Decoupling social status and status certainty effects on health in macaques: a network approach.

BackgroundAlthough a wealth of literature points to the importance of social factors on health, a detailed understanding of the complex interplay between social and biological systems is lacking. Social status is one aspect of social life that is made up of multiple structural (humans: income, education; animals: mating system, dominance rank) and relational components (perceived social status, dominance interactions). In a nonhuman primate model we use novel network techniques to decouple two components of social status, dominance rank (a commonly used measure of social status in animal models) and dominance certainty (the relative certainty vs. ambiguity of an individual's status), allowing for a more complex examination of how social status impacts health.MethodsBehavioral observations were conducted on three outdoor captive groups of rhesus macaques (N = 252 subjects). Subjects' general physical health (diarrhea) was assessed twice weekly, and blood was drawn once to assess biomarkers of inflammation (interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP)).ResultsDominance rank alone did not fully account for the complex way that social status exerted its effect on health. Instead, dominance certainty modified the impact of rank on biomarkers of inflammation. Specifically, high-ranked animals with more ambiguous status relationships had higher levels of inflammation than low-ranked animals, whereas little effect of rank was seen for animals with more certain status relationships. The impact of status on physical health was more straightforward: individuals with more ambiguous status relationships had more frequent diarrhea; there was marginal evidence that high-ranked animals had less frequent diarrhea.DiscussionSocial status has a complex and multi-faceted impact on individual health. Our work suggests an important role of uncertainty in one's social status in status-health research. This work also suggests that in order to fully explore the mechanisms for how social life influences health, more complex metrics of social systems and their dynamics are needed

Safer Prescribing:A Trial of Education, Informatics, and Financial Incentives

BACKGROUND High-risk prescribing and preventable drug-related complications are common in primary care. We evaluated whether the rates of high-risk prescribing by primary care clinicians and the related clinical outcomes would be reduced by a complex intervention. METHODS In this cluster-randomized, stepped-wedge trial conducted in Tayside, Scotland, we randomly assigned participating primary care practices to various start dates for a 48-week intervention comprising professional education, informatics to facilitate review, and financial incentives for practices to review patients’ charts to assess appropriateness. The primary outcome was patient-level exposure to any of nine measures of high-risk prescribing of nonsteroidal antiinflammatory drugs (NSAIDs) or selected antiplatelet agents (e.g., NSAID prescription in a patient with chronic kidney disease or coprescription of an NSAID and an oral anticoagulant without gastroprotection). Prespecified secondary outcomes included the incidence of related hospital admissions. Analyses were performed according to the intention-to-treat principle, with the use of mixed-effect models to account for clustering in the data. RESULTS A total of 34 practices underwent randomization, 33 of which completed the study. Data were analyzed for 33,334 patients at risk at one or more points in the preintervention period and for 33,060 at risk at one or more points in the intervention period. Targeted high-risk prescribing was significantly reduced, from a rate of 3.7% (1102 of 29,537 patients at risk) immediately before the intervention to 2.2% (674 of 30,187) at the end of the intervention (adjusted odds ratio, 0.63; 95% confidence interval [CI], 0.57 to 0.68; P<0.001). The rate of hospital admissions for gastrointestinal ulcer or bleeding was significantly reduced from the preintervention period to the intervention period (from 55.7 to 37.0 admissions per 10,000 person-years; rate ratio, 0.66; 95% CI, 0.51 to 0.86; P = 0.002), as was the rate of admissions for heart failure (from 707.7 to 513.5 admissions per 10,000 person-years; rate ratio, 0.73; 95% CI, 0.56 to 0.95; P = 0.02), but admissions for acute kidney injury were not (101.9 and 86.0 admissions per 10,000 person-years, respectively; rate ratio, 0.84; 95% CI, 0.68 to 1.09; P = 0.19). CONCLUSIONS A complex intervention combining professional education, informatics, and financial incentives reduced the rate of high-risk prescribing of antiplatelet medications and NSAIDs and may have improved clinical outcomes

Conceptualising Higher Education and the Public Good in Ghana, Kenya, Nigeria, and South Africa

