Bakken Museum

ABSTRACTThis review highlights the important role primary care plays in obesity management, using England as an example. It includes a comprehensive summary of current management and referral options for primary care clinicians, a discussion of the most up‐to‐date clinical guidelines for the use of GLP‐1 receptor agonists in England, and the evolving ways in which obesity is identified and defined. Reflections from people living with obesity are considered. Despite the potential of primary care to engage with patients regarding obesity prevention and treatment, several factors have limited this, including low prioritisation by clinicians, workload pressures, regional variations in services, insufficient specialist training and ongoing weight stigma. The introduction of new pharmacotherapies, such as GLP‐1 receptor agonists, offers both an opportunity and a challenge for primary care providers. These treatments could help patients access more effective obesity management strategies via primary care. However, there is concern about non‐specialist clinicians keeping up to date with evolving strategies and understanding how new medications fit into broader care. The current complex referral pathways hinder timely access to appropriate treatment. The need for more straightforward pathways, improved clinician education and a reduction in the stigma associated with obesity is critical for better outcomes. In summary, while primary care could play a pivotal role in addressing obesity, several issues need to be resolved for this potential to be fully realised. Addressing these challenges, via enhancing clinician training, improving referral pathways and ensuring access to new treatments, will be crucial for advancing the care of people living with obesity.

Agricultural engineering and technology have significantly contributed to India’s growth story by boosting crop yields, improving food security, increasing farmer income, promoting resource efficiency, and enabling economic development, particularly through the Green Revolution, by introducing advanced irrigation systems, high-yielding crop varieties, and mechanization, which reduced manual labor and increased productivity across the agricultural sector; this has been crucial in transforming India from a food-deficient to a food-surplus nation.

BackgroundDespite abundant data regarding factors that influence COVID-19 symptom severity and need for hospitalization, few studies examine time to resolution of symptoms and potential complementary and alternative therapies that may expedite outpatient recovery. Uncertainty in expected symptom duration and potential missed opportunities to decrease this time persist. Likewise, studies tracking outpatient COVID-19 experiences among marginalized communities are lacking. ObjectiveTo describe the impact of complex Tibetan herbal formula regimens on symptom duration among ambulatory patients with native SARS-CoV-2 infection. MethodsThis multi-center, cohort study assessed deidentified data from patients with laboratory-confirmed SARS-CoV-2 infection. The study assessed cases from March 12, 2020 to May 5, 2021 for which vaccinations were not available, and thus reflect native infections. InterventionDiagnoses were made via telemedicine by a traditional Tibetan medical physician, and herbal formulas were prescribed based on specific symptom presentation of COVID-19 using the personalized medicine approach integral to traditional Tibetan medicine. ResultsOf 145 patient cases assessed for eligibility, 86 (59.3%) met inclusion criteria, and 67 (46.2%) had documented symptom resolution. Resolution of symptoms occurred within a median [interquartile range (IQR)] of 11.7 (10.1–13.5) days. The most common symptoms reported were cough and fever. Time to recovery did not significantly differ based on symptom presentation at baseline, except for a couple symptom groupings such as headache and joint pain where recovery time was shorter when those symptoms were present. Conclusions and relevanceAmbulatory patients diagnosed with SARS-CoV-2 infection receiving Tibetan herbal formulas had recovery from symptoms at a median of 11.7 days, fewer than other published reports in patients following standard of care. The Tibetan approach of targeting treatment based on symptom groups, especially those within classical Tibetan medical nosology, appears to result in quick symptom resolution.

