Financial inclusion for people with disability: a scoping review

BACKGROUND

Financial exclusion is a human rights issue affecting health equity. Evidence demonstrates that financial exclusion is exacerbated for people with disability and those in low- to middle-income countries (LMIC). Barriers to financial access include limited demand for services, banking inadequacies in catering to people with disability, and insufficiently accessible information technologies (ICT) and infrastructure.

OBJECTIVES

This scoping review sought to identify barriers to and facilitators of financial inclusion for people with disability in LMIC. As a secondary objective, the study explored the potential of financial education and ICT utilisation as viable strategies for enhancing financial inclusion.

METHODS

This review utilised the Arksey and O'Malley framework and PRISMA Checklist for systematic literature examination and data extraction. The WHO's Environmental Factors guided the analysis to propose potential interventions and to generate recommendations.

RESULTS

The review analysed 26 publications from various global regions and fields including finance, business, technology, health and disability policy. It identified consistent financial inclusion barriers for people with disability, resulting in a set of global recommendations across attitudes, environment, technology, services, and policy.

CONCLUSIONS

Recommendations include using ICT, digital innovation and multi-stakeholder collaboration to address the financial barriers experienced by people with disability. These efforts, rooted in social justice, aim to include people with disability in LMIC as valued financial sector participants, promoting health and equity.

Evaluation of the effectiveness of single nucleotide polymorphisms compared to microsatellite markers for parentage verification in Moroccan horses

The International Society for Animal Genetics (ISAG) currently advocates for a transition towards single nucleotide polymorphism (SNP) markers as a potential alternative for equine parentage verification. To ascertain the efficacy of this transition, it is imperative to evaluate the performance of parentage testing using SNPs in juxtaposition with short tandem repeats (STRs). As per ISAG's recommendation, we used an equine genotyping-by-sequencing panel with 144 SNPs for this purpose. Equine parentage is currently realized using 16 microsatellites (STRs) excluding the LEX3 marker. In this study, 1074 horses were genotyped using the 144 SNPs panel, including 432 foals, 414 mares, and 228 stallions, from five different breeds: 293 Arabians, 167 Barbs, 189 Thoroughbreds, 73 Anglo-Arabians, and 352 Arabian-Barbs. As a result, two SNPs markers were eliminated from the panel system due to inconsistent amplification across all examined individuals leaving 142 SNPs markers for analysis. A comparative analysis between SNPs and STRs markers revealed that the mean expected heterozygosity was 0.457 for SNPs and 0.76 for STRs, while the mean observed heterozygosity stood at 0.472 for SNPs and 0.72 for STRs. Furthermore, the probability of identity was calculated to be 5.722 × 10-57 for SNPs and 1.25 × 10-15 for STRs markers. In alignment with the Hardy-Weinberg equilibrium in polyploids test, 110 out of the total SNPs were consistent with the Hardy-Weinberg equilibrium in polyploids test (p > 0.05). Employing both SNPs and STRs markers, the mean polymorphic information content was discerned to be 0.351 for SNPs and 0.72 for STRs. The cumulative exclusion probabilities for SNP markers exceeded 99.99%, indicating that the 142 SNPs panel might be adequate for parentage testing. In contrast, when utilizing STRs markers, the combined average exclusion probabilities for one and both parents were determined to be 99.8% and 99.9%, respectively. Our comprehensive study underscores the potential of SNPs in equine parentage verification, especially when compared to STRs in terms of exclusion probabilities. As a corollary, the application of SNPs for parentage verification and identification can significantly contribute to the conservation initiative for the five Moroccan horse breeds. Nonetheless, further research is required to address and replace the deficient SNPs within the panel.

The selective deployment of AI in healthcare: An ethical algorithm for algorithms

Machine-learning algorithms have the potential to revolutionise diagnostic and prognostic tasks in health care, yet algorithmic performance levels can be materially worse for subgroups that have been underrepresented in algorithmic training data. Given this epistemic deficit, the inclusion of underrepresented groups in algorithmic processes can result in harm. Yet delaying the deployment of algorithmic systems until more equitable results can be achieved would avoidably and foreseeably lead to a significant number of unnecessary deaths in well-represented populations. Faced with this dilemma between equity and utility, we draw on two case studies involving breast cancer and melanoma to argue for the selective deployment of diagnostic and prognostic tools for some well-represented groups, even if this results in the temporary exclusion of underrepresented patients from algorithmic approaches. We argue that this approach is justifiable when the inclusion of underrepresented patients would cause them to be harmed. While the context of historic injustice poses a considerable challenge for the ethical acceptability of selective algorithmic deployment strategies, we argue that, at least for the case studies addressed in this article, the issue of historic injustice is better addressed through nonalgorithmic measures, including being transparent with patients about the nature of the current epistemic deficits, providing additional services to algorithmically excluded populations, and through urgent commitments to gather additional algorithmic training data from excluded populations, paving the way for universal algorithmic deployment that is accurate for all patient groups. These commitments should be supported by regulation and, where necessary, government funding to ensure that any delays for excluded groups are kept to the minimum. We offer an ethical algorithm for algorithms-showing when to ethically delay, expedite, or selectively deploy algorithmic systems in healthcare settings.

Psychoanalysis-More Than a Profession: Presidential Address, American Psychoanalytic Association, New York, February 3, 2023

This plenary address was delivered just before learning the successful outcome of a bylaw amendment extending full American Psychoanalytic Association (APsA) membership to psychoanalytic psychotherapists, researchers, scholars, and all who share a commitment to psychoanalysis. This historic change culminated efforts over the previous four decades to rectify exclusionary harms and revitalize psychoanalysis in the United States as a clinical practice and a cultural force. Membership expansion is discussed in the historical and sociological context of psychoanalysis as a profession with a focus on organizational resistance to change. Professionalization established and legitimized psychoanalysis but also contained the seeds of gradual decline as monopoly over training and practice distanced APsA from the wider psychoanalytic community. Expanding membership beyond the profession is a step toward uniting the community and strengthening all applications of psychoanalysis, including the traditional form. These developments at APsA reflect changes in other disciplines that feature inclusion, generosity, situated learning, and distributed subjectivity in epistemic communities of practice.

Pain of Threatened Self: Explicit and Implicit Self-Esteem, Cortisol Responses to a Social Threat and Pain Perception

Background: Rejection, injustice, and exclusion from meaningful interpersonal relationships are often extremely painful and stress-generating experiences. This study aimed to define the role of explicit and implicit self-esteem in pain perception as a component of the physiological-psychological system that regulates the body's response to stress associated with the threat of social rejection. Methods: In total, 360 individuals participated in this study. The measurement of cortisol in saliva, the assessment of pain thresholds using thermal stimuli, the IAT to assess implicit self-esteem, and a questionnaire on global self-esteem and social pain were used. The study included three measurements: baseline and 15 and 45 min after the application of a laboratory socially threatening stimulus (the Trier Social Stress Test). Results: People experiencing chronic social pain (CSP) are more likely to have fragile self-esteem, higher pain thresholds, and tend to experience reduced pain tolerance in situations of acute social threat than people without CSP experience. In people with CSP and fragile self-esteem, after the introduction of a social threat, an increase in pain tolerance was observed along with a longer-lasting increase in cortisol levels. Conclusions: Fragile self-esteem, along with feelings of chronic exclusion, injustice, and rejection, may prolong stress reactions and produce a hypoalgesic effect.

