Epistemic injustice in experiences of young people with parents with mental health challenges.

Amongst the impacts of growing up with a parent with mental health challenges is the experience of stigma-by-association, in which children and young people experience impacts of stigmatisation due to their parent's devalued identity. This article seeks to expand our understanding of this issue through an abductive analysis of qualitative data collected through a codesign process with young people. Results indicate that young people's experiences of stigmatisation can be effectively understood as experiences of epistemic injustice. Participants expressed that their experiences comprised 'more than' stigma, and their responses suggest the centrality to their experiences of being diminished and dismissed in respect of their capacity to provide accurate accounts of their experiences of marginalisation and distress. Importantly, this diminishment stems not only from their status as children, and as children of parents with mental health challenges but operates through a range of stigmatised identities and devalued statuses, including their own mental health status, sexual minoritisation, disability and social class. Forms of epistemic injustice thus play out across the social and institutional settings they engage with. The psychological and social impacts of this injustice are explored, and the implications for our understanding of stigma around family mental health discussed.

StigmaBeat: Collaborating With Rural Young People to Co-Design Films Aimed at Reducing Mental Health Stigma.

Little is known about the experience and impact of intersectional stigma experienced by rural young people (15-25 years) who have a parent with mental health challenges. The StigmaBeat project employed a co-design approach to create short films to identify and challenge mental health stigma from the perspective of young people who have experienced this phenomenon. The aim of this paper is to describe the co-design methodological approach used in StigmaBeat, as an example of a novel participatory project. We describe one way that co-design can be employed by researchers in collaboration with marginalised young people to produce films aimed at reducing mental health stigma in the community. Through describing the processes undertaken in this project, the opportunities, challenges, and tensions of combining community development methods with research methods will be explored. Co-design with young people is a dynamic and engaging method of collaborative research practice capable of harnessing lived experience expertise to intervene in social issues and redesign or redevelop health services and policies. The participatory approach involved trusting and implementing the suggestions of young people in designing and developing the films and involved creating the physical and social environment to enable this, including embedding creativity, a critical element to the project's methodological success. Intensive time and resource investment are needed to engage a population that is often marginalised in relation to stigma discourse.

Editorial Perspective: Prato Research Collaborative for change in parent and child mental health - principles and recommendations for working with children and parents living with parental mental illness.

Children whose parents have mental illnesses are among the most vulnerable in our communities. There is however, much that can be done to prevent or mitigate the impact of a parent's illness on children. Notwithstanding the availability of several evidence-based interventions, efforts to support these children have been limited by a lack of adequate support structures. Major service reorientation is required to better meet the needs of these children and their families. This editorial provides recommendations for practice, organisational, and systems change.

Colon Cancer Screening in Concierge Practice.

OBJECTIVES: This study evaluated the effectiveness of the Center for Executive Medicine (CEM) concierge primary care practice on preventive colorectal cancer (CRC) screening rates relative to local and national comparator data. METHODS: We performed an electronic medical record search encompassing our entire patient population who are between the ages of 50 and 75 years to determine the rate of CRC screening. We compared this rate with the average rate of Medicare Advantage plans reported by our Independent Physician Association (IPA) in 2015 and national health plans reported by the National Committee for Quality Assurance in 2014. RESULTS: The CEM had a CRC screening rate of 90.2%, which was significantly higher than local IPA Medicare Advantage plans (63.3%) and National Committee for Quality Assurance national plans (57.7%-66.5%). CEM members were significantly more likely than were IPA members to undergo screening (odds ratio 1.425, 95% confidence interval 1.348-1.507, P < 0.0001). CONCLUSIONS: These results suggest that the CEM practice strategy and processes increase CRC screening rates.

Effects of biochar on the emissions, soil distribution, and nematode control of 1,3-dichloropropene.