BackgroundChronic low back pain (cLBP) is widespread, costly, and burdensome to patients and health systems. Little is known about non-pharmacological treatments for the secondary prevention of cLBP. There is some evidence that treatments addressing psychosocial factors in higher risk patients are more effective than usual care. However, most clinical trials on acute and subacute LBP have evaluated interventions irrespective of prognosis.MethodsWe have designed a phase 3 randomized trial with a 2 × 2 factorial design. The study is also a Hybrid type 1 trial with focus on intervention effectiveness while simultaneously considering plausible implementation strategies. Adults (n = 1000) with acute/subacute LBP at moderate to high risk of chronicity based on the STarT Back screening tool will be randomized in to 1 of 4 interventions lasting up to 8 weeks: supported self-management (SSM), spinal manipulation therapy (SMT), both SSM and SMT, or medical care. The primary objective is to assess intervention effectiveness; the secondary objective is to assess barriers and facilitators impacting future implementation. Primary effectiveness outcome measures are: (1) average pain intensity over 12 months post-randomization (pain, numerical rating scale); (2) average low back disability over 12 months post-randomization (Roland-Morris Disability Questionnaire); (3) prevention of cLBP that is impactful at 10–12 months follow-up (LBP impact from the PROMIS-29 Profile v2.0). Secondary outcomes include: recovery, PROMIS-29 Profile v2.0 measures to assess pain interference, physical function, anxiety, depression, fatigue, sleep disturbance, and ability to participate in social roles and activities. Other patient-reported measures include LBP frequency, medication use, healthcare utilization, productivity loss, STarT Back screening tool status, patient satisfaction, prevention of chronicity, adverse events, and dissemination measures. Objective measures include the Quebec Task Force Classification, Timed Up & Go Test, the Sit to Stand Test, and the Sock Test assessed by clinicians blinded to the patients’ intervention assignment.DiscussionBy targeting those subjects at higher risk this trial aims to fill an important gap in the scientific literature regarding the effectiveness of promising non-pharmacological treatments compared to medical care for the management of patients with an acute episode of LBP and the prevention of progression to a severe chronic back problem.Trial registrationClinicalTrials.gov Identifier: NCT03581123.

Abstract This article introduces the design, methods, and use cases of a novel gravity augmented additive manufacturing (GAAM) approach to fused filament fabrication (FFF) using a novel seven degree-of-freedom (DoF) delta robotic system. Capable of rotating parts and approaching the workpiece with the deposition head from user-specified or algorithm-determined angles, this system allows users the design freedom to create objects with self-supporting capability, while improving the performance of three-dimensional (3D) printed components. Additionally, this system and the methods of operation described below allow users to create objects that are otherwise impossible or impractical to construct using traditional three axis FFF 3D printing, while maintaining compatibility with existing G-code preparation techniques. Finally, this more flexible 3D printing system has advanced applications in generating patient specific objects, which may benefit from more highly specialized toolpaths and design freedom afforded by this system.

This paper explores how conceptions of death and the ways in which such conceptions shape responses to death determine ways of living as well as valued approaches to dying. The paper posits the question: can a fundamental understanding of death contribute to the development of adaptive social traits that lead to more sustainable phenomenological experiences of happiness and flourishing? Employing an anthropological lens, this work starts from the initial inquiry of “what is death?” by looking at cross-cultural historical and theoretical accounts of death and comparing the modern (medicalized) death to the Tibetan Buddhist notion of death. It examines how the practice of a “medicalized death” has shaped the understanding of contemporary death and the ways in which dying is approached. It employs the hermeneutic of a biopsychosociospiritual death to gain a holistic understanding of human mortality. This analysis, based on an 18-month ethnographic study among a Tibetan refugee community in southern India, explores the conception of death for this community using biological and cultural lenses. Moreover, it presents conceptions of death in Tibetan Buddhist culture, paying particular attention to how death is employed as an adaptive cultural tool in pursuance of positive behavioral changes and happiness at both individual and societal levels. In doing so, the paper presents both the theoretical conception of death and dying as well as its role in animating Buddhist cultural values and beliefs. Importantly, it presents a general landscape of Tibetan Buddhist cultural models that facilitate multiple ways of dying that are specifically dependent on an individual’s familiarity with practices related to death and dying and his or her own level of engaging such spiritual practices.

