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.

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.

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.

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.

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.

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.

Coupled use of Fe-impregnated biochar and urea-hydrogen peroxide to simultaneously reduce soil-air emissions of fumigant and improve crop growth.

Reducing the emissions of soil fumigants such as 1,3-dichloropropene (1,3-D) is essential to protecting air quality. Although biochar is useful in reducing such emissions, biochar-adsorbed fumigants may desorb and cause secondary air pollution. This study investigated the degradation of 1,3-D on iron (Fe)-impregnated biochar (FBC) amended with urea-hydrogen peroxide (UHP). The results indicated the degradation rate of trans-1,3-D on FBC-UHP was 54-fold higher than that on pristine biochar (PBC). Electron paramagnetic resonance (EPR) combined with other characterization methods revealed that the presence of semiquinone-type radicals in FBC effectively accelerated the Fe(III)/Fe(II) cycleto maintain enough Fe(IIII) for UHP activation and ·OH generation. ·OH, rather than ·O2-, was the dominant active oxidant. Soil column tests showed that application of FBC to the soil surface reduced cumulative 1,3-D emissions from 34.80 % (bare soil) to 0.81%. After the column experiment, the mixing of the FBC with UHP resulted in the residual cis-isomers decreasing from 32.5% to 10.5%. Greenhouse bioassays showed that mixing post-1,3-D degradation FBC-UHP with soil significantly promoted lettuce growth relative to PBC. The findings of this study provide a new approach for biochar application, especially for the emission reduction of hazardous volatile organic compounds from soil.

Physician Stress and Burnout.

Tens (or hundreds) of thousands of Americans die each year as a result of preventable medical errors. Changes in the practice and business of medicine have caused some to question whether burnout among physicians and other healthcare providers may adversely affect patient outcomes. A clear consensus supports the contention that burnout affects patients, albeit with low-quality objective data. The psychological and physical impact on physicians and other providers is quite clear, however, and the impact on the physician workforce (where large shortages are projected) is yet another cause for concern. We have all heard the airplane safety announcement remind us to "Please put on your own oxygen mask first before assisting others." Unfortunately, like many airline passengers (very few of whom use oxygen masks correctly when they are needed), physicians often do not recognize symptoms of burnout or depression, and even less often do they seek help. We detail the causes and consequences of physician burnout and propose solutions to increase physician work satisfaction.

Reducing the discrepancies between the Aerodynamic Gradient Method and other micrometeorological approaches for measuring fumigant emissions.

Observations of fumigant and pesticide emissions are needed for multiple public health and environmental protection mandates. The aerodynamic gradient method (ADM) is commonly used to measure fumigant and pesticide emissions. However, the ADM may over estimate emissions compared to other micrometeorological and modeling approaches, which would increase uncertainty over the true flux estimate. Different studies with ADM have also used multiple differing transport functions that relate concentration gradients to emissions. Therefore, we tested different and more recent transport functions to try to correct the anticipated observed higher values with ADM using observations from two sites in California, USA. We evaluated different transport functions against eddy covariance observations and found that using the functions developed by Högström (1996) corrected the ADM values to be in line with other observational methods. For the Fresno experiment, cumulative emission masses from the ADM- Högström functions were within 7% of other approaches while the Pruitt function was >15% higher. Applying the Högström functions to a series of previous fumigation experiments in California saw reductions in the ADM observations of >25% for cumulative mass emissions. The results indicate that the Högström functions should be used for future ADM experiments in the absence of more robust transport factors for local meteorological conditions. The results also illustrate how previous ADM observations could be corrected to reduce uncertainty in flux emissions estimates.

Effect of application rate on chloropicrin half-life and simulated emissions across a range of soil conditions.

The volatile release of agricultural fumigants from soil to air is a critical concern in terms of human and environmental health. A major control on the release of fumigants from soil to air is their degradation rate within the soil; however, this is a function of human/soil/environmental conditions and their inter-relationships. For the common fumigant chloropicrin (CP), it is known that application rate has a marked effect on degradation rate, with a potential further influence on CP emissions. We conducted batch degradation studies to better understand how CP degradation rate changes in response to application rate (56, 224, 392kgha-1) under gradients of soil temperature (10, 25, and 40°C), soil moisture content (1, 8, and 15%), and organic matter content (1, 2, and 3%). A general trend of degradation rate decreasing with increasing application rate was observed across almost all such gradients, which is likely attributable to decreased microbial numbers and activity (i.e., degradation) at high (toxic) application rates. The effects of these ranges in degradation rate on emissions from soil to air were predicted using an analytical solution model, indicating that between the low and high application rates, total emissions percentage increased markedly (increases ranging from 69 to 99.8 percentage points, depending on prevalent conditions). The work will be useful to state and federal regulators in assessing the likely impact of CP use on air quality and human health.

A 'history of problematizations' for dementia education: a Foucauldian approach to understanding the framing of dementia.