Emissions of volatile soil fumigant 1,3-dichloropropene (1,3-D) from soil to air are a significant concern in relation to air quality, and cost-effective strategies to reduce such emissions are urgently required by growers to help them comply with increasingly stringent regulations. In this work, application of a rice husk-derived biochar to the surface of a sandy loam soil chamber reduced soil-air emissions of 1,3-D from 42% in a control (no biochar) to 8% due to adsorption onto the biochar. This adsorbed 1,3-D showed a potential for re-volatilization into air and solubilization into the soil-liquid phase. Biochar at the soil surface also reduced soil-gas concentrations in the upper soil; based on the determination of concentration-time values, this may limit 1,3-D-induced nematode control in the upper soil. In batch studies, the mixing of biochar into the soil severely limited nematode control; 1,3-D application rates around four times greater than the maximum permissible limit would be required to give nematode control under such conditions. Therefore, the use of biochar as a surface amendment, while showing an emission reduction benefit, may limit pest control during subsequent fumigations if, as seems probable, it is plowed into the soil.

Biochar Amendment to the Soil Surface Reduces Fumigant Emissions and Enhances Soil Microorganism Recovery.

During soil fumigation, it is ideal to mitigate soil fumigant emissions, ensure pest control efficacy, and speed up the recovery of the soil microorganism population established postapplication. However, no current fumigant emission reduction strategy can meet all these requirements. In the present study, replicated soil columns were used to study the effect of biochar derived from rice husk (BR) and green waste (BG) applied to the soil surface on 1,3-dichloropropene (1,3-D) and chloropicrin (CP) emissions and soil gas distribution, and on microorganism population re-establishment. Relative to fumigated bare soil (no emission reduction strategy), high-density polyethylene (HDPE), and ammonium thiosulfate (ATS) treatments, BR gave dramatic emission reductions for both fumigants with no obvious emission peak, whereas BG was very effective only for 1,3-D. With BR application, the concentration of fumigant in the soil gas was higher than in the bare soil and ATS treatment. After the soil column experiment, mixing the BR with the fumigated soil resulted in higher soil respiration rates than were observed for HDPE and ATS treatments. Therefore, biochar amendment to the soil surface may be an effective strategy for fumigant emission reduction and the recovery of soil microorganism populations established postapplication.

Interrupting anticoagulation in patients with nonvalvular atrial fibrillation.

Three target-specific oral anticoagulants (TSOACs)-dabigatran, rivaroxaban, and apixaban-have been approved by the FDA to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation; however, no agents are currently approved to reverse the anticoagulant effects of these TSOACs in cases of active bleeding. This review discusses the benefits and risks of these TSOACs from a clinician's perspective, with a focus on the interruption of treatment for either elective or emergent surgery, monitoring, and reversal of anticoagulation. Available coagulation assays are not ideal for monitoring the effects of TSOACs and do not provide reliable quantitative measurement of their anticoagulant effects. When necessary, activated partial thromboplastin time (aPTT) may provide qualitative information on dabigatran, and prothrombin time (PT) may provide qualitative assessment of the presence of the factor Xa inhibitors, rivaroxaban and apixaban. Current recommendations for reversal of TSOACs are based largely on limited and sometimes conflicting data from in vitro or in vivo animal models, and clinical experience with these recommendations is also limited. Methods that have been investigated for effectiveness for reversal of the pharmacodynamic effects of the TSOACs include dialysis, activated charcoal, prothrombin complex concentrate (PCC), and recombinant activated factor VII. It is important to note that even within a class of anticoagulant drugs, compounds respond differently to reversal agents; therefore, recommendations for one agent should not be extrapolated to another, even if they are from the same therapeutic class. New antidotes are being explored, including a mouse monoclonal antibody to dabigatran; andexanet alfa, a potential universal factor Xa inhibitor reversal agent; and a synthetic small molecule (PER977) that may be effective for the reversal of factor Xa inhibitors and direct thrombin inhibitors. Given the short half-lives of TSOACs, watchful waiting, rather than reversal, may be the best approach in some circumstances.

The indignities of shielding during the COVID-19 pandemic for people with sickle cell disorders: an interpretative phenomenological analysis.

This article seeks to understand the first-hand experiences of people with sickle cell, a recessively inherited blood disorder, who were identified as clinically extremely vulnerable during the COVID-19 pandemic. Part of a larger sequential mixed-methods study, this article uses a selective sample of eight qualitative semi-structured interviews, which were analysed using interpretative phenomenological analysis (IPA). The first stage of IPA focused on practical concerns participants had correlated to understanding shielding and their feelings about being identified as clinically extremely vulnerable. In a secondary stage of analysis, we examined the emotions that it brought forth and the foundations of those based on discriminations. This article adds to our theoretical understanding of embodiment and temporality with respect to chronicity and early ageing. It explains how people with sickle cell disorders have an embodied ethics of crisis and expertise. It also elucidates how people's experiences during the pandemic cannot be seen in void but illustrates ableism, racism, and ageism in society writ large.