We report in situ major and trace element and Li isotope analyses of murakamiite and Li–rich pectolite in an albitite and whole–rock analyses of the albitite and host granite from Iwagi Islet, SW Japan. The albitite forms small bodies that are several tens of centimeters to tens of meters in size, disseminated in a host granite of Late Cretaceous age. The studied murakamiite–bearing albitite contains albite, sugilite, aegirine–augite, quartz, murakamiite–Li–rich pectolite, microcline, katayamalite, and accessory minerals. It shows conspicuous strain–induced textures. The murakamiite and Li–rich pectolite form a solid solution with Li × 100/(Li + Na) atomic ratios ranging from 44.2 to 60.1, and the Na line profiles show a zoning structure in which Na decreases from core to rim. Major and trace element compositions of murakamiite–pectolite normalized to that of albitite indicate the enrichments of some elements, particularly in Mn, Ca, Li, Sr, and REEs, roughly on the same order of magnitude (~ 10 times). The albitite–normalized element concentrations vary systematically with ionic radius of the element; the normalized concentrations of cations with the same valence roughly form a simple convex parabolic curve when plot against the ionic radius. This indicates that the element partitioning of murakamiite and pectolite during metasomatism to form albitite took place under a strong control of crystal structure, quasi–equilibrated with metasomatic fluids and coexisting minerals. The δ7Li values of murakamiite and Li–rich pectolite show a wide range from −9.1 to +0.4‰ (average −2.9‰), and no obvious correlation with Li contents was observed. These δ7Li values should have resulted from hydrothermal fluid–rock interactions at the temperatures of 300–600 °C. The very low δ7Li values down to −9.1‰ may have originated from intra–crystalline Li isotope diffusion, or involvement of deep–seated, Li–Na–enriched subduction–zone fluids with low δ7Li values.

PURPOSE: The U.S. healthcare system is overwhelmed by diet- and lifestyle-related diseases and, increasingly, provider burnout. (1,2) Most health professionals receive inadequate education around lifestyle-based health promotion, the impact of food choices on one’s health and strategies for personal wellbeing. (3) Over the course of health professions training programs, students often experience growing rates of burnout themselves. (4, 5) To meet these challenges, a Chef/MPH and integrative medicine physician developed “Food Matters for Health Professionals,” a brief, experiential, interprofessional cooking and nutrition course aimed at equipping healthcare professionals and students with self- and patient-care skills. We measured outcomes around personal wellbeing as well as knowledge, confidence and skills in nutrition and culinary competencies. METHODS: The course presents an evidence-based nutrition curriculum, and includes hands-on preparation of plant-forward recipes made with locally-sourced, sustainably-produced ingredients. Themes covered include the importance of provider self-care, mindful eating and a review of the literature around the impact of dietary patterns on health outcomes. Participants included students in graduate health professions programs and practicing healthcare providers. An optional, de-identified survey was given pre- and post-course; only participants who completed both were included in data analysis. The survey included questions on culinary and nutrition knowledge, personal wellbeing and food habits, and clinical application of the material. Paired t tests were conducted to compare participants’ pre- and post-survey responses. RESULTS: Course participants (n=18) showed statistically significant (p< 0.05) changes between the pre- and post-surveys in budgeting time to eat and prepare nutritionally balanced meals, stocking a kitchen with staple items, use of plant-forward foods and improved personal wellbeing. Additional positive changes included greater knowledge of the nutritional quality of food choices, ability to describe macronutrient composition in foods and discuss major dietary patterns in a clinical setting, and confidence to adapt recipes to suit various health conditions. CONCLUSIONS A positive change in personal wellbeing and nutrition habits was observed after a brief, experiential cooking and nutrition course. Additionally, skills were acquired which have the potential to translate into improvements in sustained provider wellbeing and the management of lifestyle-related chronic diseases in clinical settings. (1) CDC: About Chronic Diseases: https://www.cdc.gov/chronicdisease/about/index.htm (2) West et al. Journal of Internal Medicine, 2018 (3) Devries et al. The American Journal of Medicine, 2014 (4) Rudman and Gustavsson, International Journal of Nursing Studies, 2012. (5) IsHak W. et al. The Clinical Teacher, 2013. Full citations available upon request.

The 17 United Nations Sustainable Development Goals (SDG) are intended to promote a safe, healthy, and equitable world by the year 2030. Nurses are at the forefront of realizing the 2030 agenda through concerned citizenship and professional leadership. Nursing theory informs knowledge development and theory-guided practice essential for nurses working in all domains and in all nations. Although all extant nursing theories are relevant, a select few are discussed in detail to make explicit the links between theory and SDG realization. Middle-range theories are also valuable in helping to contextualize nursing practice through the lens of the SDGs. The SDGs address five themes - People, Planet, Peace, Prosperity, and Partnership - and theory remains vital to ensure nurses working in all settings are equipped to meet the needs of humanity and the world, now and in the future.