Factors Associated With Experiences of Harassment or Abuse Among Lesbian, Gay, Bisexual, Trans, Queer, and Asexual Young People With Disability in Australia

Lesbian, gay, bisexual, trans, queer, and asexual (LGBTQA+) young people with disability are known to experience higher rates of harassment or abuse than LGBTQA+ young people without disability. This study focused on participants in Australia and identified factors associated with harassment or abuse among LGBTQA+ adolescents and young adults who reported a disability as well as associations with mental health outcomes. Analyses were conducted from a national survey that included 2,500 LGBTQA+ people who reported a disability and were aged 14 to 21 years. Measures included experiences in the past 12 months of verbal and physical harassment or abuse due to one's sexual orientation or gender identity, sexual harassment or abuse, mental health, suicidality, and sociodemographic traits. Overall, 48.4% of participants with disability reported experiencing verbal harassment or abuse, 12.4% physical harassment or abuse, and 29.7% sexual assault or harassment. In multivariable regression analyses, verbal harassment or abuse was significantly more likely among trans men, participants with an intellectual disability, and those who were "out" to most or all of their family. Physical harassment or abuse was significantly more likely among participants with a physical or sensory disability. Sexual harassment or abuse was significantly more likely among trans women and participants with a physical or sensory disability. Participants who experienced harassment or abuse were also significantly more likely to have attempted suicide in the past 12 months. These findings will assist policymakers and practitioners in identifying contexts linked to a heightened risk of abuse among LGBTQA+ young people with disability and further underscore an immediate need to address and prevent harm in this population.

Being close or being alone: How Social ostracism affects solitude preference

Social ostracism refers to the phenomenon of being excluded from social interactions and not being accepted by society. While previous research has examined its impact on prosocial and antisocial behaviour, few studies have investigated how individuals respond to ostracism by seeking solitude. Therefore, our study aims to explore the association between social ostracism and solitude seeking as well as the potential psychological mechanisms involved. We conducted three studies involving 488 Chinese students (59% female) and found that (a) long-term ostracism experiences positively correlated with preference for solitude, (b) short-term ostracism did not immediately lead to solitude seeking but increased the desire to establish new connections with others and (c) hostile assessment and negative emotions played a chain mediation role in the relationship between social ostracism and solitude seeking. These findings provide new insights and empirical evidence for understanding the relationship between social ostracism and solitude-seeking.

Probiotic Effect of Streptococcus dentisani on Oral Pathogens: An In Vitro Study

Probiotics, including Streptococcus dentisani, have been proposed as an alternative to re-establish the ecology of the oral cavity and inhibit the formation of pathogenic biofilms. The main objective of this work was to assess the probiotic ability of S. dentisani against Streptococcus mutans, Streptococcus mitis, and Candida albicans biofilms. The ability of the strains to form a monospecies biofilm and the probiotic potential of S. dentisani using the competition, exclusion, and displacement strategies were determined. All strains were moderate biofilm producers. The ability of S. dentisani to compete with and exclude S. mutans and S. mitis during biofilm formation was not significant. However, S. dentisani significantly reduced pathologic streptococcal biofilms using the displacement strategy. Also S. dentisani reduced the formation of the C. albicans biofilm mainly through competition and displacement. In vitro, S. dentisani exhibited probiotic potential to reduce the formation of potentially pathogenic biofilms. Further investigation is required to understand the biofilm-inhibiting mechanisms exhibited by this probiotic strain.

The Role of Exceptionalism in the Evolution of Bioethical Regulation

The paper aims to present a critical analysis of the phenomenon and notion of exceptionalism in bioethics. The authors demonstrate that exceptionalism pertains to phenomena that are not (yet) entirely familiar to us and could potentially bear risks regarding their regulation. After an overview of the state of the art, we briefly describe the origins and evolution of the concept, compared to exception and exclusion. In the second step, they look at the overall development debates on genetic exceptionalism, compared to other bioethical debates on exceptionalism, before presenting a detailed analysis of a specific case of early regulation of genetic screening. In the last part, the authors explain the historical background behind the connection between exceptionalism and exclusion in these debates. Their main conclusion is that while the initial stage of the discussion is shaped by the concept of exceptionalism and awareness of risks of exclusion, the later development centers around exceptions that are needed in detailed regulatory procedures.

[The Mission Migrants of the Samu social de Paris, a mobile healthcare service for exiles]

Since its creation in 1993, Samusocial de Paris has been working with homeless people as part of its "outreach" approach. Mission Migrants, a mobile healthcare access service, works throughout the inner suburbs of Paris, helping precarious exiles wherever they are, and wherever they are at (in their pathways and access to healthcare). Its teams of nurses and mediator-interpreters visit camps, squats, shelters, day shelters and temporary accommodation centers to mediate, assess and guide them towards the care they need.

Using stink bug migration behavior for physical exclusion

Stink bugs have become an increasing concern for tree fruit growers due to changing management strategies and the introduction of an invasive species. The use of broad-spectrum insecticides for stink bug control disrupts biological control and leads to secondary pest outbreaks. To seek alternative tactics, we investigated the physical exclusion of native stink bugs with single-wall net barriers at orchard borders. First, stink bug capture on clear sticky panels along orchard edges showed that movement between the native shrub-steppe vegetation and the orchard occurs for much of the growing season instead of the presumed single migration event in August. Most stink bugs were captured between 1 m and 3 m heights, signifying a 4 m exclusion barrier would intercept migrating bugs. We tested large net barriers (4 m × 23 m) constructed of plain netting with or without deltamethrin-infused netting in flaps compared to a no-net control. The capture of target and nontarget arthropods was determined with plastic tarps below the nets or on the open ground of the control. Net barriers did not directly affect stink bug densities in the orchards, although orchard populations were low overall. Barriers did intercept stink bugs, and the addition of deltamethrin flaps enhanced stink bug mortality but at the price of nontarget arthropod mortality. Our results indicate that stink bug management efforts should focus earlier in the growing season and given the long period of migration, barriers are a more sustainable way of slowing movement into the orchard than the current sole reliance on chemical control.

Peeling back the many layers of competitive exclusion

Baby chicks administered a fecal transplant from adult chickens are resistant to Salmonella colonization by competitive exclusion. A two-pronged approach was used to investigate the mechanism of this process. First, Salmonella response to an exclusive (Salmonella competitive exclusion product, Aviguard®) or permissive microbial community (chicken cecal contents from colonized birds containing 7.85 Log10Salmonella genomes/gram) was assessed ex vivo using a S. typhimurium reporter strain with fluorescent YFP and CFP gene fusions to rrn and hilA operon, respectively. Second, cecal transcriptome analysis was used to assess the cecal communities' response to Salmonella in chickens with low (≤5.85 Log10 genomes/g) or high (≥6.00 Log10 genomes/g) Salmonella colonization. The ex vivo experiment revealed a reduction in Salmonella growth and hilA expression following co-culture with the exclusive community. The exclusive community also repressed Salmonella's SPI-1 virulence genes and LPS modification, while the anti-virulence/inflammatory gene avrA was upregulated. Salmonella transcriptome analysis revealed significant metabolic disparities in Salmonella grown with the two different communities. Propanediol utilization and vitamin B12 synthesis were central to Salmonella metabolism co-cultured with either community, and mutations in propanediol and vitamin B12 metabolism altered Salmonella growth in the exclusive community. There were significant differences in the cecal community's stress response to Salmonella colonization. Cecal community transcripts indicated that antimicrobials were central to the type of stress response detected in the low Salmonella abundance community, suggesting antagonism involved in Salmonella exclusion. This study indicates complex community interactions that modulate Salmonella metabolism and pathogenic behavior and reduce growth through antagonism may be key to exclusion.

