Living in relationship with the Ocean to transform governance in the UN Ocean Decade.

Humanity's relationship with the Ocean needs to be transformed to effectively address the multitude of governance crises facing the Ocean, including overfishing, climate change, pollution, and habitat destruction. Earth law, including Rights of Nature, provides a pathway to center humanity as a part of Nature and transform our relationship from one of dominion and separateness towards holism and mutual enhancement. Within the Earth law framework, an Ocean-centered approach views humanity as interconnected with the Ocean, recognizes societies' collective duty and reciprocal responsibility to protect and conserve the Ocean, and puts aside short-term gain to respect and protect future generations of all life and the Ocean's capacity to regenerate and sustain natural cycles. This Essay presents Ocean-centered governance as an approach to help achieve the 10 challenges for collective impact put forward as part of the UN Decade of Ocean Science for Sustainable Development and therefore living in a harmonious relationship with the Ocean.

Two-eyed seeing: Embracing the power of Indigenous knowledge for a healthy and sustainable Ocean.

Indigenous knowledge is often disregarded and opportunities for positive change are lost. To protect the Ocean, a "two-eyed seeing" approach combining Indigenous and western knowledge systems can create advancements while empowering coastal Indigenous Peoples.

Association of Alanine Aminotransferase Flares to Hepatitis B Surface Decline During Tenofovir Alone or With Pegylated Interferon Alfa.

INTRODUCTION: We aimed to determine whether the intensity of alanine aminotransferase (ALT) flares during antiviral therapy is associated with the level of hepatitis B surface antigen (HBsAg) decline. METHODS: Quantitative HBsAg was determined during tenofovir monotherapy or tenofovir plus peginterferon alfa-2a in 201 participants with hepatitis B e antigen-positive or -negative chronic hepatitis B. A multivariable analysis identified factors associated with a shorter time to reduction in HBsAg. RESULTS: Fifty flares occurred during treatment of which 74% were moderate (ALT >5-10 × upper limit of normal) or severe (ALT >10 × upper limit of normal). These flares were associated with greater HBsAg decline compared with no flares. Significantly faster times to HBsAg decline >1 log 10 IU ( P = 0.04) and to HBsAg level <100 IU/mL ( P = 0.01) were observed with severe flares. DISCUSSIONS: Flare severity is a potentially important factor associated with shorter time to HBsAg reduction. These findings can be useful when evaluating HBsAg response to evolving hepatitis B virus therapies.

Immunostaining for hepatitis B viral antigens in liver: Association with clinical, biochemical, and virologic features of disease.

BACKGROUND AND AIM: Staining for hepatitis B viral antigens is often done in liver biopsies from patients with chronic hepatitis B, but its correlates with clinical phenotypes are not well described. METHODS: Biopsies were collected from a large cohort of adults and children with chronic hepatitis B viral infection through the Hepatitis B Research Network. Immunohistochemical staining of sections was done for hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) and then centrally read by the pathology committee. The degree of liver injury and pattern of staining were then correlated with clinical characteristics, including the clinical phenotype of hepatitis B. RESULTS: Biopsies from 467 subjects were studied, including 46 from children. Immunostaining for HBsAg was positive in 417 (90%) with scattered hepatocyte staining being the most common pattern. HBsAg staining correlated best with serum levels of HBsAg and hepatitis B viral DNA; the absence of HBsAg staining was often a prelude to loss of HBsAg from serum. HBcAg staining was positive in 225 (49%), and, while cytoplasmic staining was more frequent than nuclear staining, both nuclear and cytoplasmic positivity were often seen in the same specimen. Staining for HBcAg correlated with both level of viremia and liver injury. No biopsies from inactive carriers had stainable HBcAg, while 91% of the biopsies from those with hepatitis B e antigen-positive chronic hepatitis B stained positively for HBcAg. CONCLUSION: Immunostaining for hepatitis B viral antigens may yield helpful insights into liver disease pathogenesis but appears to add little to commonly used serological and biochemical blood tests.

The Impact of Library Resources and Services on the Scholarly Activity of Medical Faculty and Residents.