Mitigating iodomethane emissions and iodide residues in fumigated soils.

Although long-regarded as an excellent soil fumigant for killing plant pests, methyl bromide (MeBr) was phased out in 2005 in the USA, because it can deplete the stratospheric ozone layer. Iodomethane (MeI) has been identified as an effective alternative to MeBr and is used in a number of countries for preplant pest control. However, MeI is highly volatile and potentially carcinogenic to humans if inhaled. In addition, iodide anions, a breakdown product of MeI, can build up in fumigated soils and potentially cause plant toxicity and contaminate groundwater via leaching. In order to overcome the above two obstacles in MeI application, a method is proposed to place reactive bags containing ammonium hydroxide solution (NH4OH) on the soil surface underneath an impermeable plastic film covering the fumigated area. Our research showed that using this approach, over 99% of the applied MeI was quantitatively transferred to iodide. Of all the resulting iodide, only 2.7% remained in the fumigated soil, and 97.3% was contained in the reactive bag that can be easily removed after fumigation.

Water and methyl isothiocyanate distribution in soil after drip fumigation.

Methyl isothiocyanate (MITC) generators, such as metam sodium (Met-Na), are used for soil fumigation of agricultural land. The ban on the fumigant methyl bromide has resulted in greater use of MITC generators. To understand the efficacy of MITC, it is necessary to assess its generation and disappearance kinetics when Met-Na is applied to soil. This study evaluated the movement of water and distribution and dissipation of MITC in soil after application of Met-Na through surface drip irrigation systems. The effects of varying water application volume (25, 50, and 75 mm) and rate (1.9, 5.0, and 7.5 L h m) were evaluated in a sandy loam soil. Good fumigant distribution within the sandy loam soil was observed under medium water application amount (50 mm) with slow to intermediate drip application rates (1.9-5.0 L h m). Low water application amount (25 mm) or high application rate (7.5 L h m) did not provide adequate MITC distribution throughout the soil bed width and rooting depth. Dissipation patterns of MITC in soil in all water application amounts and rates followed first-order kinetics, with a rate constant of 0.025 ± 0.004 h and a half-life of 27 ± 3 h. Simulated water distribution through the soil profile using HYDRUS 2D/3D fitted measured field data well, and the model accurately simulated MITC fumigant distribution in the soil.

Mitigating 1,3-dichloropropene, chloropicrin, and methyl iodide emissions from fumigated soil with reactive film.

Implicated as a stratospheric ozone-depleting compound, methyl bromide (MeBr) is being phased out despite being considered to be the most effective soil fumigant. Its alternatives, i.e., 1,3-dichloropropene (1,3-D, which includes cis and trans isomers), chloropicrin (CP), and methyl iodide (MeI), have been widely used. High emissions of MeI from fumigated soil likely put farm workers and other bystanders at risk of adverse health effects. In this study, two types of constructed reactive film were tested for their ability to mitigate emissions of 1,3-D, CP, and MeI using laboratory permeability cells. Before activation, these films act as a physical barrier to trap fumigants leaving soil. After activation of the reactive layer containing ammonium thiosulfate solution, the films also act as a sink for the fumigants. Over 97% of trans-1,3-D and 99% of the cis-1,3-D, CP and MeI were depleted when they passed into the reactive film. Half-lives (t(1/2)) of cis-, trans-1,3-D, CP and MeI under activated reactive film were 1.2, 1.4, 1.6, and 2.0 h respectively at 40 °C.

Anaerobic transformation kinetics and mechanism of steroid estrogenic hormones in dairy lagoon water.

