND: In Ontario, there are approximately 66,000 adults living with a diagnosis of intellectual and developmental disabilities (IDD). These individuals are nearly twice as likely to experience an injury compared to the general population. Falls are an important contributor to injuries in persons with IDD and in the general population, and are consistently found to be the leading cause of traumatic brain injury (TBI). There is currently no literature that quantitatively examines TBI among persons with IDD. The purpose of this study was to compare the risk of TBI for adults with and without IDD in Ontario over time and by demographic information. METHODS: Using administrative health databases, two main cohorts were identified: (1) adults with IDD, and (2) a random 10% sample of adults without IDD. Within each cohort, annual crude and adjusted incidence of TBI were calculated among unique individuals for each fiscal year from April 1, 2002 to March 31, 2017. RESULTS: Over the 15-year study period, the average annual adjusted incidence of TBI was approximately 2.8 new cases per 1000 among Ontario adults with IDD, compared to approximately 1.53 per 1000 among those without IDD. In both cohorts, a higher proportion of TBI cases were younger (19-29 years) and male. CONCLUSIONS: During the study period, persons with IDD experienced a significantly higher risk of TBI compared to the general population indicating the possibility, and need, for targeted TBI prevention.

The pedagogical value of testing: how far does it extend?

Information is generally more memorable after it is studied and tested than when it is only studied. One must be cautious to use this phenomenon strategically, however, due to uncertainty about whether testing improves memorability for only tested material, facilitates learning of related non-tested content, or inhibits memory of non-tested material. 52 second-year Pharmacy students were asked to study therapeutic aspects of gastroesophageal reflux disease and peptic ulcer disease. One group was given 30 min to study. Another was given 20 min to study and 10 min to complete a 10-item test. Two weeks later a 40-item test was delivered to both groups that contained (a) the 10 learning phase questions, (b) 10 new questions drawn from the studied material, (c) 10 new questions about therapeutics in different disease states, and (d) 10 new questions drawn from more general pharmaceutical knowledge (e.g., basic physiology and drug characteristics). Moderate to large retrieval-enhanced learning effects were observed for both questions about material that was tested (22.9% difference in scores, p < 0.05, d = 0.60) and questions about material that was studied without being tested (18.9% difference, p < 0.05, d = 0.75). Such effects were not observed for questions that were not part of the study material: therapeutic questions that addressed different disease states (1.8% difference, p > 0.7, d = 0.08) or generic pharmaceutical questions (7.4% difference, p > 0.2, d = 0.32). Being tested made it more likely that students would report reviewing the material after the initial learning session, but such reports were not associated with better test performance. The benefit of mentally retrieving information from studied material appears to facilitate the retrieval of information that was studied without being tested. Such generalization of the benefit of testing can increase the flexibility of test-based pedagogic interventions.

Use of sedation and neuromuscular blockers in critically ill adults receiving high-frequency oscillatory ventilation.

BACKGROUND: Nearly all patients receive sedation and neuromuscular blockers (NMBs) during high-frequency oscillatory ventilation (HFOV). OBJECTIVE: To describe analgo-sedation and NMB use prior to and during HFOV in adults with acute respiratory distress syndrome. METHODS: Retrospective single-center study of 131 consecutive adults whose care was managed with HFOV from 2002 to 2011. RESULTS: During the first 4 days of HFOV, 89% and 95% of patients received sedation and opioids, respectively. Upon HFOV initiation, 119 (90.8%) patients received fentanyl doses higher than 200 µg/h; of these, 48 also received more than 20 mg/h of midazolam. Analgo-sedation doses increased significantly over time such that doses were double by day 3. Factors independently associated with fentanyl doses higher than 200 µg/h were NMB ever used (OR 4.43; 95% CI 1.26-15.65, p = 0.02), pH less than 7.15 (OR 2.08; 95% CI 1.22-3.5, p = 0.007), worsening partial pressure of oxygen/fraction of inspired oxygen (OR 1.05; 95% CI 1.00-1.10, p = 0.04), and Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR 0.87; 95% CI 0.79-0.97, p = 0.009). Deep sedation was commonly administered when NMBs were not being used, with 99.2% of sedation-agitation scores of 1 or 2. Eighty-six patients (65.6%) received NMBs and use was greatest on day 1 (59.5%). Train-of-Four was measured every hour for 53.4% of patients; 29.2% of the measurements were 0 of 4. NMB use declined over the 10-year study period. CONCLUSIONS: High analgo-sedation doses were associated with APACHE II scores, worsening gas exchange, and NMB use. Two thirds of patients received NMBs; use was highest on day 1 and subsequently declined. The percentage of patients who received NMB during HFOV in our study was lower than that previously reported. Future research should evaluate patient outcomes with and without use of NMBs, as well as the potential to manage patients with less sedation.