Librarians at an academic medical center library gathered data to determine if library services and resources impacted scholarly activity. A survey was developed and sent out to faculty and residents asking how they used the library during scholarly activity. Sixty-five faculty members and residents responded to the survey. The majority of respondents involved with scholarly activity use the library's services and resources. PubMed is the most frequently used database. The positive results show the library impacts the scholarly activity of medical faculty and residents.

Great expectations: A multisite, randomized controlled open-label trial of a novel patient expectations communication tool.

Objectives: In emergency medicine (EM), discerning patient expectations to inform patient-centered care poses unique challenges. We devised a novel questionnaire to facilitate clinicians' understanding of patients' expectations for their visit. Methods: We conducted a multisite, randomized controlled trial. A brief questionnaire soliciting patient expectations was developed through feedback from clinicians and patients. At the beginning of their visit, the intervention group patients completed the questionnaire and provided it to their treating clinician. The control group patients received standard care. Participants in both groups completed a survey at time of disposition assessing five satisfaction domains. The primary ordinal logistic regression analysis modeled the extent to which the intervention led to patient-reported improvement in clinician understanding of expectations with adjustment for demographic factors and site. Results: Among the 308 participants, 141 intervention and 123 control exit surveys were collected. In the primary analysis, the intervention group had 2.1 times greater odds of strongly agreeing that their clinician understood their expectations (odds ratio: 2.1, 95% confidence interval: 1.2, 3.7, p-value: 0.01), roughly equivalent to a net number needed to treat of 11 for one more improved satisfaction rating. Although the secondary outcome results were not significantly different between groups, all results tended toward the intervention group having more favorable answers. Conclusions: While more patients reported that their expectations were addressed when the novel tool was used, no significant difference was found for conventional satisfaction measures. Future studies may examine whether a tool to elicit patient expectations can lead to other improved outcomes.

Racial Disparities in Treatment Initiation and Outcomes of Chronic Hepatitis B Virus Infection in North America.

Importance: Disparities in treatment initiation may affect outcomes, but data on racially diverse populations with chronic hepatitis B virus (HBV) infection are limited. Objective: To examine whether HBV treatment initiation and outcomes differ among racial groups. Design, Setting, and Participants: From January 14, 2011, to January 28, 2018, hepatitis B surface antigen-positive adults (age ≥18 years) not receiving anti-HBV therapy were enrolled and followed up at weeks 12, 24, and every 24 weeks thereafter in a multicenter longitudinal cohort study (Hepatitis B Research Network [HBRN] adult cohort study) conducted in North America. The last study visit and data collection were completed January 28, 2019. Data were analyzed from August 27, 2021, to August 25, 2022. All HBRN participants were included unless they had acute HBV, HIV, hepatitis C or D, less than 24-weeks of follow-up after enrollment, initiated treatment at or immediately after enrollment, or had unknown race. Exposures: Participants had clinical and laboratory assessments and could receive anti-HBV treatment after enrollment. Main Outcomes and Measures: Hepatitis B virus treatment initiation and major adverse liver outcomes (hepatic decompensation, hepatocellular carcinoma, liver transplant, and death). Results: Of 1550 participants, 193 (12%) were African American or Black, 1157 (75%) were Asian, 157 (10%) were White, and 43 (3%) were other races; 789 (51%) were women, and the median age was 41.2 (IQR, 32.9-51.6) years. Sociodemographic and virologic parameters differed between groups. During 5727 person-years of follow-up, 504 participants initiated treatment, with incidences of 4.8 per 100 person-years in African American or Black individuals, 9.9 per 100 person-years in Asian individuals, 6.6 per 100 person-years in White individuals, and 7.9 per 100 person-years in those of other races (P < .001). A lower proportion (14%) of African American or Black participants met treatment criteria compared with Asian (22%) and White (27%) individuals (P = .01). The cumulative probabilities of treatment initiation after meeting the criteria were not significantly different among racial groups (African American or Black, 0.45; Asian, 0.38; White, 0.40 at 48 weeks and African American or Black, 0.45; Asian, 0.51; White, 0.51 at 72 weeks; P = .68). The incidence of major adverse liver outcomes was 0.1 per 100 person-years and did not differ by race. Conclusions and Relevance: In this observational study of chronic HBV, African American or Black participants were less likely than individuals of other races to meet treatment criteria, but among those who did, HBV treatment receipt did not differ significantly by race or socioeconomic factors. Not all eligible participants initiated treatment, but adverse liver outcomes were rare. These findings may not be generalizable to patients with chronic HBV receiving care in other settings.