The Game of Queer Family Life: Exploring 2SLGBTQI+ Parents' Experiences of Cisheteronormativity, Racism, and Colonialism Through Digital Storytelling in Ontario, Canada

In this article we describe and analyze five videos created through an arts-informed research project, Precarious Inclusion: Studying Ontarian 2SLGBTQI+ parents' experiences childrearing in a post-legal parity framework. Precarious Inclusion used interviews and digital storytelling to investigate Ontario 2SLGBTQI+ parents' current experiences of inclusion and exclusion when navigating institutional and social interactions in everyday life in a post-legal parity context. The study centrally explored how intersecting identities with regards to sexuality, gender, geography, disability, class, race, Indigeneity, and ethnicity intersect with structural forces to influence 2SLGBTQI+ parents' inclusion and exclusion experiences. We examine research creation activities that supported 2SLGBTQI+ parents in making short videos about their experiences of parenting. Our analysis of the five videos created by Indigenous, racialized, trans, nonbinary, Two-Spirit, and disabled parents show how consistent experiences of exclusion mark 2SLGBTQI+ parents' everyday lives. We deepen theorizations of the material and psychological impacts of exclusion for 2SLGBTQI+ families through foregrounding three themes: 1) the operations of racism, white supremacy, and colonialism in makers' lives; 2) misrecognition and its psychic effects of bifurcation and disjuncture; and 3) love, joy, and multi-species kinship as powerful sites of healing and belonging. We further demonstrate how parents used their videos as self-advocacy for resisting precarious inclusion.

Socioeconomic-Status-Based Disrespect, Discrimination, Exclusion, and Shaming: A Potential Source of Health Inequalities?

Observing an association between socioeconomic status (SES) and health reliably leads to the question, "What are the pathways involved?" Despite enormous investment in research on the characteristics, behaviors, and traits of people disadvantaged with respect to health inequalities, the issue remains unresolved. We turn our attention to actions of more advantaged groups by asking people to self-report their exposure to disrespect, discrimination, exclusion, and shaming (DDES) from people above them in the SES hierarchy. We developed measures of these phenomena and administered them to a cross-sectional U.S. national probability sample (N = 1,209). Consistent with the possibility that DDES represents a pathway linking SES and health, the SES→health coefficient dropped substantially when DDES variables were controlled: 112.9% for anxiety, 43.8% for self-reported health, and 49.4% for cardiovascular-related conditions. These results illustrate a need for a relational approach emphasizing the actions of more advantaged groups in shaping health inequities.

Rhizospheric Precipitation of Manganese by Phosphate: A Novel Strategy to Enhance Mn Tolerance in the Hyperaccumulator Phytolacca americana

Manganese (Mn) exclusion in the Mn hyperaccumulator pokeweed (Phytolacca americana L.) was investigated. Hydroponic experiments were carried out to observe the responses of pokeweeds continually exposed to high levels of Mn. In this study, crystals were observed to appear firstly on the root hair, and soon after, more crystals appeared on the root surface, and crystals of Mn phosphate were observed to appear on the root surface in a time sequence negatively correlated with the number of leaves treated with 5 mM Mn. Crystals were identified via phase analysis of X-ray diffraction and element analysis, and these white insoluble crystals were identified using XRD to be Mn phosphate, with the molecular formula (Mn,Fe)3(PO4)2·4H2O. The nutrient solution pH increased from 4.5 to about 5.6 before the crystals appeared. Mn phosphate crystals appeared in all solutions except those without phosphate and emerged earlier in the solutions containing no Fe. Compared with control group, pokeweed accumulated much more Mn in the leaves when treated without phosphate or Fe. The present study suggests that pokeweed can exclude Mn by means of rhizosphere precipitation by phosphate to form Mn phosphate crystals that accumulate on the root surface. Although the detailed mechanism requires further investigation, this study provides the first direct evidence of a novel strategy to inhibit Mn uptake in the roots of a hyperaccumulator in a P-enriched environment.

The possible transport and exclusion mode of lipofuscin in rat myocardium under electron microscopy

Lipofuscin accumulation has been observed in human coronary arteries but whether or not myocardial tissue can release lipofuscin generated within cardiomyocytes must be clarified, as this may provide indicators for future anti-ageing research. The hearts of Sprague Dawley rats, aged 6-24 months, were embedded in resin and ultrathin sections cut for electron microscopy. Lipofuscin granules were abundant in cardiomyocytes. Cardiomyocytes were seen to release lipofuscin granules into the myocardial interstitium as cytoplasmic fragments with irregular protrusions on the sarcolemma surface. The cytoplasmic fragments entering the stroma fused directly with the endothelial cells of adjacent capillaries, delivering lipofuscin to the vessel wall. These fragments were also seen to be engulfed by stromal macrophages or fused with fibroblasts, which then combined with capillary endothelial cells to deliver lipofuscin to the vessel wall. Some cytoplasmic fragments disaggregated and formed membrane-like waste, which travelled to the vessel wall from the myocardial stroma as soluble fine particles via diffusion or pinocytosis of capillary endothelial cells. Lipofuscin entered the vascular wall and endothelial cells, forming large and small protrusions or folds that transported the lipofuscin to the vascular lumen and bloodstream.

Hail netting: an economically competitive IPM alternative to insecticides for Midwest apple production

Apple orchards are highly managed agricultural ecosystems where growers typically rely on insecticides to minimize the risk of pest-related fruit losses. Apple growers practicing integrated pest management require cost-effective alternatives to conventional insecticides for control of major pests such as codling moth (Cydia pomonella L.) and apple maggot (Rhagoletis pomonella Walsh). Exclusion netting has been shown to effectively control multiple insect pest species, limit fruit damage and reduce the use of insecticides while also conferring consumer and environmental benefits. In this study, partial budgeting was applied to explore the financial efficacy of using a hail netting (DrapeNet®) system as a sustainable pest management strategy for Midwest U.S. apple (Malus x domestica). The cost of the hail netting was compared to a common Midwest insecticide spray regimen for apples using yield and quality data from a field study at two Minnesota apple orchards in 2021-2022. The PB analysis indicated that the netting system was an economically competitive alternative to conventional insecticide applications. The economic results were robust across a range of apple prices and yields suggesting that Minnesota apple growers can benefit economically from the application of hail netting for sustainable pest management.

The Paradox of Love: A Historical Exploration of Western Philosophical Perspectives on Love, Exclusion, and Liberatory Potential

The present work tracks some of the most well-known thinkers on love in the Western philosophical tradition, where various theories emerge, conflict, converge, and fade away. Given that many questions about its nature have persisted for centuries, love's identity appears unsettled. Due to its unresolved identity, love might be best understood as a paradox existing between its resistance to definition and yet commonly recognized and experienced. The other central thread stemming from these philosophers of love is how the history of its theorizing constructed a restrictive notion that commonly excluded women from the experience. Offering a natural rebuttal to the history of exclusion promoted by these prominent thinkers is bell hooks' notion of an expansive and healing love that possessed the capacity to realize more fulfilling relationships and a compassionate society. This paper concludes with thoughts on love's liberatory nature, its capacity to create personal meaning, and its identity as a paradox without attempting to define it.