Fishing through the cracks: The unregulated nature of global squid fisheries.

While most research has focused on the legality of global industrial fishing, unregulated fishing has largely escaped scrutiny. Here, we evaluate the unregulated nature of global squid fisheries using AIS data and nighttime imagery of the globalized fleet of light-luring squid vessels. We find that this fishery is extensive, fishing 149,000 to 251,000 vessel days annually, and that effort increased 68% over the study period 2017-2020. Most vessels are highly mobile and fish in multiple regions, largely (86%) in unregulated areas. While scientists and policymakers express concerns over the declining abundance of squid stocks globally and regionally, we find a net increase in vessels fishing squid globally and spatial expansion of effort to novel areas. Since fishing effort is static in areas with increasing management, and rising in unmanaged areas, we suggest actors may take advantage of fragmented regulations to maximize resource extraction. Our findings highlight a profitable, but largely unregulated fishery, with strong potential for improved management.

Study Protocol: Interactive Dynamics of Coral Reef Fisheries and the Nutrition Transition in Kiribati.

The Kiribati 2019 Integrated Household Income and Expenditure Survey (Integrated HIES) embeds novel ecological and human health research into an ongoing social and economic survey infrastructure implemented by the Pacific Community in partnership with national governments. This study seeks to describe the health status of a large, nationally representative sample of a geographically and socially diverse I-Kiribati population through multiple clinical measurements and detailed socio-economic surveys, while also conducting supporting food systems research on ecological, social, and institutional drivers of change. The specific hypotheses within this research relate to access to seafood and the potential nutritional and health benefits of these foods. We conducted this research in 21 of the 23 inhabited islands of Kiribati, excluding the two inhabited islands-Kanton Islands in the Phoenix Islands group with a population of 41 persons (2020 census) and Banaba Island in the Gilbert Islands group with a population of 333 persons (2020 census)-and focusing exclusively on the remaining islands in the Gilbert and Line Islands groups. Within this sample, we focused our intensive human health and ecological research in 10 of the 21 selected islands to examine the relationship between ecological conditions, resource governance, food system dynamics, and dietary patterns. Ultimately, this research has created a baseline for future Integrated HIES assessments to simultaneously monitor change in ecological, social, economic, and human health conditions and how they co-vary over time.

Risperidone in schizophrenia: is there a role for therapeutic drug monitoring?

BACKGROUND: Although risperidone is commonly used in the acute and maintenance treatment of schizophrenia, the role of therapeutic drug monitoring has yet to be elucidated. The purpose of this review was to determine whether risperidone warrants therapeutic drug monitoring in patients with schizophrenia. METHODS: Using a previously published nine-step decision-making algorithm, the available evidence was examined to determine whether therapeutic drug monitoring of risperidone is warranted in adult schizophrenic patients. RESULTS: Analytical methods used to quantify risperidone, 9-hydroxyrisperidone, and the combined active moiety are specific, sensitive, accurate, and precise; however, the therapeutic range for risperidone has not yet been established. Relationships between risperidone dose and plasma concentrations of risperidone, 9-hydroxyrisperidone, or the active moiety have not yet been demonstrated. A clear correlation between plasma risperidone concentrations and therapeutic response has also not been shown. Intrinsic interpatient variability, genetically based differences in drug metabolism, and metabolic drug interactions may all influence the variability in plasma concentrations. Patients with schizophrenia on risperidone for prevention of relapse take the medication for a sufficient duration of therapy to benefit from therapeutic drug monitoring; however, the routine use of risperidone concentrations in all patients with schizophrenia is not likely to have a significant impact on the clinical decision-making process or provide more information than clinical judgment alone. CONCLUSIONS: The routine use of risperidone levels does not seem warranted in all patients with schizophrenia. Clinical end points (ie, response and toxicity) should be monitored by assessing changes in symptoms and emergence of adverse effects, especially extrapyramidal symptoms. Therapeutic drug monitoring of risperidone may be beneficial in certain circumstances, including assessing potential noncompliance and supporting compliance, ruling out therapeutic failure as a result of low drug concentrations, and identifying and managing drug interactions, adverse effects, and use in special populations.

Resource allocation in transboundary tuna fisheries: A global analysis.