BACKGROUND: Debates relevant to both undergraduate and postgraduate nurse education regarding the conceptualisation and disciplinary ownership of dementia, including its framing as a neuro-psychiatric condition, a terminal illness or a consequence of ageing, are important in supporting an understanding of the lived experience of dementia for individuals and their family carers and how, as a condition, it has come to be problematised in Western society. The work of Michel Foucault is useful in setting this debate within a critical historical context. AIMS: Using Foucault's 'history of problematizations' we present such debates around dementia's conceptualisation in Western society and consider how a Foucauldian critical historical project influences nursing education by re-examining the problematisation of dementia within society, what it is to be a person with dementia, and how alternative conceptualisations shape how we see the condition - as well as how we provide learning opportunities for dementia-care professionals. RESULTS: Six differing ways of conceptualising or problematising dementia were found (as a natural consequence of ageing, a mental disorder, a bio-medical disease, a neuro-cognitive disorder, a disability and a terminal illness), each offering alternative ways we might present it in an educational context. CONCLUSIONS: We argue for both undergraduate and postgraduate student nurses to engage in learning that locates what it is to be a person with dementia within particular conceptual frameworks that would allow understanding of how these ideas or constructs are reliant on historically contingent assumptions. Here, taken-for-granted assumptions are unsettled, and a more critically reflective position is adopted. This will have an impact on the type of nurse to emerge from educational institutions, thus also affecting service delivery and the dementia care provided, as well as the knock-on effects for dementia education in other medical, health and social care courses and for institutions whose role it is to approve professional practice curricula content.

Dissolved organic matter and estrogen interactions regulate estrogen removal in the aqueous environment: A review.

This review summarizes the characterization and quantification of interactions between dissolved organic matter (DOM) and estrogens as well as the effects of DOM on aquatic estrogen removal. DOM interacts with estrogens via binding or sorption mechanisms like π-π interaction and hydrogen bonding. The binding affinity is evaluated in terms of organic-carbon-normalized sorption coefficient (Log KOC) which varies with types and composition of DOM. DOM has been suggested to be a more efficient sorbent compared with other matrices, such as suspended particulate matter, sediment and soil; likely associated with its large surface area and concentrated carbon content. As a photosensitizer, DOM enhanced estrogen photodegradation when the concentration of DOM was below a threshold value, and when above, the acceleration effect was not observed. DOM played a dual role in affecting biodegradation of estrogens depending on the recalcitrance of the DOM and the nutrition status of the degraders. DOM also acted as an electron shuttle (redox mediator) mediating the degradation of estrogens. DOM hindered enzyme-catalyzed removal of estrogens while enhanced their transformation during the simultaneous photo-enzymatic process. Membrane rejection of estrogens was pronounced for hydrophobic DOM with high aromaticity and phenolic moiety content. Elimination of estrogens via photolysis, biodegradation, enzymolysis and membrane rejection in the presence of DOM is initiated by sorption, accentuating the role of DOM as a mediator in regulating aquatic estrogen removal.

Degradation and metabolite formation of 17ß-estradiol-3-glucuronide and 17ß-estradiol-3-sulphate in river water and sediment.

Laboratory degradation tests with two model estrogen conjugates, 17ß-estradiol-3-glucuronide (E2-3G) and 17ß-estradiol-3-sulphate (E2-3S), using river water and sediment as inoculum under aerobic conditions were investigated. Throughout the 14-day incubation, degradation of E2-3G in river water, at environmentally-relevant level (25 ng/L), obeyed first-order kinetics with the formation of 17-ß estradiol and estrone; in contrast, E2-3S was slowly converted to estrone-3-sulphate stoichiometrically. Degradation of the two conjugates across the spiking concentrations (0.01-1 µg/g) was much faster in sediment than in river water where 25 ng/L of conjugate standards were spiked, possibly due to relatively high population densities of microorganisms in sediment. De-conjugation of the thio-ester bond at C-3 position and oxidation at C-17 position were the predominant degradation mechanisms for E2-3G and E2-3S, respectively, with negligible presence of metabolites estrone-3-glucuronide for E2-3G and 17ß-estradiol for E2-3S. In addition, delta-9(11)-dehydroestrone and 6-ketoestrone were determined as new metabolites of the two conjugates. Also, a lactone compound, hydroxylated estrone and a few sulfate conjugates were tentatively identified. With the observation of new metabolites, biodegradation pathways of E2-3G and E2-3S were proposed. The formation of new metabolites may pose unknown risks to aquatic biota.

Application rate affects the degradation rate and hence emissions of chloropicrin in soil.