Wastewater from concentrated animal feeding operations (CAFOs) frequently contains high concentrations of steroid estrogenic hormones. Release of these hormones into the environment may occur when CAFO wastewater is applied to agricultural lands as a nutrient and water source for crop production. To assess the potential risk of hormone contaminants derived from animal wastewater, we investigated the transformation kinetics and mechanisms of three natural estrogenic hormones (17α-estradiol, 17ß-estradiol, and estrone) in aqueous solutions blended with dairy lagoon water under anaerobic conditions. Initial transformations of the three hormones in the dairy lagoon water were dominated by biodegradation and the degradation rates were temperature-dependent. The total amounts of hormones (initial concentration at 5 mg L(-1)) remaining in the solution after 52 days at 35 °C accounted for approximately 85%, 78%, and 77% of the initial amounts of 17α-estradiol, 17ß-estradiol, and estrone, respectively. This observation suggests that these hormones are relatively stable over time and may accumulate in anaerobic or anoxic environments and anaerobic CAFO lagoons. A racemization reaction between 17α-estradiol and 17ß-estradiol via estrone was observed in aqueous solutions in the presence of CAFO wastewater under anaerobic conditions. The initial hormone concentrations did not affect this degradation mechanism. A reversible reaction kinetic model was applied to fit the observed transformation dynamics. The degradation and regeneration of the parent hormone and its metabolites were successfully simulated by this model. The information in this study is useful for assessing the environmental risk of steroid hormones released from CAFO wastewater and to better understand why these hormone contaminants persist in many aquatic environments.

Black sickle cell patients' lives matter: healthcare, long-term shielding and psychological distress during a racialised pandemic in England - a mixed-methods study.

OBJECTIVE: To understand the psychological and social impact of shielding on people with sickle cell disorders and their carers in the Midlands region of England. This region was badly affected during the pandemic, with the city of Birmingham having some of the highest rates of COVID-19 deaths. DESIGN: A mixed-methods project with a quantitative survey on shielding and adapted SF36 V.2 questionnaire, which was supplemented by qualitative semistructured interviews analysed using interpretive phenomenological analysis (IPA). PARTICIPANTS: Fifty-one participants who were predominantly of Black Caribbean or Black African heritage anonymously took part in the online survey. We supplemented this with eight in-depth semistructured interviews with adults with sickle cell disorders using IPA. RESULTS: The adapted 36-Item Short Form Survey (SF36) version 2 (V. 2) survey indicated worse quality of life and mental health. The open-ended questions from the adapted survey also identified shielding concerns about hospital care, pain management and knowledge of sickle cell by healthcare professionals. From the interviews, it emerged that the racialised element of the pandemic caused significant psychological distress for a population group that had to regularly access hospitals. It was noted that psychological health needs both during a pandemic and outside of it were poorly understood and became invisible in services. The psychological impact of experiences of hospital care as well as growing up with an invisible chronic condition were important to understand psychologically.

Reactive films for mitigating methyl bromide emissions from fumigated soil.

Emissions of methyl bromide (MeBr) from agricultural fumigation can lead to depletion of the stratospheric ozone layer, and so its use is being phased out. However, as MeBr is still widely used under Critical Use Exemptions, strategies are still required to control such emissions. In this work, novel reactive films (RFs) were designed and their efficacy in limiting loss of MeBr from soil was tested. A reactive layer, containing dry ammonium thiosulfate (ATS), was sandwiched between two layers of plastic film, the lower layer being HDPE (high-density polyethylene film, which is permeable to MeBr) and the upper layer HDPE or VIF (virtually impermeable film). MeBr diffusion through, and transformation by, the RFs were tested in a stainless-steel permeability cell. Although ineffective when dry, the RFs substantially depleted MeBr when activated with water to produce ATS solution. MeBr half-life (t(1/2)) was around 9.0 h at 20 °C in the presence of activated RF, and was sensitive to temperature (t(1/2) 15.7 and 2.9 h at 10 and 40 °C, respectively). When the upper film layer was VIF, less than 0.15% of the added MeBr diffused through the film, with the remainder being transformed within the reactive layer. These findings indicate that such films have good potential to reduce MeBr loss from fumigated soils to the atmosphere.

Diurnal variation of diazinon volatilization: soil moisture effects.

