Use of an expert elicitation methodology to compare welfare impacts of two approaches for blood sampling European badgers (Meles meles) in the field.

In the UK and Republic of Ireland, the European badger (Meles meles) is considered the most significant wildlife reservoir of the bacterium Mycobacterium bovis, the cause of bovine tuberculosis (bTB). To expand options for bTB surveillance and disease control, the Animal and Plant Health Agency developed a bespoke physical restraint cage to facilitate collection of a small blood sample from a restrained, conscious badger in the field. A key step, prior to pursuing operational deployment of the novel restraint cage, was an assessment of the relative welfare impacts of the approach. We used an established welfare assessment model to elicit expert opinion during two workshops to compare the impacts of the restraint cage approach with the only current alternative for obtaining blood samples from badgers in the field, which involves administration of a general anaesthetic. Eleven panellists participated in the workshops, comprising experts in the fields of wildlife biology, animal welfare science, badger capture and sampling, and veterinary science. Both approaches were assessed to have negative welfare impacts, although in neither case were overall welfare scores higher than intermediate, never exceeding 5-6 out of a possible 8. Based on our assessments, the restraint cage approach is no worse for welfare compared to using general anaesthesia and possibly has a lower overall negative impact on badger welfare. Our results can be used to integrate consideration of badger welfare alongside other factors, including financial cost and efficiency, when selecting a field method for blood sampling free-living badgers.

Healthcare experiences of patients with Down syndrome from primarily Spanish-speaking households.

We report on the health care experiences of individuals with Down syndrome (DS) from families who are primarily Spanish-speaking. Data were collected through three methods: (1) a nationally distributed, 20-item survey, (2) two focus groups with seven family caregivers of individuals with DS who self-identified as living in primarily Spanish speaking households, and (3) 20 interviews with primary care providers (PCPs) who care for patients who are underrepresented minorities. Standard summary statistics were used to analyze the quantitative survey results. Focus group and interview transcripts, as well as an open-ended response question in the survey, were analyzed using qualitative coding methods to identify key themes. Both caregivers and PCPs described how language barriers make giving and receiving quality care difficult. Caregivers additionally described condescending, discriminatory treatment within the medical system and shared feelings of caregiver stress and social isolation. Challenges to care experienced by families of individuals with DS are compounded for Spanish-speaking families, where the ability to build trust with providers and in the health care system may be compromised by cultural and language differences, systemic issues (lack of time or inability to craft more nuanced schedules so that patients with higher needs are offered more time), mistrust, and sometimes, overt racism. Building this trust is critical to improve access to information, care options, and research opportunities, especially for this community that depends on their clinicians and nonprofit groups as trusted messengers. More study is needed to understand how to better reach out to these communities through primary care clinician networks and nonprofit organizations.

Views on the impact of the COVID-19 pandemic on health in people with Down syndrome from diverse backgrounds.

Down syndrome (DS) has a unique medical and psychological profile. To date, few studies have asked individuals with DS about their views of health, and fewer have explored the impact of COVID-19 on the health of individuals with DS and their families. We used a mixed methods approach including two studies on the health of individuals with DS and their parents conducted during the COVID-19 pandemic: (1) eight virtual focus groups, comprised of 20 parents and 8 individuals with DS to obtain participants' views of health, and (2) a 20-item questionnaire on health care experience of patients with DS who are African American or come from primarily Spanish-speaking homes. Focus group transcripts were coded using a hybrid inductive/deductive framework and thematically analyzed using the Framework Method. This questionnaire included questions regarding the impact of COVID-19 on caregivers and their loved ones with DS; responses to these questions were summarized using descriptive statistics. Individuals with DS discussed the impact of the COVID-19 pandemic on their physical and social health including masking, online learning, and online communication with friends and family. Parents of individuals with DS discussed how the COVID-19 pandemic negatively impacted their child's physical, social, and mental health, as a result of virtual schooling and decreased socialization. There were unexpected positives of the pandemic such as improved hygiene and eased scheduling with telehealth visits. Caregivers noted COVID-19 impacted their own anxiety, employment, and other domains that have potential ripple effects on the health of their children. The COVID-19 pandemic had a pervasive impact on the mental health and wellness of caregivers as well as the physical, social, and mental health of individuals with DS.