Analysis of Instrument Motion and the Impact of Residency Level and Concurrent Distraction on Laparoscopic Skills.

OBJECTIVE: Using a laparoscopic box trainer fitted with motion analysis trackers and software, we aim to identify differences between junior and senior residents performing the peg transfer task, and the impact of a distracting secondary task on performance. DESIGN: General surgery residents were asked to perform the laparoscopic peg transfer task on a trainer equipped with a motion tracker. They were also asked to perform the laparoscopic task while completing a secondary task. Extreme velocity and acceleration events of instrument movement in the 3 rotational degrees of freedom were measured during task completion. The number of extreme events, defined as velocity or acceleration exceeding 1 SD above or below their own mean, were tabulated. The performance of junior residents was compared to senior residents. SETTING: Simulation learning institute, Beaumont Hospital, Royal Oak, Michigan. PARTICIPANTS: Thirty-seven general surgery residents from Beaumont Hospital, Royal Oak. RESULTS: When completing the primary task alone, senior residents executed significantly fewer extreme motion events specific to acceleration in pitch (16.63 vs. 20.69, p = 0.04), and executed more extreme motion events specific to velocity in roll (16.14 vs. 15.11, p = 0.038), when compared to junior residents. With addition of a secondary task, senior residents had fewer extreme acceleration events specific to pitch, (14.69 vs. 22.22, p < 0.001). CONCLUSIONS: While junior and senior residents completed the peg transfer task with similar times, motion analysis identified differences in extreme motion events between the groups, even when a secondary task was added. Motion analysis may prove useful for real-time feedback during laparoscopic skill acquisition.

Research Methodology and Community Participation: A Decade of Indigenous Social Science Research in Canada.

Those engaged in community-based participatory research often comment on tensions between social scientific and community values, yet little systematic evidence exists about the relationship between social science research methodologies and community participation. We analyze nearly 500 peer-reviewed articles published between 2005 and 2015 on Indigenous issues in Canada, where policies encourage participatory research methods with disempowered groups. We find that research that includes Indigenous participation is more likely to include Indigenous epistemologies and participatory evidence sources and analysis methods. We also find that peer-reviewed research involving Indigenous participants often fails to go beyond minimum levels of consultation required by policies.

Les personnes qui prennent part à la recherche participative communautaire (RPC) font souvent des commentaires sur les tensions entre les valeurs sociales scientifiques et communautaires, bien qu'il y ait fort peu d'évidence systémique au sujet des relations entre les méthodologies de recherche en sciences sociales et la participation de la collectivité. Nous analysons près de 500 articles revus par des pairs publiés entre 2005 et 2015 sur des questions autochtones au Canada, lorsque les politiques ont favorisé les méthodes de recherche participative auprès de groupes privés de pouvoir. Nous avons découvert que la recherche qui avait recours à la participation autochtone tend davantage à inclure les épistémologies autochtones, les sources de preuve participative et les méthodes d'analyse. Nous avons également constaté que souvent, la recherche revue par les pairs faisant intervenir des participants autochtones n'allait pas au-delà des degrés minimaux de consultation qu'exigent les politiques.

Deconstructing Weight Management Interventions for Young Adults: Looking Inside the Black Box of the EARLY Consortium Trials.