Increasingly stringent regulations to control soil-air emissions of soil fumigants has led to much research effort aimed at reducing emission potential. Using laboratory soil columns, we aimed to investigate the relationship between chloropicrin (CP) application rate and its emissions from soil across a wide range of CP applications (equivalent to 56-392kgha-1). In contrast to the known behavior of other fumigants, total emission percentages were strongly and positively related to application rate (i.e., initial mass), ranging from 4 to 34% across the application rate range. When combined, data from a previous study and the present study showed good overall comparability in terms of CP application rate vs. emission percentage, yielding a second-order polynomial relationship with an R2 value of 0.93 (n=12). The study revealed that mass losses of CP were strongly disproportional to application rate, also showing a polynomial relationship. Based on degradation studies, we consider that a shorter half-life (faster degradation) at lower application rates limited the amount of CP available for emission. The non-linear relationship between CP application rate and CP emissions (both as % of that applied and as total mass) suggests that low application rates likely lead to disproportionally low emission losses compared with higher application rates; such a relationship could be taken into account when assessing/mitigating risk, e.g., in the setting of buffer zone distances.

Degradation and metabolite formation of estrogen conjugates in an agricultural soil.

Estrogen conjugates are precursors of free estrogens such as 17ß-estradiol (E2) and estrone (E1), which cause potent endocrine disrupting effects on aquatic organisms. In this study, microcosm laboratory experiments were conducted at 25°C in an agricultural soil to investigate the aerobic degradation and metabolite formation kinetics of 17ß-estradiol-3-glucuronide (E2-3G) and 17ß-estradiol-3-sulfate (E2-3S). The aerobic degradation of E2-3G and E2-3S followed first-order kinetics and the degradation rates were inversely related to their initial concentrations. The degradation of E2-3G and E2-3S was extraordinarily rapid with half of mass lost within hours. Considerable quantities of E2-3G (7.68ng/g) and E2-3S (4.84ng/g) were detected at the end of the 20-d experiment, particularly for high initial concentrations. The major degradation pathway of E2-3G and E2-3S was oxidation, yielding the primary metabolites 17ß-estrone-3-glucuronide and 17ß-estrone-3-sulfate, respectively. Common metabolites were E2, the second primary metabolite, and E1, the secondary metabolite. Additionally, ring B unsaturated estrogens and their sulfate conjugates were tentatively proposed as minor metabolites. The persistence of E2-3G and E2-3S (up to 20 d) suggests that the high rate of application of conjugated estrogen-containing substances could be responsible for the frequent detection of free estrogens in surface and subsurface water.

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.

Simultaneous determination of estrogens and progestogens in honey using high performance liquid chromatography-tandem mass spectrometry.

This work describes the development and validation of a method for the simultaneous determination of 13 estrogens and progestogens in honey by high performance liquid chromatography-tandem mass spectrometry. The hormones were preconcentrated by solid phase extraction. Pretreatment variables were optimized for a better compatibility with electrospray ionization interfaced mass spectrometry. The analytes were analyzed in multiple-reaction monitoring mode with two pairs of precursor product ion transitions. The proposed method was validated with method detection limits of 0.01-0.33ng/g and good linearities (r2>0.9901) throughout the studied concentration range. The recoveries of analytes at the spiking levels (5ng/g and 25ng/g) ranged from 71.2% to 99.7%, with relative standard deviations below 20%. The method was used to determine the target compounds in honey samples (orange blossom, clover and multiflower) obtained from supermarkets. Two samples of honey were found to contain trace amounts of estrone (

Living with sickle cell disease and depression in Lagos, Nigeria: A mixed methods study.

Sickle cell disorders (SCD) and depression are both chronic illnesses of global significance. Past research on SCD and depression struggles to make sense of statistical associations, essentializes depression within the person with SCD, and treats stigma as an automatic correlate of chronic illness. A mixed methods study (March 2012-April 2014) was undertaken with people living with SCD and depression in Lagos, Nigeria, examining depression-as disease (questionnaires); depression-as-illness-experience (individual depth interviews), and depression-as-societal-sickness (focus groups). 103 people with SCD attending an outpatients clinic were administered the Patient Health Questionnaire-9, and 82 self-identified with some level of depression. Fifteen were subsequently interviewed about their illness experience. Their lives were characterized by being extensively subjected to vicious discriminatory remarks, including from significant others, negative experiences they felt contributed to their depression and even to suicidal thoughts and actions. Contrary to misconceptions of the relational nature of stigma, respondents recognized that stigma resulted not from their SCD but from assumed broken social norms and expectations, norms to do with educability, employability and parenthood. They recounted either that they successfully met such expectations in their own lives, or that they could conceivably do so with reasonable societal adjustments. Ten respondents with SCD and depression further took part in two series of three focus groups with five people in each series of groups. In groups people living with SCD were able to challenge negative assumptions about themselves; to begin to recognize collective social interests as a group, and to rehearse backstage, in discussions between themselves, social actions that they might engage in frontstage, out in wider society, to challenge discriminatory societal arrangements they held to contribute to their depression. To the extent that depression in SCD has social origins, then social interventions, such as anti-discrimination laws and policies, are key resources in improving mental health.