Diurnal variations in diazinon volatilization were monitored in three field experiments conducted with differing soil moisture contents. The highest flux rates in all experiments were recorded just after diazinon application, but the magnitudes of those initial rates differed according to the soil moisture content, with wetter soil producing a higher rate: 5.6 × 10(-4) µg cm(-2) min(-1) for initial soil moisture above field capacity, 8.3 × 10(-5) µg cm(-2) min(-1) for initial soil moisture at field capacity, and 2.5 × 10(-5) µg cm(-2) min(-1) for initially very dry soil. Volatilization decreased during the first day in the two experiments with initially wet soils but remained relatively constant in the experiment with initially dry soil. The volatilization rate during the first night for the wettest soil remained about an order-of-magnitude higher than that observed for driest soil. When the surface dried in the experiment conducted at the intermediate water content, the volatilization rate and temporal pattern transitioned and became similar to that observed for the initially dry soil. Around noon of the second day, a daily maximum value was observed in the volatilization rate for wet soil, whereas a minimum value was observed for the dry soil, resulting in an order-of magnitude difference. This study demonstrates the importance of soil moisture on emissions of pesticides to the atmosphere.

Predicting methyl iodide emission, soil concentration, and pest control in a two-dimensional chamber system.

Due to ever-increasing state and federal regulations, the future use of fumigants is predicted on reducing negative environmental impacts while offering sufficient pestcontrol efficacy. To foster the development of a best management practice, an integrated tool is needed to simultaneously predict fumigant movement and pest control without having to conduct elaborate and costly experiments. The objective of this study was (i) to present a two-dimensional (2-D) mathematical model to describe both fumigant movement and pestcontrol and (ii) to evaluate the model by comparing the simulated and observed results. Both analytical and numerical methods were used to predict methyl iodide (MeI) transport and fate. To predict pest control efficacy, the concentration-time index (CT) was defined and a two-parameter logistic survival model was used. Dose-response curves were experimentally determined for MeI against three types of pests (barnyardgrass [Echinochloa crus-galli] seed, citrus nematode [Tylenchulus semipenetrans], and fungi [Fusarium oxysporum]). Methyl iodide transport and pest control measurements collected from a 2-D experiimental system (60 by 60 cm) were used to test the model. Methyl iodide volatilization rates and soil gas-phase concentrations over time were accurately simulated by the model. The mass balance analysis indicates that the fraction of MeI degrading in the soil was underestimated when determined by the appearance of iodide concentration. The experimental results showed that after 24 h of MeI fumigation in the 2-D soil chamber, fungal population was not suppressed; > 90% of citrus nematodes were killed; and barnyardgrass seeds within 20-cm distance from the center were affected. These experimental results were consistent with the predicted results. The model accurately estimated the MeI movement and control of various pests and is a powerful tool to evaluate pesticides in terms of their negative environmental impacts and pest control under various environmental conditions and application methods.

A standardized approach for estimating the permeability of plastic films to soil fumigants under various field and environmental conditions.

Minimizing atmospheric emissions of soil fumigants is critical for protecting human and environmental health. Covering the soil surface with a plastic tarp is a common approach to restrict fumigant emissions. The mass transfer of the fumigant vapors through the tarp is often the rate-limiting factor in fumigant emissions. An approach for standardizing measurements of film permeability is proposed that is based on determining the resistance (R) of films to diffusion of fumigants. Using this approach, values were determined for more than 200 film-chemical combinations under a range of temperature, relative humidity, and film handling conditions. Resistance to diffusion was specific for each fumigant/film combination, with the largest range of values observed for the fumigant chloropicrin. For each fumigant, decreased with increasing temperature. Changes in film permeability due to increases in temperature or field installation were generally less than a factor of five. For one film, values determined under conditions of very high relative humidity (approximately 100%) were at least 100 times lower than when humidity was very low (approximately 2%). This approach simplifies the selection of appropriate films for soil fumigation by providing rapid, reproducible, and precise measurements of their permeability to specific fumigants and application conditions.

Comparisons of soil surface sealing methods to reduce fumigant emission loss.

