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Constipation is a significant problem for people with intellectual disabilities, with a prevalence of 33–50%, causing at least five deaths annually in England. Individualised bowel care plans (IBCP) are recommended in England and Wales.
Aims
We evaluated the feasibility and impact of IBCPs for people with intellectual disabilities who are in in-patient psychiatric units, and the effect on clinical outcomes.
Method
People with intellectual disabilities who were at risk of constipation were recruited from four specialist in-patient psychiatric units in England and Wales. A constipation questionnaire was used to capture relevant data to devise IBCPs. Baseline, 3- and 6-monthly Health of the Nation Scales – Learning Disability (HoNOS-LD) were completed after the intervention. Descriptive statistics, Wilcoxon signed-rank, Mann-Whitney U, repeated-measures analyses of variance, with Bonferroni adjustment and Mauchly’s tests were conducted. Significance was taken at P < 0.05.
Results
Of 24 people with intellectual disabilities recruited from four units, all three data points were available for 18 patients. Constipation rates showed no statistically significant decline. The total HoNOS-LD score (18 items) did not decline. HoNOS-LD item 12 for physical functioning showed significant improvement for PwID with constipation compared with those without, between baseline and 6 months.
Conclusions
This quality improvement project suggests that a bigger study of IBCPs is feasible. Most outcomes examined via the HoNOS-LD, particularly those linked with mental illness, challenging behaviour and quality of life, did not show significant change, possibly because of the small sample size. However, people with intellectual disabilities and constipation showed positive changes in their physical functioning outcomes compared with those without constipation. Further in-depth evaluation of this intervention is needed.
This introductory chapter begins with a provocation from Busta Rhymes at the 2023 BET Awards, where he advocates for the multi–locational precedents of hip-hop music, most notably its Jamaican forebears. Accordingly, and following this, it sets out this book’s core agenda and goals. Firstly, through calling for a a deepening of our gaze on rap, as a performed verbal art, specifically. Secondly, a widening of our gaze to acknowledge the truly global significance of this art form. It also addresses the dangers of lionising ‘foundational’ figures and moments in popular histories rap, and advocates for a critical engagement with global rap and the myriad cultures produced through this art-form. The introduction closes by detailing the book’s four key sections – “Historical and Cultural Perspectives”, “Approaches to Rap”, “Applications of Rap”, and “Contexts for Rap”. In both its theoretical and empirical endeavours, the Cambridge Companion to Global Rap enters into communion with artists, their work, and their lives. Rap’s status as a global force therefore demands appreciation of myriad cultural contexts, approaches to performance, and means by which this art form is sustained.
Rap has remapped the way we think about music. For more than fifty years its poetics, performance and political power has resonated across the globe. This Companion offers an array of perspectives on the form, from the fields of sociology, linguistics, musicology, psychology, literary studies, education and law, unpacking how this versatile form of oral communication has permeated nearly every aspect of daily life. Taking a decidedly global perspective, these accounts draw from practice in Australia, China, France, Germany, Jamaica, India and Tanzania; exploring how the form has taken hold in particular contexts, and what this can tell us about the medium itself and the environments in which it was repurposed. An indispensable resource for students and researchers, the collection provides an introduction to global rap studies as well as insights into the some of the most important and exciting new developments in this field.
The macro-social and environmental conditions in which people live, such as the level of a country’s development or inequality, are associated with brain-related disorders. However, the relationship between these systemic environmental factors and the brain remains unclear. We aimed to determine the association between the level of development and inequality of a country and the brain structure of healthy adults.
Methods
We conducted a cross-sectional study pooling brain imaging (T1-based) data from 145 magnetic resonance imaging (MRI) studies in 7,962 healthy adults (4,110 women) in 29 different countries. We used a meta-regression approach to relate the brain structure to the country’s level of development and inequality.
Results
Higher human development was consistently associated with larger hippocampi and more expanded global cortical surface area, particularly in frontal areas. Increased inequality was most consistently associated with smaller hippocampal volume and thinner cortical thickness across the brain.