Resource allocation is a fundamental and challenging component of common pool resource governance, particularly transboundary fisheries. We highlight the growing importance of allocation in fisheries governance, comparing approaches of the five tuna Regional Fisheries Management Organizations (tRFMOs). We find all tRFMOs except one have defined resources for allocation and outlined principles to guide allocation based on equity, citizenship, and legitimacy. However, all fall short of applying these principles in assigning fish resources. Most tRFMOs rely on historical catch or effort, while equity principles rarely determine dedicated rights. Further, the current system of annual negotiations reduces certainty, trust, and transparency, counteracting many benefits asserted by rights-based management proponents. We suggest one means of gaining traction may be to shift conversations from allocative rights toward weighting of principles already identified by most tRFMOs. Incorporating principles into resource allocation remains a major opportunity, with important implications for current and future access to fish.

Illuminating dark fishing fleets in North Korea.

Illegal, unreported, and unregulated fishing threatens resource sustainability and equity. A major challenge with such activity is that most fishing vessels do not broadcast their positions and are "dark" in public monitoring systems. Combining four satellite technologies, we identify widespread illegal fishing by dark fleets in the waters between the Koreas, Japan, and Russia. We find >900 vessels of Chinese origin in 2017 and >700 in 2018 fished illegally in North Korean waters, catching an estimated amount of Todarodes pacificus approximating that of Japan and South Korea combined (>164,000 metric tons worth >$440 million). We further find ~3000 small-scale North Korean vessels fished, mostly illegally, in Russian waters. These results can inform independent oversight of transboundary fisheries and foreshadow a new era in satellite monitoring of fisheries.

Curriculum integration of virtual patients.

BACKGROUND AND PURPOSE: Virtual patients (VP) offer an enhanced learning experience for students to assume the role of health professional and make therapeutic decisions in a simulated environment. While VPs are valued by students and offer benefits to the learner, little is known about how best to implement them in pharmacy education curricula. The purpose of our study was to investigate students' perceptions of VPs and build understanding about how to optimally implement them in the future. EDUCATIONAL ACTIVITY AND SETTING: Four VP cases were implemented over the first three years of the entry to practice doctor of pharmacy program. Each case was focused on a different condition and implemented in one of three settings (i.e. integration activities, large lecture setting, or independent review). Students were invited to complete a survey and participate in a focus group after completing the patient case. FINDINGS: One-hundred eighty students completed the survey and six students participated in a focus group. Ninety-four percent of respondents strongly agreed/agreed that VPs were valuable for their learning. Students preferred the VP cases be implemented in small-group settings and be relevantly timed with course material. Students found helpful that cases were realistic, clear, comprehensive, engaging, and incorporated feedback. Perceived benefits included enhanced learning about medical conditions, development of clinical reasoning skills and processes for working through cases. SUMMARY: VPs continue to be identified as a valuable learning experience. When implemented it is important to consider the learner setting in order to get the greatest value from their use.

The cost effectiveness of human papillomavirus vaccines: a systematic review.

INTRODUCTION: Human papillomavirus (HPV) is one of the world's most common sexually transmitted infections, and has been associated with a number of cervical and non-cervical diseases, including cancer. HPV vaccines have been licensed for use in females for some time, but the quadrivalent vaccine has only recently become licensed for use in males. Many countries have adopted a vaccination programme for adolescent females based on results of cost-effectiveness analyses. However, given the new indications for use of the vaccine in males, decision makers require information on the cost effectiveness of vaccinating males in order to make policy decisions on whether or not to fund such programmes. OBJECTIVE: Our objective was to conduct a qualitative systematic review to update a previously conducted review of HPV vaccine studies. METHODS: Articles were obtained from an extensive literature search to determine the cost effectiveness of implementing an HPV vaccination programme with routine cervical cancer screening. A total of 29 studies were included in this review. Seventeen of the included articles looked only at cervical disease outcomes, and 12 studies also included non-cervical disease outcomes. Four studies explored the economic impact of vaccinating both boys and girls. One study focused on a population of men who have sex with men (MSM). RESULTS: While different model structures, input parameters and baseline assumptions were used, the consistent message in studies that focused on female-only vaccination programmes was that routine vaccination of females is cost effective compared with cervical cancer screening alone. DISCUSSION: Based on the currently available literature, it appears that the addition of boys to a vaccination programme generally exceeds traditional cost-effectiveness thresholds. The MSM population represents a potential additional target for routine HPV vaccination; however, more cost-effectiveness studies are required before making such a policy change.