Healthcare experiences of patients with Down syndrome who are Black, African American, of African descent, or of mixed race.

Scant research has explored the healthcare experiences of people with Down syndrome (DS) in the United States who are Black, African American, of African descent, or of mixed race. The purpose of this study was to identify and describe the barriers and facilitators that such patients and their caregivers face when accessing healthcare. We gathered data in three ways: focus groups with caregivers, a national survey completed by caregivers, and in-depth interviews with primary care providers. Many caregivers and primary care physicians felt that patients with DS who are Black, African American, of African descent, or of mixed race receive a lower quality of medical care than their white counterparts with DS. Caregivers mentioned feeling tired of being reminded by the medical community about their race and wanting acknowledgment that raising a child with DS can be hard at times. Many felt that the medical community's conscious and unconscious racial biases do negatively impact the care of their loved ones with DS. Caregivers desired more race concordant medical providers or, when not possible, medical providers who are willing to learn more about DS and build trusted, longitudinal relationships. Primary care providers discussed the need for funded resources and support services to effectively care for their patients with DS.

Feasibility of Implementing a Food Skills Intervention.

BACKGROUND: Food skills are defined as meal planning, preparation, shopping, budgeting, resourcefulness, and label reading/consumer awareness. To date, food skills have not been tested in intervention-based studies. OBJECTIVE: To evaluate the feasibility of implementing a food skills intervention. DESIGN: This was an 8-week prospective food skills intervention. Study measures were completed through questionnaires provided before the start of the intervention and after the intervention was completed. For questionnaires, the web platform REDCap was used. PARTICIPANTS AND SETTING: Thirty parents (aged 18 years or older) with at least one child (aged 2 to 12 years), attended weekly virtual intervention sessions via Zoom. The intervention took place from August to October 2020 with assessment measures collected within 2 months of the start and end date of the intervention. Participants were from the mid-Atlantic region of the United States INTERVENTION: A food skills intervention based on behavior modification strategies from the Social Cognitive Theory was implemented. Intervention goals included meal planning (six of seven dinner meals per week), meal plan implementation (at least four of six planned dinner meals), and always using a grocery list when shopping. MAIN OUTCOME MEASURES: Feasibility was evaluated based on parent attendance, number of self-monitoring booklets completed, adherence to goals, implementation fidelity, and qualitative responses to interviews. Change in food skills confidence and nutrition knowledge were also assessed. STATISTICAL ANALYSIS: Descriptive statistics and qualitative responses were used to describe feasibility. Paired t tests were used to evaluate change in food skills confidence and nutrition knowledge from baseline to 8 weeks. RESULTS: Parents attended a mean of 7.6 ± 1.0 (out of eight) sessions and completed a mean of 6.2 ± 1.7 (out of seven) self-monitoring booklets. Parents planned a mean of 6.1 ± 1.5 dinners per week and implemented a mean of 4.7 ± 1.6 of the six planned dinners, achieving the intervention goals. Of the mean 1.2 ± 0.6 trips/week to the grocery store reported, grocery lists were used a mean of 1.1 ± 0.6 times. Mean food skills confidence score increased significantly from baseline to 8 weeks (baseline = 86.5 ± 18.0; 8 weeks = 101.4 ± 15.3; P < 0.001). Mean nutrition knowledge score also significantly increased (baseline = 64.1 ± 7.2; 8 weeks = 69.1 ± 6.6; P < 0.001). Parents reported on a scale of zero ("easy") to 10 ("difficult") a mean difficulty rating of 2.4 ± 2.4 for meal planning, a mean of 2.1 ± 2.1 for meal plan implementation, and a mean of 1.0 ± 1.7 for always using a grocery shopping list indicating acceptability of goals. CONCLUSIONS: Feasibility of a food skills intervention was demonstrated by high session attendance, high numbers of self-monitoring booklets turned in, high achievement of intervention goals, parent acceptability, and high ratings of implementation fidelity. There was an increase in food skill confidence and nutrition knowledge. Future research should examine the efficacy of changing food skill behaviors on dietary intake.