Corrigendum: Motivating factors and barriers to help-seeking for casino gamblers: results from a survey in Swiss casinos

[This corrects the article DOI: 10.3389/fpsyt.2023.1128291.].

[From morbid obesity to complex obesity: somato-psychic issues]

Complex obesity is a chronic, multifactorial pathology. These repercussions (respiratory insufficiency, hypoventilation syndrome, cardiac insufficiency, loss of functional autonomy and mobility with a tendency to grabatization, depression, behavioral disorders) directly sustain the disease. Access to care is virtually impossible for them outside specialized obesity centers (CSO) and specialized medical and rehabilitation care (SMR). We need to support healthcare teams by analyzing their practices, including those of expert patients, to ensure that complex obesity is treated with the humanity it requires.

Laboratory diagnosis of von Willebrand disease in the age of the new guidelines: considerations based on geography and resources

von Willebrand disease (VWD) is considered the most common bleeding disorder and arises from deficiency and/or defect in the adhesive plasma protein von Willebrand factor (VWF). Diagnosis of VWD requires clinical assessment and is facilitated by laboratory testing. Several guidelines for VWD diagnosis exist, with the latest American Society of Hematology, International Society on Thrombosis and Haemostasis, National Hemophilia Foundation, and World Federation of Hemophilia 2021 guidelines presenting 11 recommendations, some of which have drawn controversy. In the current narrative review, we provide additional context around difficulties in laboratory diagnosis/exclusion/typing of VWD, with a focus on developing countries/resource-poor settings. In particular, there are many variations in assay methodology, and some methods express high assay variability and poor low-level VWF sensitivity that compromises their utility. Although we favor an initial 4-test assay panel, comprising factor (F) VIII coagulant activity, VWF antigen, VWF glycoprotein Ib binding (VWF:GPIbR or VWF:GPIbM favored over VWF Ristocetin cofactor) and VWF collagen binding, we also provide strategies for laboratories only able to incorporate an initial 3-test assay panel, as favored by the latest guidelines, to improve diagnostic accuracy.

Needs and experiences of cancer care in patients' perspectives among the lesbian, gay, bisexual, transgender and queer community: a systematic review

Individuals within the Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) community who are diagnosed with cancer experience inequitable treatment in healthcare systems worldwide, resulting in dissatisfaction, communication challenges with healthcare providers, and a deep sense of disappointment. Stigma, discrimination, and perceived homophobia further heighten the risk of psychological and attitudinal disorders, including depression and suicidal tendencies, among LGBTQ cancer patients. To comprehensively assess the discrimination faced by LGBTQ cancer patients and gain deeper insights into their needs and experiences, we conducted a systematic review following PRISMA guidelines. We searched for relevant articles using specific keywords in reputable databases such as PubMed, Google Scholar, and PsycINFO. We rigorously evaluated article quality using the CASP (Critical Appraisal Skills Programme) checklist. From a total of 75 eligible studies, we carefully selected 14 studies, specifically examining LGBTQ cancer patients who were currently undergoing or had previously undergone cancer treatment. The studies revealed various factors, including unmet needs related to anxiety and depression, instances of discrimination, disparities in care, and inadequate support systems. A majority of patients expressed dissatisfaction with their cancer care and continued to encounter discrimination and disparities throughout their treatment journeys. Consequently, this led to heightened levels of anxiety, stress, depression, and negative perceptions of healthcare providers. Based on these findings, we recommend providing specialized training to social workers and healthcare providers. This training will equip them with the necessary skills and knowledge to deliver culturally sensitive care tailored to the unique needs of LGBTQ cancer patients. By addressing discrimination, reducing disparities, and fostering an inclusive environment, healthcare professionals can strive to ensure that LGBTQ cancer patients receive the care they deserve.

Motivating factors and barriers to help-seeking for casino gamblers: results from a survey in Swiss casinos

Introduction

Gambling can have serious consequences for many aspects of a person's life. Yet relatively few people with gambling problems seek help. This study examines the extent to which exclusion from casino venues among other factors may act as a motivator for further help-seeking among casino gamblers (both landbased and remote) with at-risk or disordered gambling behavior. In addition, the barriers that prevent gamblers from accepting help are examined.

Methods

Gamblers from Swiss casinos completed a written questionnaire twice, at 6-month intervals. The questions included whether they had sought help in the past 6 months.

Results

For those with a SOGS-R rating of 1 or over (n = 173) at the second survey point, a difference in help-seeking was found between the excluded and non-excluded gamblers (p < .001), suggesting that exclusion may be a motivator for help-seeking. Reported differences in levels of debt (p = .006), recognition of gambling problems (p = .010) and severity of gambling-related problems (p = .004) can be taken to suggest that other motivating factors may also influence help-seeking behavior. With regard to the support sought, the most frequently used forms of support were specialized addiction counseling centers (39.5%), followed by self-help groups (21.1%) and remote counseling centers (10.5%). In terms of barriers, reasons relating to attitude, such as denial, appear to pose greater barriers than treatment-related concerns.

Discussion

From a public health perspective, an overarching strategy is required to increase the share of help-seekers among casino gamblers through targeted measures.

The importance of multi-year studies and commercial yield metrics in measuring pollinator dependence ratios: A case study in UK raspberries Rubus idaeus L

The benefit of pollinators to crop production is normally calculated using "pollinator dependence ratios," which reflect the proportion of yield lost (here reported as a value between 0 and 1) in the absence of pollinators; these ratios are quantified experimentally using pollinator exclusion experiments. Pollinator dependence ratio estimates can vary considerably for a single crop, creating large, frequently overlooked, uncertainty in economic valuations of pollinators. The source of this variation is usually unclear. We experimentally measured the pollinator dependence ratio of two UK commercial cultivars of raspberry Rubus idaeus L., using a range of yield metrics-fruit set, marketable fruit set, fruit weight, and marketable fruit weight-over 3 years (2019-2021), to quantify the effects of yield metric, interannual variation, and cultivar on pollinator dependence ratio estimates. We found a difference in the pollinator dependence ratio for fruit set of 0.71 between 2019 and 2020, showing the importance of carrying out exclusion studies over multiple years. Averaged over multiple years and two cultivars, the dependence ratio was 0.68 measured using marketable fruit set and 0.64 using marketable fruit weight. Imposing a quality threshold (size and shape) below which fruits would not be of commercial value (marketable fruit set/weight) dramatically increased both the pollinator dependence ratio and subsequent economic valuations of pollination service derived from it. Our study shows that, for raspberry, estimates of the pollinator dependence ratio, and therefore, the economic value of insect pollinators, are highly sensitive to the choice of yield metric and can change between years and cultivars. Many economic decisions about pollinator management, at farm, regional and national scales rely on estimates of pollinator dependence. We, therefore, recommend that for estimating pollinator dependence ratios, pollinator exclusion studies are conducted over three or more years and use yield metrics that incorporate quality criteria linked to actual market values and commercial thresholds.