Higher education has been the object of policy attention in sub-Saharan Africa in recent years. It has been seen as key to unlocking the potential of the youth bulge, responding to the demands of a growing middle class and to transforming commodities-based economies into knowledge societies (World Bank 2009; Cloete, Maassen & Bailey 2015; Chuks, 2017). Yet despite significant expansions of enrolment – including widening participation by women, major barriers to access exist, reflecting inequalities based on class, gender, geographical location, ethnicity, religion, language and disability (AAI 2015; Morley & Lugg 2009; Morley & Croft, 2011). There are quality challenges in relation to teaching and learning, research, and governance. While some comment on a ’renaissance in African higher education’ (Higgs, 2016), and others on the effects and framings of colonial epistemicides (Nyamnjoh, 2012) key questions abound about relevance and power relations highlighting the need to decolonise the curriculum, structure, organisation and cultures of universities. The student protests in South Africa from 2015 highlighted problems of access and funding, but these are not isolated events. They expose an unresolved colonial legacy in these higher education systems. These processes raise questions not only of the public good relevance of higher education - beyond the obvious advantages conferred on those who manage to go to these institutions – but also of how higher education and its relationship with society may be conceptualised given these contexts (Lebeau and Milla, 2008; Mamdani, 2017). An overarching question is who is defining the public good and how? While many of the above issues are global e.g. universities throughout Latin America, Australasia, Asia and Europe are involved in similar debates and protests, this paper explores the relationship between higher education and the public good in the sub- Saharan African context through a consideration of some connections and disconnections. There appear to be two distinct ways in which higher education and the public good have been conceptualised are discussed. Firstly, higher education can be portrayed as instrumental in shaping a version of the public good where its qualifications, knowledge production, innovation, development of the professional classes, and expertise are perceived to lead to particular manifestations of public good, delineated as economic, social, political or cultural (McMahon 2009; Stiglitz 1999). The key arguments that underpin this conceptual framing speak to different levels of the public good, whether individual and community levels or the provision of ‘global public goods’ (Marginson 2007; 2013; Menashy 2009). However, a contrasting set of arguments portray the relationship between higher education and the public good as an intrinsic one, where the intellectual, physical and cultural experiences enabled through higher education express and enact the public good e.g. prejudice reduction, democratisation, critical thinking, active citizenship (Singh 2001; Calhoun 2006; Leibowitz, 2013; Marginson, 2011; Locatelli, 2017). Important here are considerations of the historical conjuncture that shapes experiences of higher education at a particular time and what these may mean. In considering the connections and disjunctures between these two formulations and the way writings on higher education in contemporary Africa have engaged with this debate, the paper makes an argument for discussing the importance of processes that link instrumental and intrinsic visions of higher education and the public good. The analysis of these from a rigorous review of literature leads to a delineation of some different views of time, space and evaluation. The paper argues that these contestations need to be read contextually. Higher education in sub-Saharan Africa has moved through phases, from the establishment of flagship national universities in the post-independence period for state bureaucracy formation (Teferra, 2017), to the emergence of developmental universities with a commitment to indigenising knowledge and benefiting marginalised populations, through more recent tendencies towards the marketisation of public institutions and the significant growth of the private sector (Assié-Lumumba & CODESRIA 2006; ADEA & AAU 2004; Coleman 1986; Mamdani, 2007; McCowan 2016). Appreciating these contextual factors in shaping the role and functioning of higher education and thus its relationship to the public good is a central theme in our analysis. We suggest that mainstream conceptualisations of higher education and the public good are underpinned by particular understandings of the nature and form of higher education and how knowledge is acquired, developed and disseminated – orientations that may be very far from the reality of highly unequal, socially stratified, and politically complex societies within which higher education is deeply embedded. Thus a reconceptualisation of the public is required by these contexts and some challenge to conceptualisations of the private, given the strong obligations of individuals to extended families, and the sharing of the benefits of higher education amongst their communities of origin. The paper concludes with a consideration of what may be important in conceptualising higher education and the public good in the African context and the value of such thinking for broader debates on the role of higher education

Technology in Healthcare: How Artificial Intelligence Will Revolutionize the Profession

The topic of artificial intelligence is a hot topic in the U.S. healthcare system and despite some uncertainties, continues to be increasingly integrated into healthcare delivery. Artificial intelligence can be used for different purposes including but not limited to data storage, decision making and image analysis. Critics of artificial intelligence in healthcare are skeptical of its ability to provide security of medical information and afraid that it will eventually replace the need for human healthcare workers. Although the critics skepticisms seem rational, further research of artificial intelligence in healthcare shows that those fears are not based on fact. Artificial intelligence in healthcare has been proven to reduce healthcare expenditures, increase access and improve quality of care and overall health outcomes. It is important for future healthcare providers to increase familiarity with artificial intelligence in order to effectively integrate it into practice to improve the health and well-being of future clients

Is equal access to higher education in South Asia and sub-Saharan Africa achievable by 2030?