Scientific Assessment of the Welfare of Trapped Mammals-Key Considerations for the Use of the Sharp and Saunders Humaneness Assessment Model.

Scientific assessment of the impacts of trapping on mammal welfare is necessary to inform cost-benefit analyses of using traps in wildlife management, improve trap performance and trapping processes and develop international trap standards. The Sharp and Saunders humaneness assessment model was developed specifically for assessing welfare impacts in vertebrate wildlife management and has been used to assess the impacts of trapping various mammals. It is a specific version of the more general Five Domains model for welfare assessment which is based on the understanding that welfare state reflects the sum of the animal's mental experiences. Our experience of applying the Sharp and Saunders model allows us to make key recommendations for those wishing to use it. First, the exact parameters of the trapping scenario to be assessed must be decided. Second, assessments should be based on published data, as well as integrating both scientific and practitioner expertise to provide rigorous and relevant outcomes. Third, conclusions about welfare impacts should be based on the appropriate indicators. As far as is possible, mental experiences should be inferred using animal-based indicators, and some representation should be provided of the scorers' confidence in the data on which assessment is based. Careful consideration of these points will help optimize the value of information produced using the model for wildlife management decision-making.

Understanding Mothers' Perceptions of Food Skills: A Qualitative Study.

BACKGROUND: Food skills are behaviors surrounding the planning, purchasing, and preparing of food. Food skills have been identified as important for promoting diet quality. Little work has investigated specific food skills perceived by parents to promote a healthy diet or parents' perceived barriers to implementing food skills. OBJECTIVE: Our aim was to determine current food skills that parents identify as helpful behaviors for consuming a healthy diet and the perceived barriers to implementing food skills. DESIGN: We conducted a qualitative study using focus groups with mothers (18 years or older) who reported being primarily responsible for acquiring and preparing food. PARTICIPANTS/SETTING: Thirty mothers with at least 1 child under the age of 18 years were asked to attend 1 of 5 focus groups held in a university setting. MAIN OUTCOMES: Outcomes included emergent themes and subthemes within the domains of food skill behaviors identified as helpful and perceived barriers to implementing food skills. ANALYSIS: Focus groups were audio-recorded and transcribed. Thematic analysis was used to analyze transcripts and descriptive statistics were used to characterize participant demographics. RESULTS: Food skill themes identified as helpful behaviors for consuming a healthy diet included mothers' resourcefulness, overall planning behaviors, and child involvement and influence. Themes for barriers to implementing food skills included limited time, cooking for multiple needs and tastes, exposure to food and sales while shopping, and food cost. CONCLUSIONS: Qualitative findings indicated that mothers need behavior strategies for time management, meeting multiple family needs, dealing with exposure to food and sales, and food resource management rather than being provided solely with education. These findings can inform future behavior-based interventions to improve the diet quality of families.

A randomized controlled trial of an online health tool about Down syndrome.

PURPOSE: We sought to determine if a novel online health tool, called Down Syndrome Clinic to You (DSC2U), could improve adherence to national Down syndrome (DS) guidelines. We also sought to determine if primary care providers (PCPs) and caregivers are satisfied with this personalized online health tool. METHODS: In a national, randomized controlled trial of 230 caregivers who had children or dependents with DS without access to a DS specialist, 117 were randomized to receive DSC2U and 113 to receive usual care. The primary outcome was adherence to five health evaluations indicated by national guidelines for DS. DSC2U is completed electronically, in all mobile settings, by caregivers at home. The outputs-personalized checklists-are used during annual wellness visits with the patient's PCP. RESULTS: A total of 213 participants completed a 7-month follow-up evaluation. In the intention-to-treat analysis, the intervention group had a 1.6-fold increase in the number of indicated evaluations that were recommended by the primary care provider or completed compared with controls. Both caregivers and PCPs reported high levels of satisfaction with DSC2U. CONCLUSIONS: DSC2U improved adherence to the national DS health-care guidelines with a novel modality that was highly valued by both caregivers and PCPs.

Fit-to-Targets and Aided Speech Intelligibility Index Values for Hearing Aids Fitted to the DSL v5-Adult Prescription.