On the triple exclusion of older adults during COVID-19: Technology, digital literacy and social isolation

During the COVID-19 pandemic, the relationship between older adults and digital technology became complicated. Prior to the pandemic, some older adults may have faced a double exclusion due to a lack of digital literacy and social interaction, and the pandemic-imposed transition to nearly all aspects of life being online magnified the requirement for people to be increasingly digitally literate. This paper presents an exploratory analysis to understand how the increased online nature of the world during the pandemic may have impacted older adults’ relationship with digital technology by conducting an expansion on a prior study of older adults who, pre-pandemic, self-identified as occasional or non-users of digital technology. Follow-up interviews were conducted with 12 of these people during the pandemic. Our findings demonstrate the ways that their risk of precarity became heightened and how they began to use digital technology more frequently, strengthening and applying their digital literacy skills to remain virtually connected with friends and family. Further, the paper advances the concept of a triple exclusion for older adults who are non-users of digital technology and describes how digital literacy and remaining virtually connected can work in tandem, helping older adults to remain included in society.

Aging in rural Nigeria: gendered exclusion of rural older adults and its impact on their perceived life satisfaction in South-East Nigeria

Globally, there is an immense increase in the number of older adults. This can be attributed to an increase in life expectancy brought about by advances in general living standards as well as medicine and healthcare. However, exclusion which is linked to discrimination and access restrictions in areas such as education, employment, housing, and medical care has been identified as one of the challenges facing this increasing demographic. This study explored the exclusion of older rural women in southeast Nigeria and its impact on their life satisfaction. The study used a qualitative method of research to obtain data from a sample of 32 older adults aged 65 years and above through focus group discussions in Nru community in Nsukka Local Government Area of Enugu State. The obtained data were thematically analyzed and the findings showed that many older rural women in the study area are socially excluded at home, churches, and the larger society, with poverty and stereotyping of older rural women as less intelligent identified as the leading factor predisposing them to social exclusion in Nigeria. Results also showed that social exclusion brings about sadness and depression which have severe negative implications on their life satisfaction. Finally, implications of the findings for gerontological social workers through advocacy geared toward changes in social policy and structures that promote ageism were discussed.

An Examination of the Relationships between Psychological Resilience, Organizational Ostracism, and Burnout in K-12 Teachers through Structural Equation Modelling

Psychological resilience, burnout, and ostracism are significant variables that may affect teachers' performance and well-being. While psychological resilience is the ability of individuals to cope with the challenges of life/work and could support teachers in performing their profession, burnout (i.e., high levels of emotional exhaustion and desensitization) and ostracism (i.e., being ignored by others in the workplace) could lead to serious negative outcomes for both teachers and the educational system. Despite their significance, studies addressing the relationships between these variables are rare. Therefore, this study aimed to investigate the relationships between teachers' psychological resilience, burnout, and organizational ostracism. The study used structural equation modeling (SEM) to test the hypothetical relationships between these variables. The participants were selected using a simple random sampling method among K-12 teachers working in Elazig, Turkey. The data were collected using Psychological Resilience Scale-Short Form, Organizational Ostracism Scale, and Burnout Syndrome Inventory-Short Form. Data obtained from 309 K-12 teachers were analyzed using path analysis. The findings showed that teachers' psychological resilience was quite low, whilst they experienced high levels of burnout and organizational ostracism. The results also showed a negative relationship between their psychological resilience and organizational ostracism and burnout while determining a positive relationship between ostracism and burnout. Psychological resilience was determined to have a moderating role in the relationship between organizational ostracism and burnout. Implications were suggested for both research and practice.

Meaningful approaches to content selection and ways of working: Norwegian instrumental music teachers' experiences

The Norwegian municipal schools of music and arts are publicly funded institutions which offer extra-curricular activities for children and adolescents in music and other art forms. The system is designed to ideally reach all children, but while each municipality is legally responsible for providing school of music and arts education for its inhabitants, the law does not state anything about teaching content or ways of working. Consequently, this is up to the teachers to decide. What is taught in these schools is, however, relevant to whether children feel included or excluded. This means that music teachers' beliefs and actions are among the factors that influence who will feel welcomed and who will feel alienated. On this basis, in this article we explore music teachers' approach to content-related decision-making processes by asking about their meaningful approaches to selecting content and ways of working within instrumental music teaching. To answer that question, we discuss what kinds of teaching content the teachers choose in general, as well as for beginner and advanced students, the reasons they express for selecting content, which, if any, music they find not to be suitable as teaching content, and how they work with the selected repertoire. We draw on empirical data from a survey among 151 music teachers and an interview study with 11 music teachers. Discussing results from these sources of data in relation to the Nordic and German music Didaktik theories, enables us to address meaningful approaches to selecting content and ways of working. From the analysis, we draw conclusions about what the music teachers experience as meaningful approaches. These can be summarized as (a) the centrality of the students in the process of selecting content; (b) genre versatility, meaning that students should be exposed to a broad range of musical genres and styles; and (c) that students are exposed to the "classical repertoire," or the standard repertoire within a genre or tradition. In general, what seems to be meaningful for the teachers is working "close to the student's wishes and preferences," but in ways that relate to a variety of Didaktik principles.

Inhibition of Listeria monocytogenes Growth, Adherence and Invasion in Caco-2 Cells by Potential Probiotic Lactic Acid Bacteria Isolated from Fecal Samples of Healthy Neonates

Lactic acid bacteria (LAB) isolated from healthy humans may prove an effective tool against pathogen growth, adherence and invasion in intestinal epithelial cells. This study aimed to evaluate the antilisterial properties of LAB isolated from fecal samples of healthy neonates. Forty-five LAB strains were tested for their antimicrobial activity against ten Listeria monocytogenes strains with spot-on-lawn and agar-well diffusion assays, and ten lactobacilli strains were further assessed for their inhibitory effect against adherence and invasion of Caco-2 cells by L. monocytogenes EGDe. Inhibition was estimated in competition, exclusion or displacement assays, where lactobacilli and L. monocytogenes were added to Caco-2 monolayers simultaneously or 1 h apart from each other. Inhibition of L. monocytogenes growth was only displayed with the spot-on-lawn assay; cell-free supernatants of lactobacilli were not effective against the pathogen. Lactobacillus (L.) paragasseri LDD-C1 and L. crispatus LCR-A21 were able to adhere to Caco-2 cells at significantly higher levels than the reference strain L. rhamnosus GG. The adherence of L. monocytogenes to Caco-2 cells was reduced by 20.8% to 62.1% and invasion by 33.5% to 63.1% during competition, which was more effective compared to the exclusion and displacement assays. These findings demonstrate that lactobacilli isolated from neonatal feces could be considered a good candidate against L. monocytogenes.

Aluminum in plant: Benefits, toxicity and tolerance mechanisms

Aluminum (Al) is the third most ubiquitous metal in the earth's crust. A decrease in soil pH below 5 increases its solubility and availability. However, its impact on plants depends largely on concentration, exposure time, plant species, developmental age, and growing conditions. Although Al can be beneficial to plants by stimulating growth and mitigating biotic and abiotic stresses, it remains unknown how Al mediates these effects since its biological significance in cellular systems is still unidentified. Al is considered a major limiting factor restricting plant growth and productivity in acidic soils. It instigates a series of phytotoxic symptoms in several Al-sensitive crops with inhibition of root growth and restriction of water and nutrient uptake as the obvious symptoms. This review explores advances in Al benefits, toxicity and tolerance mechanisms employed by plants on acidic soils. These insights will provide directions and future prospects for potential crop improvement.