OBJECTIVE: The goal of the present study was to deconstruct the 17 treatment arms used in the Early Adult Reduction of weight through LifestYle (EARLY) weight management trials. METHODS: Intervention materials were coded to reflect behavioral domains and behavior change techniques (BCTs) within those domains planned for each treatment arm. The analytical hierarchy process was employed to determine an emphasis profile of domains in each intervention. RESULTS: The intervention arms used BCTs from all of the 16 domains, with an average of 29.3 BCTs per intervention arm. All 12 of the interventions included BCTs from the six domains of Goals and Planning, Feedback and Monitoring, Social Support, Shaping Knowledge, Natural Consequences, and Comparison of Outcomes; 11 of the 12 interventions shared 15 BCTs in common across those six domains. CONCLUSIONS: Weight management interventions are complex. The shared set of BCTs used in the EARLY trials may represent a core intervention that could be studied to determine the required emphases of BCTs and whether additional BCTs add to or detract from efficacy. Deconstructing interventions will aid in reproducibility and understanding of active ingredients.

Assessing the Print Communication and Technology Attributes of an Academic Medical Center.

BACKGROUND: Historically, health literacy has been viewed as the patient's problem; however, it is now accepted that the responsibility for improving health literacy lies with the health care professionals and systems. An Institute of Medicine report outlines the health literacy attributes, such as printed patient education and technology, which both play a role in patient decision-making and engaging them in their health care. Research suggests that patients who are engaged in their health care have improved health outcomes. For health care organizations to accommodate the needs of all patients, it is imperative that they determine the current organizational state and discover opportunities for improvement. METHODS: The Health Literacy Environment of Hospitals and Health Centers (HLEHHC) Print Communication Rating and Technology Rating Tool were used to measure the internal aspects of organizational health literacy at The University of Tennessee Medical Center (UTMC). Included in the print assessment were the 150 most distributed patient education handouts. Researchers also used the Simple Measure of Gobbledygook and Patient Education Materials Assessment Tool to assess print material. Technology was assessed using UTMC's website as the authoritative source. KEY RESULTS: The HLEHHC was useful for assessing print material and technology. Reviewing and reporting the data question-by-question revealed more granular, actionable information on where there are opportunities to improve the health care environment for all patients. This analysis resulted in proposing actions based on best practices that UTMC could implement in the coming year. The process is replicable in other settings. IMPLICATIONS: Responsibility for improving informed medical decision-making lies with health care organizations. Low health literacy influences the effectiveness of print patient education and technology in informing patients about their health. Assessing these aspects of the health care organization as part of quality improvement provides necessary data for improvements. The Health Literacy Environment of Hospital and Health Centers was a useful tool to measure characteristics of print and technology. [HLRP: Health Literacy Research and Practice. 2018;2(1):e26-e34.]. PLAIN LANGUAGE SUMMARY: A task force at an academic medical center assessed the health literacy attributes of their organization. Researchers assessed print patient education and patient-related technology. The researchers found areas for improvements to make health information easier to understand.

Fractal gait patterns are retained after entrainment to a fractal stimulus.

Previous work has shown that fractal patterns in gait can be altered by entraining to a fractal stimulus. However, little is understood about how long those patterns are retained or which factors may influence stronger entrainment or retention. In experiment one, participants walked on a treadmill for 45 continuous minutes, which was separated into three phases. The first 15 minutes (pre-synchronization phase) consisted of walking without a fractal stimulus, the second 15 minutes consisted of walking while entraining to a fractal visual stimulus (synchronization phase), and the last 15 minutes (post-synchronization phase) consisted of walking without the stimulus to determine if the patterns adopted from the stimulus were retained. Fractal gait patterns were strengthened during the synchronization phase and were retained in the post-synchronization phase. In experiment two, similar methods were used to compare a continuous fractal stimulus to a discrete fractal stimulus to determine which stimulus type led to more persistent fractal gait patterns in the synchronization and post-synchronization (i.e., retention) phases. Both stimulus types led to equally persistent patterns in the synchronization phase, but only the discrete fractal stimulus led to retention of the patterns. The results add to the growing body of literature showing that fractal gait patterns can be manipulated in a predictable manner. Further, our results add to the literature by showing that the newly adopted gait patterns are retained for up to 15 minutes after entrainment and showed that a discrete visual stimulus is a better method to influence retention.