BACKGROUND: Matching hearing aid output levels to prescribed targets is a component of preferred practice, yet recent normative data on appropriateness of fittings are lacking. Verification measures that assess closeness of fit-to-target include raw deviations from target, root-mean-squared-error (RMSE) deviations from target, and aided Speech Intelligibility Index (SII) values. Establishing normative ranges for these measures may help hearing professionals determine whether a patient's fit-to-targets and/or aided speech audibility is typical for his or her degree of hearing loss. PURPOSE: This article aims to characterize the range of fit-to-target and the range of aided SII associated with hearing aid fittings using the Desired Sensation Level version 5.0 (DSL v5-adult) prescription with adults, considering also hearing aid style, venting, and audiometric characteristics. RESEARCH DESIGN: A descriptive and correlational study of data collected from a retrospective chart review. RESULTS: Hearing aid fittings to 281 ears were compiled. The four-frequency average deviation from target (RMSE) was within ± 5 dB of target in 77% of fittings for mid-level speech. Deviation from targets increased with hearing loss, particularly when the loss is greater than 85 dB hearing level or if the loss was steeply sloping. Venting increased the deviation from targets in the low frequencies. Aided SII values strongly correlated with the participants' hearing thresholds. Clinical ranges for RMSE and aided SII were developed for characterization of fitting outcomes. CONCLUSION: Fitting to DSL v5-adult targets was observed within ± 5 dB absolute deviation, or within 5 dB RMSE, on average for typical adult hearing aid fittings. Confidence intervals for deviation from target and aided SII are proposed.

Updating the AIHTS Trapping Standards to Improve Animal Welfare and Capture Efficiency and Selectivity.

In 1999, after pressure from the European Union, an Agreement on International Humane Trapping Standards (AIHTS) that would result in the banning of the steel-jawed leghold traps in the European Community, Canada, and Russia was signed. The United States implemented these standards through an Agreed Minute with the European Community. Over the last two decades, scientists have criticized the AIHTS for (1) omitting species that are commonly trapped; (2) threshold levels of trap acceptance that are not representative of state-of-the-art trap technology; (3) excluding popular traps which are commonly used by trappers although they are known to cause prolonged pain and stress to captured animals; (4) inadequate coverage of capture efficiency and species selectivity (i.e., number of captures of target and non-target species) performance. Concerns about the ability of standards and test procedures to ensure animal welfare, and about the implementation of standards, have also been voiced by wildlife biologists, managers, and conservation groups. In this review, we present a synopsis of current trapping standards and test procedures, and we compare the standards to a then contemporary 1985-1993 Canadian trap research and development program. On the basis of the above-noted concerns about AIHTS, and our experience as wildlife professionals involved in the capture of mammals, we formulated the following hypotheses: (1) the list of mammal species included in the AIHTS is incomplete; (2) the AIHTS have relatively low animal welfare performance thresholds of killing trap acceptance and do not reflect state-of-the-art trapping technology; (3) the AIHTS animal welfare indicators and injuries for restraining traps are insufficient; (4) the AIHTS testing procedures are neither thorough nor transparent; (5) the AIHTS protocols for the use of certified traps are inadequate; (6) the AIHTS procedures for the handling and dispatching of animals are nonexistent; (7) the AIHTS criteria to assess trap capture efficiency and species selectivity are inappropriate. We conclude that the AIHTS do not reflect state-of-the-art trapping technology, and assessment protocols need to be updated to include trap components and sets, animal handling and dispatching, and trap visit intervals. The list of traps and species included in the standards should be updated. Finally, the concepts of capture efficiency and trap selectivity should be developed and included in the standards. Based on our review, it is clear that mammal trapping standards need to be revisited to implement state-of-the-art trapping technology and improve capture efficiency and species selectivity. We believe that a committee of international professionals consisting of wildlife biologists and veterinarians with extensive experience in the capture of mammals and animal welfare could produce new standards within 1-2 years. We propose a series of measures to fund trap testing and implement new standards.

Erratum: Baker, S.E.; Maw, S.A.; Johnson P.J.; Macdonald, D.W. Not in My Backyard: Public Perceptions of Wildlife and 'Pest Control' in and around UK Homes, and Local Authority 'Pest Control'.

The authors wish to make the following corrections to their paper [...].