More-than-care: People with intellectual disability and emerging vulnerability during pandemic lockdown

This paper offers more-than-care as a framework for analysing how vulnerability emerges in the lives of people with intellectual disability beyond relations of care. More-than-care detaches vulnerability from the identity category of disability. It provides a framework for conceptualising vulnerability in an unequal, neoliberalising, and ableist world and sheds new light on the ever-evolving constitution of vulnerability and disability. This intervention breaks with conceptions of vulnerability centred on care needs that leave other circumstances that inform vulnerabilities unexamined. Importantly, the framework shifts responsibility for managing vulnerabilities away from carers alone. The more-than-care framework is grounded in socio-material conceptualisations of disability and advances a tripartite framing of vulnerability. First, it grounds studies of vulnerability in histories of spatially uneven investment in infrastructure and resources that shape how care and other practices can assemble to produce, challenge, and manage vulnerability. Second, it recalibrates dominant conceptions of the temporality of vulnerability to ensure sensitivity to the unpredictability of emergent vulnerabilities. Third, in following a socio-material conceptualisation of intellectual disability, more-than-care expands discussions about agency in the context of vulnerability. These concepts are empirically examined through an analysis of how vulnerability emerges in the lives of four self-advocates with intellectual disability during Melbourne's first and second COVID-19 lockdowns. The analysis shows that vulnerability was highly dynamic and unpredictable as it emerged in complex socio-material assemblages that included care arrangements, embodied experiences and agencies, and past instances of neglect and exploitation.

Bacterial composition of a competitive exclusion product and its correlation with product efficacy at reducing Salmonella in poultry

The mature intestinal microbiome is a formidable barrier to pathogen colonization. Day-old chicks seeded with cecal contents of adult hens are resistant to colonization with Salmonella, the basis of competitive exclusion. Competitive exclusion products can include individual microbes but are commonly undefined intestinal communities taken from adult animals and in commercial production is amplified in fermentator and sold commercially in freeze dried lots. While superior to single and multiple species probiotics, reducing Salmonella colonization by multiple logs, undefined products have limited acceptance because of their uncharacterized status. In this study, the bacterial composition of the master stock, preproduction seed stocks and commercial lots of a poultry competitive exclusion product, was defined by 16S rRNA sequence analysis, targeting the 16S rRNA variable region (V1-V3). The samples contained a diversity of genera (22-52 distinct genera) however, the commercial lots displayed less diversity compared to the seeds and the master stock. Community composition varied between seeds and the master stock and was not a good predictor of potency, in terms of log₁₀ reduction in Salmonella abundance. While there was significant correlation in composition between seeds and their commercial lots, this too was a not a good predictor of potency. There was linear correlation between unclassified Actinobacteria, Peptococcus, and unclassified Erysipelotrichaceae, and Salmonella abundance (r ² > .75) for commercial seeds. However, upon review of the literature, these three genera were not consistently observed across studies or between trials that examined the correlation between intestinal community composition and Salmonella prevalence or abundance.

Invisibility as a structural determinant: Mortality outcomes of Asians and Pacific Islanders experiencing homelessness

Introduction

Asians and Pacific Islanders (APIs) who are experiencing homelessness are situated in a social intersection that has rendered them unrecognized and therefore vulnerable. There has been increasing attention to racial disparities in homelessness, but research into API homelessness is exceedingly rare, despite rapidly growing populations. The purpose of this study is to examine the causes of death among APIs who died while homeless in Santa Clara County (SCC) and compare these causes to other racial groups.

Materials and methods

We report on data obtained from the SCC Medical Examiner-Coroner's Office on unhoused people's deaths that occurred between 2011 and 2021 (n = 1,394), including data on deaths of APIs experiencing homelessness (n = 87).

Results

APIs comprised 6.2% of total deaths of unhoused people. APIs died less often of causes related to drug/alcohol use than all other racial groups (24.1, compared to 39.3%), and there was a trend toward more API deaths from injuries or illnesses. When APIs were disaggregated into sub-groups (East/Southeast Asian, South Asian, Pacific Islander), there were notable mortality differences in cause of death, age, and sex.

Discussion

We argue that invisibility is a structural determinant of health that homeless APIs face. Though relatively small in numbers, APIs who are invisible may experience increased social isolation and, subsequently, specific increased mortality risks. To understand the health outcomes of unhoused APIs, it is essential that researchers and policymakers recognize API homelessness and gather and report disaggregated races and ethnicities.

We Are Still Here: Living with HIV in the UK

In this article we highlight a number of the ongoing challenges faced by people living with HIV in the UK today (2021). Based on in-depth interviews with 23 respondents drawn from a range of ages, backgrounds and walks of life, we offer an insight into deeply personal experiences of what it means to have HIV. We demonstrate the degree to which, 40 years on from the formal emergence of the HIV pandemic, stigma and related structural violence remain both extremely present and extraordinarily debilitating. In essence, social responses to HIV remain mired in a past age.

[The Pass, a medical and social device for vulnerable people]

The permanence of access to health care is a system that aims to facilitate access to ambulatory medical care for poor and vulnerable people who do not have social security or health insurance coverage, or who have incomplete social security coverage (neither mutual insurance, nor complementary health insurance from the primary health insurance fund). A health care team from the Ile-de-France region shares its know-how and expertise with the most disadvantaged.

"Because we all love K-Pop": How young adults reshape symbolic boundaries in Paris, Manchester, and Philadelphia

In this paper, we examine how young adults who are consumers of K-Pop in three culturally diverse cities (Paris, Philadelphia, and Manchester) reshape their symbolic boundaries to face social challenges. Analyzing data from 132 interviews, we show how young adults mainly confront social exclusion in Paris, fight racism in Philadelphia and deal with xenophobia in Manchester. Although K-Pop adds to the dynamics of exclusion due to being perceived as culturally foreign, our participants use K-Pop as a resource to reshape social boundaries towards new forms of inclusion. They do this by relying on K-Pop as a cultural product that promotes inclusion, and on their affiliation with the K-Pop community on a local and global level.

[The outreach teams, first contact for screening and care]

Since its creation in 1993, the Samusocial de Paris has been working with homeless people in a "going towards" approach. Within this framework, professionals - social workers, nurses, interpreters-mediators, drivers-social workers - seek out and provoke encounters by going to the place where the person is: it can be the place where a homeless person lives, the day care center he or she attends, the shelter or the hotel room where he or she is staying. This exercise is based on specific expertise in multidisciplinary health mediation with the public in very precarious situations.

Revisiting the Exhibits-Medical Student Reflections on Changes to the Institutional Portraiture at a US Medical School

BACKGROUND

Yale School of Medicine's (YSM) Sterling Hall of Medicine (SHM) has historically been lined with large oil paintings of mostly White men, despite over a century of Black and female enrollment. These spaces can be seen as exclusionary to students underrepresented in medicine, and may result in decreased well-being and adversely affect academic performance. Student-led activism has resulted in recent changes to these walls, including the addition of images of women faculty, and artwork by students, faculty, and staff.

OBJECTIVE

We aimed to evaluate how recent changes to longstanding historical portraiture in SHM affected students' reflections on being in that space.

DESIGN

This was a qualitative study based on semi-structured interviews conducted virtually.

PARTICIPANTS

Second- to fourth-year YSM medical students were interviewed.

APPROACH

Qualitative interviews were used to gauge students' impressions of how they perceived both the original and updated artwork and portraiture, as well as the overall physical environment.