Higher education is back in the spotlight, with post-2015 sustainable development goals emphasising equality of access. In this paper, we highlight the long distance still to travel to achieve the goal of equal access to higher education for all, with a focus on poorer countries which tend to have lower levels of enrolment in higher education. Analysing Demographic and Health Survey data from 35 low- and middle-income countries in sub-Saharan Africa and South Asia, we show wide wealth inequalities in particular, with few if any of the poorest gaining access to higher education in some countries. We further identify that wealth and gender inequalities interact and tend to be wider in countries where levels of higher education are higher. This implies that expansion in access to higher education may predominantly benefit the rich, unless measures are taken to tackle inequalities. We find that that the rates of increase necessary for the attainment of the equal access goal by 2030 are particularly high. They pose a particularly difficult challenge given the access inequalities present from primary and secondary education in a wide majority of countries in our analysis. We therefore suggest that any measures aimed at attaining the goal need to tackle inequalities in access within a system-wide approach, focusing on the level of education at which inequalities initially manifest, alongside higher education.This is the final version of the article. It first appeared from Springer via http://dx.doi.org/10.1007/s10734-016-0039-

Individual, unit and vocal clan level identity cues in sperm whale codas

Fieldwork was supported by Discovery and Equipment grants to H.W. from the Natural Sciences and Engineering Research Council of Canada (NSERC) and the Whale and Dolphin Conservation Society. S.G. and L.R. were supported by the Marine Alliance for Science and Technology for Scotland (MASTs) pooling initiative and their support is gratefully acknowledged. MASTs is funded by the Scottish Funding Council (grant reference HR09011) and contributing institutions. S.G. was also supported by an NSERC Postgraduate Scholarship (PGS-M), an NSERC Canadian Graduate Scholarship (CGS-D), the Izaak Killam Memorial Scholarship, the Patrick F. Lett Fund, the Dalhousie’s Presidents Award, and an FNU fellowship for the Danish Council for Independent Research from the Ministry of Higher Education and Science supplemented by a Sapere Aude Research Talent Award.The ‘social complexity hypothesis’ suggests that complex social structure is a driver of diversity in animal communication systems. Sperm whales have a hierarchically structured society in which the largest affiliative structures, the vocal clans, are marked on ocean-basin scales by culturally transmitted dialects of acoustic signals known as ‘codas’. We examined variation in coda repertoires among both individual whales and social units—the basic element of sperm whale society—using data from nine Caribbean social units across six years. Codas were assigned to individuals using photo-identification and acoustic size measurement, and we calculated similarity between repertoires using both continuous and categorical methods. We identified 21 coda types. Two of those (‘1+1+3’ and ‘5R1’) made up 65% of the codas recorded, were shared across all units and have dominated repertoires in this population for at least 30 years. Individuals appear to differ in the way they produce ‘5R1’ but not ‘1+1+3’ coda. Units use distinct 4-click coda types which contribute to making unit repertoires distinctive. Our results support the social complexity hypothesis in a marine species as different patterns of variation between coda types suggest divergent functions, perhaps representing selection for identity signals at several levels of social structure.Publisher PDFPeer reviewe

Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis

<b>Background</b><p></p> It is assumed within the accumulated literature that children born of pregnant opioid dependent mothers have impaired neurobehavioral function as a consequence of chronic intrauterine opioid use.<p></p> <b>Methods</b><p></p> Quantitative and systematic review of the literature on the consequences of chronic maternal opioid use during pregnancy on neurobehavioral function of children was conducted using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched Cinahl, EMBASE, PsychINFO and MEDLINE between the periods of January 1995 to January 2012.<p></p> <b>Results</b><p></p> There were only 5 studies out of the 200 identified that quantitatively reported on neurobehavioral function of children after maternal opioid use during pregnancy. All 5 were case control studies with the number of exposed subjects within the studies ranging from 33–143 and 45–85 for the controls. This meta-analysis showed no significant impairments, at a non-conservative significance level of p < 0.05, for cognitive, psychomotor or observed behavioural outcomes for chronic intra-uterine exposed infants and pre-school children compared to non-exposed infants and children. However, all domains suggested a trend to poor outcomes in infants/children of opioid using mothers. The magnitude of all possible effects was small according to Cohen’s benchmark criteria.<p></p> <b>Conclusions</b><p></p> Chronic intra-uterine opioid exposed infants and pre-school children experienced no significant impairment in neurobehavioral outcomes when compared to non-exposed peers, although in all domains there was a trend to poorer outcomes. The findings of this review are limited by the small number of studies analysed, the heterogenous populations and small numbers within the individual studies. Longitudinal studies are needed to determine if any neuropsychological impairments appear after the age of 5 years and to help investigate further the role of environmental risk factors on the effect of ‘core’ phenotypes