Not in My Backyard: Public Perceptions of Wildlife and 'Pest Control' in and around UK Homes, and Local Authority 'Pest Control'.

Human-wildlife conflict occurs globally. Attempts to control 'pest' wildlife involve killing and harming the welfare of animals on a vast scale. We examined public perceptions of 10 wildlife species/groups and wildlife management, in and around UK homes, and public authority 'pest control' provision, in an effort to identify ethical, welfare-friendly ways to reduce conflict. Most people reported never having problems with each of the 10 species, and reported problems for some species were largely tolerated. Wasps, mice, and rats were the most frequently problematic species, the least tolerated, and those for which local authorities most often offered pest control services. Do-It-Yourself pest control was preferred over professional control, except for with wasps. People wanted control to be quick, lasting, and safe for people and non-target animals. Where people accepted lethal control, they were nevertheless concerned for animal welfare. Drivers of pest status were complex, while drivers of demand for control were fewer and species-specific. Local authority pest control provision increased over the four years studied, but only half of councils offered advice on preventing/deterring wildlife; this advice was patchy and variable in quality. Greater focus is required on preventing/deterring rather than controlling wildlife problems. Councils should provide standardised, comprehensive advice on prevention/deterrence and prevention/deterrence services.

Qualitative Research on the Real-Time Decision Making of WIC Participants While Food Shopping: Use of Think-Aloud Methodology.

BACKGROUND: People of lower socioeconomic status often experience disparities related to dietary intake as compared with People of higher socioeconomic status. Foods purchased influence the availability of foods in the home environment, and availability of foods in the home environment is associated with dietary intake. OBJECTIVE: To identify what factors influence food purchasing decisions of low-income parents while food shopping. DESIGN: A qualitative study using think-aloud methodology, the processing of information through verbalization concurrent with task performance, was used to verbally capture real-time decision making. PARTICIPANTS AND SETTING: Twenty-eight parents with a preschool-aged child enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Study visits took place at the WIC clinic office and local grocery stores. MAIN OUTCOMES: Reasons for making decisions while food shopping. ANALYSIS: Audio recordings were transcribed, and thematic analysis was used to analyze the data. Descriptive statistics were used to characterize demographics and shopping behaviors. RESULTS: A parent's decision in a food purchase was based on child preference, value, need of an item, or the parent choice for a product. In addition, themes emerged related to participant shopping behavior included the influence of participation in WIC on food and beverage purchases, multiple trips to the store, and a frequent focus on purchasing bottled water and juice. The average shopping trip was 31.5±15.7 minutes, and the median amount spent was $38.61. CONCLUSION: Understanding the influences of parent decisions while making food purchases can better help inform the nutrition education provided as part of WIC.

Food Purchasing Behaviors of WIC Participants: What Non-WIC Eligible Foods Items Are Being Purchased.

PURPOSE: To describe items purchased during a shopping trip by families enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). DESIGN: Cross-sectional, quantitative, observational study. SETTING: Grocery stores in the Newark, Delaware area. PARTICIPANTS: A convenience sample of mothers (n = 35) were recruited from a local WIC Clinic waiting room. MEASURES: The number of items categorized into 12 food groups, (baby food, beverages, dairy, fats/oils, fruit, vegetables, grains, protein, preprepared, seasonings, sweets, and other) extracted from grocery receipts. ANALYSIS: Means and frequencies were used to analyze continuous and categorical data, respectively, for receipt data and demographics. RESULTS: The most common foods purchased not included as part of the WIC food package included protein (1.0 [standard deviation, SD 3.0]), preprepared foods (0.9 [SD 2.0]), and other foods (1.0 [SD 1.9]). The most frequent foods purchased included as part of the WIC food package included fruit (2.3 [SD 1.5]), grains (1.7 [SD 1.6]), and dairy (1.5 [SD 0.8]). CONCLUSIONS: Further investigation of foods purchased that were not part of the WIC food package is warranted, as understanding food purchases particularly among low-income mothers may inform nutrition education practices.

Consequences Matter: Compassion in Conservation Means Caring for Individuals, Populations and Species.