KEY RESULTS

Nine interviews were conducted, with interviewees describing the portraiture as reflective of YSM's institutional values. They related this to other aspects of an exclusionary environment, and noted that they created belonging at YSM within smaller communities. Students recognized and expressed appreciation for the changes to the portraiture, particularly the increase in diverse representation, and they noted stark contrasts to the prior space. While they describe positive attitudes regarding changes in SHM's exhibited portraiture and art, they also expressed skepticism about whether these changes were performative or whether they reflected true commitment to reform.

CONCLUSIONS

This study depicts how the portraiture and physical environment of a medical school affects medical students, and that interventions to reform institutional portraiture can have considerable impact on students' attitudes regarding their medical school experiences.

Inclusion of pregnant and breastfeeding women in nonobstetrical randomized controlled trials

BACKGROUND

There is an urgent need to prioritize and expedite the inclusion of pregnant and breastfeeding women in research. Characterizing trials that have successfully included these populations could inform the design and execution of future studies. In addition, up-to-date data on their inclusion in clinical research could assist in setting benchmarks, establishing targets, and monitoring progress toward more equitable inclusion.

OBJECTIVE

This study aimed to characterize the eligibility and enrollment of pregnant and breastfeeding women in randomized controlled trials evaluating interventions for nonobstetrical conditions experienced by, but not limited to, these populations.

STUDY DESIGN

We developed a literature search in collaboration with an information specialist. We included randomized controlled trials published between 2017 and 2019 in the 5 highest-impact general medicine journals and the 3 highest-impact specialty journals in cardiovascular disease, critical care, general infectious diseases, HIV, and psychiatry. We included randomized controlled trials that evaluated screening, diagnosis, prevention, or treatment of nonobstetrical medical conditions. We excluded randomized controlled trials exclusively focused on males, pediatrics, geriatrics, oncology, or postmenopausal women, and publications reporting subgroup, pooled, or follow-up analyses of previously published randomized controlled trials. We screened titles and abstracts independently and in duplicate, with discrepancies resolved by a third reviewer. We entered data into a standardized electronic case report form. We reviewed study protocols, appendices, and trial registries for additional data.

RESULTS

Of the 1333 randomized controlled trials, pregnant and breastfeeding women were eligible for 13 (1.0%) and 6 (0.5%), respectively. Pregnancy and breastfeeding eligibility criteria were not addressed in 383 of 1333 (28.7%) and 710 of 1333 (53.3%) randomized controlled trials, respectively. In total, 102 of 937 (10.9%) and 33 of 617 (5.3%) randomized controlled trials that explicitly excluded pregnant and breastfeeding women documented the rationale. Most studies excluding pregnant women (542/937; 57.8%) required at least 1 method of contraception and/or pregnancy testing as part of trial participation for women with reproductive capacity. Among the 13 randomized controlled trials that allowed inclusion of pregnant women, 3 restricted eligibility to specific trimesters. Two randomized controlled trials enrolled pregnant women after the first year of the study following interim review of safety results in nonpregnant participants. Four randomized controlled trials reported the number of pregnant women enrolled, which ranged from 0.7% to 3.4% of the study population. None of the studies reported on pregnancy or perinatal outcomes. Compared with randomized controlled trials that excluded pregnant women, those including them more commonly had an infectious disease focus (12/13 [92.3%] vs 270/937 [28.8%]; p<.0001), including HIV (5/13 [38.5%] vs 96/937 [10.2%]; p=.0079), enrolled participants in sub-Saharan Africa (5/13 [38.5%] vs 111/937 [11.8%]; p=.0143), and had exclusively nonindustry sponsorship (13/13 [100%] vs 559/937 [59.7%]; p=.0025); inclusion varied by study phase, randomization level, and intervention type.

CONCLUSION

This study illustrates a major inequity in research involving pregnant and breastfeeding women. As new health challenges arise, including novel pandemics, and the research community mobilizes to develop therapies and innovate in patient care, it is crucial that pregnant and breastfeeding women not be left behind. Greater regulatory support, in the form of explicit requirements and incentives, will be needed to ensure these populations are integrated into the research agenda.

Last Honors and Life Experiences of Bereaved Families in the Context of COVID-19 in Kashmir: A Qualitative Inquiry About Exclusion, Family Trauma, and Other Issues

This study examined the changing character of the last honours of those who died of COVID-19 in Kashmir and the life experiences of the families of the deceased. A semi-structured interview schedule was used to collect information from 21 participants. Using qualitative data analysis approaches, five key themes were identified vis-à-vis the impact of COVID-19 on burial rituals and customs; effects on bereaved families, shades of grief, bereavement care, community response, and coping with loss. Based on examining the pandemic-induced changes related to customs and rituals around death, the study found that the bereaved family members were in danger of marginalization, economic burdens, psychological traumas, and overall reduced quality of life. This study would be a credible addition to the existing literature on death practices as there is a shortage of research on funeral rituals during the post-pandemic period in Kashmir.

Exclusionary Effects of Campsite Allocation through Reservations in U.S. National Parks: Evidence from Mobile Device Location Data

Campsites represent highly sought after recreational amenities in the national parks of the United States. Equitable allocation of scarce recreational resources has long been a key management issue in U.S. national parks, but has become increasingly difficult in an era of increasing demand. At present, a growing number of national park campsites are allocated through an online reservation system well in advance of a camper's arrival at a park. Compounding the challenge of allocating these campsites is a long history of exclusivity within national park camping-institutionalized through campground design and predicated on a legacy of the leisure class's affinity for camping in national parks. Given national park camping's history of exclusivity, this exploratory study seeks to explore how online reservation systems may impact the demographics of national park campers. Using mobile device location data, estimated demographics were calculated for campers in five national park campgrounds in the U.S. that each contained some sites requiring reservations and some sites available on a first-come, first-served basis. We detail results from analyses of variance between campsites requiring reservations and those that are available on a first-come, first-served basis. Results suggest that for each of the five campgrounds, those campers camping in sites that require reservations came from areas with higher median household incomes, on average. In three of the five campgrounds, this difference was significant. Additionally, in an urban-proximate setting, those camping in sites requiring reservations came from areas with a higher portion of White residency than those campers in campsites not requiring reservations, on average. We conclude with discussion that includes management implications concerning the growing prominence of online reservation systems for outdoor recreation amenities, and a brief research agenda for diversity, equity, and inclusion (DEI) as they relate to campgrounds. Principally, the former group of implications includes the realization that online reservation systems present the unintended consequence of excluding low-income, and perhaps non-White, would-be campers-a conclusion drawn from the results of this exploratory study. This discussion includes an analysis of the distributive justice of online reservation systems.

A Rare Complication of Esophageal Exclusion: Esophageal Mucocele

Bipolar esophageal exclusion is a "Hail Mary" procedure for control of leak and persistent mediastinal soilage from esophageal injury. Usually, the esophageal remnant scars down without negative consequences. Esophageal mucocele is a rare complication of bipolar esophageal exclusion. This is a case report of an iatrogenic esophageal transection and the subsequent treatment course. A retrospective chart review of the patient's medical and surgical history was performed. After a robotic hiatal hernia repair at an outside institution, the patient suffered an esophageal leak and was surgically treated with esophageal exclusion, wide drainage of the mediastinum, and decortication of the resulting empyema. She subsequently underwent retrosternal gastric conduit for esophageal reconstruction 4 months later. Three years after this, she developed a rare complication of esophageal exclusion, a symptomatic esophageal mucocele that required resection.