State and federal regulatory agencies depend on quality field data for determining the effects of agricultural management practices on fumigant emissions to develop sound, science-based policies and regulations on preplant soil fumigants. Field plot tests, using growers' standard field operation procedures, were used to simultaneously determine the effectiveness of several commonly proposed emission reduction methods, in a trial involving shank injection of Telone II [a.i. 1,3-dichloropropnene (1,3-D)] to a sandy loam soil to a target rate of 372 kg ha(-1). The experiment was conducted in late September 2008 in the San Joaquin Valley of California. Fumigant emissions were captured using dynamic flux chambers. The results showed that virtually impermeable film (VIF) reduced emissions >95% when compared to bare soil, and the glue joints in the film did not significantly affect the tarp performance. The VIF also created a more uniform distribution of gaseous fumigant in the soil profile, which would likely benefit pest control efficacy. Standard high-density polyethylene (HDPE) tarp reduced total 1,3-D emissions about 50% (higher than most reported values) in this trial, whereas postfumigation intermittent water treatments (seals) reduced cumulative emission losses by approximately 20%. Adding 49.4 Mg ha (equivalent to 20 tons per acre) of composted dairy manure to surface soils did not reduce 1,3-D emissions during this experiment. Use of VIF was the most promising technique in reducing emissions and has the potential to allow lower application rates while providing satisfactory pest control.

Soil fate of agricultural fumigants in raised-bed, plasticulture systems in the southeastern United States.

Soil concentrations and degradation rates of methyl isothio-cyanate (MITC), chloropicrin (CP), 1,3-dichloropropene (1,3-D), and dimethyl disulfide (DMDS) were determined under fumigant application scenarios representative of commercial raised bed, plastic mulched vegetable production systems. Five days after application, 1,3-D, MITC, and CP were detected at concentrations up to 3.52, 0.72, and 2.45 µg cm, respectively, in the soil atmosphere when applications were made in uniformly compacted soils with a water content >200% of field capacity and covered by a virtually impermeable or metalized film. By contrast, DMDS, MITC, and CP concentrations in the soil atmosphere were 0.81, 0.02, and 0.05 µg cm, respectively, 5 d after application in soil containing undecomposed plant residue, numerous large (>3 mm) clods, and water content below field capacity and covered by low-density polyethylene. Ranked in order of impact on the persistence of fumigants in soil were soil water content (moisture), soil tilth (the physical condition of soil as related to its fitness as a planting bed), the type of plastic film used to cover fumigated beds, and soil texture. Fumigants were readily detected 13 d after application when applied in uniformly compacted soils with water contents >200% of capacity and covered by a virtually impermeable or metalized film. By contrast, 1,3-D and MITC had dissipated 5 d after application in soils with numerous large (>3 mm) clods and water contents below field capacity that were covered by low-density polyethylene. Soil degradation of CP, DMDS, and MITC were primarily attributed to biological mechanisms, whereas degradation of 1,3-D was attributed principally to abiotic factors. This study demonstrates improved soil retention of agricultural fumigants in application scenarios representative of good agricultural practices.

Stigma in relation to families living with parental mental illness: An integrative review.

Stigma is a pervasive social mechanism with negative ramifications for people who experience mental illness. Less is known about the stigma experiences of families where a parent has a mental illness. This review aims to identify and synthesize evidence on the concept of stigma and stigma-related experiences and outcomes reported by parents and children living with parental mental illness. An integrative review method was employed, with PRISMA (Preferred Reporting Items of Systematic Review and Meta-Analyses) guidelines to search and select literature and extract and analyse data. This approach allows for inclusion of theoretical and empirical literature and for concept definition. Fifty-eight papers, mostly from the USA, Australia, and the UK, met the inclusion criteria. Stigma was primarily conceptualized in families as a marked difference that was negatively appraised, and which could be internalized. Some articles examined how underpinning assumptions could shape the behaviour of individuals and groups and be embedded within social institutions and structures. For parents, mental illness stigma was interconnected with stigma relating to perceived violations of social and cultural norms related to parenting. Children's experience of stigma resulted in bullying, embarrassment, guilt and social isolation, and efforts to conceal their parent's mental illness. One outcome was that stigma prevented children and parents from seeking much needed supports. Public health policies and campaigns that focus exclusively on promoting open disclosure of mental illness to foster community education outcomes are unlikely to be effective without additional strategies aimed at preventing and redressing the structural impacts of stigma for all family members.