Human activity affecting the welfare of wild vertebrates, widely accepted to be sentient, and therefore deserving of moral concern, is widespread. A variety of motives lead to the killing of individual wild animals. These include to provide food, to protect stock and other human interests, and also for sport. The acceptability of such killing is widely believed to vary with the motive and method. Individual vertebrates are also killed by conservationists. Whether securing conservation goals is an adequate reason for such killing has recently been challenged. Conventional conservation practice has tended to prioritise ecological collectives, such as populations and species, when their interests conflict with those of individuals. Supporters of the 'Compassionate Conservation' movement argue both that conservationists have neglected animal welfare when such conflicts arise and that no killing for conservation is justified. We counter that conservationists increasingly seek to adhere to high standards of welfare, and that the extreme position advocated by some supporters of 'Compassionate Conservation', rooted in virtue ethics, would, if widely accepted, lead to considerable negative effects for conservation. Conservation practice cannot afford to neglect consequences. Moreover, the do-no-harm maxim does not always lead to better outcomes for animal welfare.

"Feelings and Fitness" Not "Feelings or Fitness"-The Raison d'être of Conservation Welfare, Which Aligns Conservation and Animal Welfare Objectives.

Increasingly, human activities, including those aimed at conserving species and ecosystems (conservation activities) influence not only the survival and fitness but also the welfare of wild animals. Animal welfare relates to how an animal is experiencing its life and encompasses both its physical and mental states. While conservation biology and animal welfare science are both multi-disciplinary fields that use scientific methods to address concerns about animals, their focus and objectives sometimes appear to conflict. However, activities impacting detrimentally on the welfare of individual animals also hamper achievement of some conservation goals, and societal acceptance is imperative to the continuation of conservation activities. Thus, the best outcomes for both disciplines will be achieved through collaboration and knowledge-sharing. Despite this recognition, cross-disciplinary information-sharing and collaborative research and practice in conservation are still rare, with the exception of the zoo context. This paper summarizes key points developed by a group of conservation and animal welfare scientists discussing scientific assessment of wild animal welfare and barriers to progress. The dominant theme emerging was the need for a common language to facilitate cross-disciplinary progress in understanding and safeguarding the welfare of animals of wild species. Current conceptions of welfare implicit in conservation science, based mainly on "fitness" (physical states), need to be aligned with contemporary animal welfare science concepts which emphasize the dynamic integration of "fitness" and "feelings" (mental experiences) to holistically understand animals' welfare states. The way in which animal welfare is characterized influences the way it is evaluated and the emphasis put on different features of welfare, as well as, the importance placed on the outcomes of such evaluations and how that information is used, for example in policy development and decision-making. Salient examples from the New Zealand and Australian context are presented to illustrate. To genuinely progress our understanding and evaluation of wild animal welfare and optimize the aims of both scientific disciplines, conservation and animal welfare scientists should work together to evolve and apply a common understanding of welfare. To facilitate this, we propose the formal development of a new discipline, Conservation Welfare, integrating the expertise of scientists from both fields.

International consensus principles for ethical wildlife control.

Human-wildlife conflicts are commonly addressed by excluding, relocating, or lethally controlling animals with the goal of preserving public health and safety, protecting property, or conserving other valued wildlife. However, declining wildlife populations, a lack of efficacy of control methods in achieving desired outcomes, and changes in how people value animals have triggered widespread acknowledgment of the need for ethical and evidence-based approaches to managing such conflicts. We explored international perspectives on and experiences with human-wildlife conflicts to develop principles for ethical wildlife control. A diverse panel of 20 experts convened at a 2-day workshop and developed the principles through a facilitated engagement process and discussion. They determined that efforts to control wildlife should begin wherever possible by altering the human practices that cause human-wildlife conflict and by developing a culture of coexistence; be justified by evidence that significant harms are being caused to people, property, livelihoods, ecosystems, and/or other animals; have measurable outcome-based objectives that are clear, achievable, monitored, and adaptive; predictably minimize animal welfare harms to the fewest number of animals; be informed by community values as well as scientific, technical, and practical information; be integrated into plans for systematic long-term management; and be based on the specifics of the situation rather than negative labels (pest, overabundant) applied to the target species. We recommend that these principles guide development of international, national, and local standards and control decisions and implementation.