A New Approach to Simplifying and Harmonizing Cancer Clinical Trials-Standardizing Eligibility Criteria

Importance

Clinical trial sponsors rely on eligibility criteria to control the characteristics of patients in their studies, promote the safety of participants, and optimize the interpretation of results. However, in recent years, complex and often overly restrictive inclusion and exclusion criteria have created substantial barriers to patient access to novel therapies, hindered trial recruitment and completion, and limited generalizability of trial results. A LUNGevity Foundation working group developed a framework for lung cancer clinical trial eligibility criteria. The goals of this framework are to (1) simplify eligibility criteria, (2) facilitate stakeholders' (patients, clinicians, and sponsors) search for appropriate trials, and (3) harmonize trial populations to support intertrial comparisons of treatment effects.

Observations

Clinicians and representatives from the pharmaceutical industry, the National Cancer Institute, the US Food and Drug Administration (FDA), the European Medicines Agency, and the LUNGevity Foundation undertook a process to identify and prioritize key items for inclusion in trial eligibility criteria. The group generated a prioritized library of terms to guide investigators and sponsors in the design of first-line, advanced non-small cell lung cancer clinical trials intended to support marketing application. These recommendations address disease stage and histologic features, enrollment biomarkers, performance status, organ function, brain metastases, and comorbidities. This effort forms the basis for a forthcoming FDA draft guidance for industry.

Conclusions and Relevance

As an initial step, the recommended cross-trial standardization of eligibility criteria may harmonize trial populations. Going forward, by connecting diverse stakeholders and providing formal opportunity for public input, the emerging FDA draft guidance may also provide an opportunity to revise and simplify long-standing approaches to trial eligibility. This work serves as a prototype for similar efforts now underway for other cancers.

Combined de novo transcriptomic and physiological analyses reveal RyALS3-mediated aluminum tolerance in Rhododendron yunnanense Franch

Rhododendron (Ericaceae) not only has ornamental value, but also has great medicinal and edible values. Many Rhododendron species are native to acid soils where aluminum (Al) toxicity limits plant productivity and species distribution. However, it remains unknown how Rhododendron adapts to acid soils. Here, we investigated the physiological and molecular mechanisms of Al tolerance in Rhododendron yunnanense Franch. We found that the shoots of R. yunnanense Franch did not accumulate Al after exposure of seedlings to 50 μM Al for 7 days but predominantly accumulated in roots, suggesting that root Al immobilization contributes to its high Al tolerance. Whole-genome de novo transcriptome analysis was carried out for R. yunnanense Franch root apex in response to 6 h of 50 μM Al stress. A total of 443,639 unigenes were identified, among which 1,354 and 3,413 were up- and down-regulated, respectively, by 6 h of 50 μM Al treatment. Both Gene Ontology (GO) enrichment and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses revealed that genes involved in "ribosome" and "cytoskeleton" are overrepresented. Additionally, we identified Al-tolerance homologous genes including a tonoplast-localized ABC transporter RyALS3; 1. Overexpression of RyALS3; 1 in tobacco plants confers transgenic plants higher Al tolerance. However, root Al content was not different between wild-type plants and transgenic plants, suggesting that RyALS3; 1 is responsible for Al compartmentalization within vacuoles. Taken together, integrative transcriptome, physiological, and molecular analyses revealed that high Al tolerance in R. yunnanense Franch is associated with ALS3; 1-mediated Al immobilization in roots.

Mycophagous beetle females do not behave competitively during intrasexual interactions in presence of a fungal resource

Intrasexual interactions can determine which individuals within a population have access to limited resources. Despite their potential importance on fitness generally and mating success especially, female-female interactions are not often measured in the same species where male-male interactions are well-defined. In this study, we characterized female-female interactions in Bolitotherus cornutus, a mycophagous beetle species native to Northeastern North America. We used dyadic, behavioral assays to determine whether females perform directly aggressive or indirectly exclusionary competitive behaviors. Polypore shelf fungus, an important food and egg-laying resource for B. cornutus females, is patchily distributed and of variable quality, so we tested for competition over fungus as a resource. Behavior of females was assessed in three sets of dyadic trials with randomly paired female partners. Overall, females did not behave aggressively toward their female partner or perform exclusionary behaviors over the fungal resource. None of the behaviors performed by females were individually repeatable. Two scenarios may explain our lack of observed competition: our trial context may not induce competition, or female B. cornutus simply may not behave competitively in the wild. We compare our results to a similar study on male-male interactions in the same species and propose future studies on female-female interactions under different competitive contexts to expand the understanding of female competition.

Evolutionary Perspective on Self-Concept: The Effects of Interpersonal Motivations and Inclusionary Status on Spontaneous Self-Descriptions of Communion and Agency

Evolutionary models suggest that self-concept is a dynamic structure shaped jointly by interpersonal motivations and social challenges. Yet, empirical data assessing this claim are sparse. We examined this question in two studies. In study 1, participants (N = 386) generated spontaneous self-descriptions and filled out questionnaires assessing dominance and affiliation motivations. We found that self-descriptions categorized as communion or agency were associated with affiliation and dominance motivations, respectively. In study 2, participants (N = 360) underwent an inclusionary manipulation (exclusion, inclusion, popularity) and completed self-description and motivation measures. We found that exclusion (compared to inclusion/popularity) enhanced the salience of communion self-descriptions such that participants described themselves using more communion traits. Finally, in the popularity condition (compared to exclusion/inclusion), an enhanced positive association between salience of agency self-descriptions and dominance motivation was found. Our results support evolutionary models suggesting that self-concept organization shapes and is being shaped by social motivations to enhance interpersonal functioning.

Neural Mechanisms of Intergroup Exclusion and Retaliatory Aggression

Aggression occurs frequently and severely between rival groups. Although there has been much study into the psychological and socio-ecological determinants of intergroup aggression, the neuroscience of this phenomenon remains incomplete. To examine the neural correlates of aggression directed at outgroup (versus ingroup) targets, we recruited 35 healthy young male participants who were current or former students of the same university. While undergoing functional MRI, participants completed an aggression task against both an ingroup and an outgroup opponent in which their opponents repeatedly provoked them at varying levels and then participants could retaliate. Participants were then socially included and then excluded by two outgroup members and then completed the same aggression task against the same two opponents. Both before and after outgroup exclusion, aggression towards outgroup members was positively associated with activity in the ventral striatum during decisions about how aggressive to be towards their outgroup opponent. Aggression towards outgroup members was also linked to greater post-exclusion activity in the rostral and dorsal medial prefrontal cortex during provocation from their outgroup opponent. These altered patterns of brain activity suggest that frontostriatal mechanisms may play a significant role in motivating aggression towards outgroup members.

"This isn't a fairy tale we're talking about; this is our real lives": Community-orientated responses to address trans and gender diverse homelessness

Globally, trans and gender diverse people contend with day-to-day exclusion, discrimination, and marginalisation, often culminating in experiences of poverty and homelessness. In this discussion article, we outline a bricolage research orientation rooted in liberation and Indigenous approaches brought into dialogue with the broader cannon of community psychology for meaningful research with homeless trans and gender diverse people. Such an approach transcends rigid disciplinary divides and shapes a framework for collaborative action, advocacy, and social change. We argue that scholar-activism, social justice, and relationality and collaboration should inform every stage of the research process and beyond when engaging with minoritized communities.