Conclusions
Our results suggest that the macro-economic conditions of a country are reflected in its inhabitants’ brains and may explain the different incidence of brain disorders across the world. The observed variability of brain structure in health across countries should be considered when developing tools in the field of personalized or precision medicine that are intended to be used across the world.
In July 2022, a genetically linked and geographically dispersed cluster of 12 cases of Shiga toxin-producing Escherichia coli (STEC) O103:H2 was detected by the UK Health Security Agency using whole genome sequencing. Review of food history questionnaires identified cheese (particularly an unpasteurized brie-style cheese) and mixed salad leaves as potential vehicles. A case–control study was conducted to investigate exposure to these products. Case food history information was collected by telephone. Controls were recruited using a market research panel and self-completed an online questionnaire. Univariable and multivariable analyses were undertaken using Firth Logistic Regression. Eleven cases and 24 controls were included in the analysis. Consumption of the brie-style cheese of interest was associated with illness (OR 57.5, 95% confidence interval: 3.10–1,060). Concurrently, the production of the brie-style cheese was investigated. Microbiological sample results for the cheese products and implicated dairy herd did not identify the outbreak strain, but did identify the presence of stx genes and STEC, respectively. Together, epidemiological, microbiological, and environmental investigations provided evidence that the brie-style cheese was the vehicle for this outbreak. Production of unpasteurized dairy products was suspended by the business operator, and a review of practices was performed.
Recent research on the organisation and growth of large settlements (both urban and non-urban) has prompted a reassessment of factors driving population aggregation. Systematic aerial and ground survey of the South Caucasus mega-fortress Dmanisis Gora, described here, contributes to the understanding of large fortress settlements in the South Caucasus (c. 1500–500 BC) as part of this wider debate. Substantial defensive walls and stone architecture in the outer settlement contrast with low-intensity occupation, possibly by a seasonally mobile segment of the population. The exceptional size of Dmanisis Gora helps add new dimensions to population aggregation models in Eurasia and beyond.
We estimate the economic value of birding, which is an important ecosystem service produced by bird populations in recreation areas. Our research identifies the link between values and species richness as well as the abundance of the sandhill crane (Grus canadensis), which migrates each year through our study area. Sandhill crane stopovers at state and federal wildlife areas can attract many birders. We estimate this nonmarket value using the zonal travel cost method and data from the eBird project on wildlife areas in Indiana. We compare crane counts based on eBird with those from the Indiana Department of Natural Resources (DNR). We find important differences depending on whether we use eBird or DNR counts. On average, birders are willing to pay $28 per trip to sites in the study area and less than $1 per trip to see an additional species, while the value of 1000 more cranes is either about $1 or $10 per trip depending on how abundance is measured.
To reconstruct behavioural changes that underpin evolutionary transitions between solitary and eusocial behaviour, we need detailed behavioural information about both solitary and eusocial species. Most behavioural studies of sweat bees have focused on sociality. We addressed the lack of detailed information about solitary species using pinned specimens of Lasioglossum leucozonium (Schrank) and L. zonulum (Smith) from Ontario (2003–2019) and Alberta (2016). We used weekly abundance of trapped bees to evaluate flight phenology (univoltine versus bivoltine), delineating two phases of flight activity, P1 and P2, before and after the first appearance of males, and evaluated female traits related to reproduction (body size, wear, and ovary development). All populations were confirmed to be solitary. The Ontario L. leucozonium and Alberta L. zonulum were univoltine, with P1 and P2 females being similar in size but P2 females more worn and with less-developed ovaries. Ontario L. zonulum were bivoltine, with P2 females being larger, more worn, and having more ovary development than P1 females, a unique pattern among bivoltine sweat bees. Contrasting observations between univoltine and bivoltine populations support the contention that solitary reproduction is not necessarily “simple” and that detailed information is needed to illuminate behavioural changes during bee social evolution.