In the Meantime: RE/UN/DIScover Heuristic for Small-Scale Antioppressive Action within Systems and Organizations.

The dehumanizing effects of neoliberal, white dominant regulations, laws, policies, and cultural assumptions seep into the everyday practice of social workers in frontline and mid-level positions. Many social workers are learning various antioppressive practices and becoming aware of how microaggressions and other oppressive dynamics can manifest in workplaces but lack models to guide efforts for small-scale action. This article describes how the RE/UN/DIScover heuristic can be used to interrupt and shift oppressive processes during everyday moments of practice within organizations and systems by social workers and their interested colleagues who have some awareness of oppressive and antioppressive dynamics. The RE/UN/DIScover heuristic is an iterative set of three practices: (1) tend to self with compassionate REcover practices; (2) engage in curious, critical reflection to UNcover full understandings of the power dynamics, impacts, and meanings of specific challenges; and (3) DIScover and try out just, humanizing responses with creative courage, individually and with other colleagues. The heuristic uses a dual focus on self and situation with an ad hoc group of other colleagues to raise awareness; cultivate humanizing spaces; and implement antioppressive, relational responses. The article describes the heuristic practices and how to apply the heuristic with two composite practice applications.

RE/UN/DIScover Heuristic: Working with Clinical Practice Impingements in Dehumanizing Times.

Although clinical social work seeks to center the transformative potential of human relationships, practitioners are experiencing heightened systemic and organizational impingements from the dehumanizing pressures of neoliberalism. Neoliberalism and racism diminish the vitality and transformative potential of human relationships, disproportionately affecting Black, Indigenous and People of Color (BIPOC) communities. Practitioners are also experiencing increased stress and burnout related to increased caseloads and decreased professional autonomy and organizational practitioner support. Holistic, culturally responsive, and anti-oppressive processes seek to counter these oppressive forces but need further development to synthesize antioppressive structural understandings with embodied relational interactions. Practitioners can potentially contribute to efforts that apply critical theories and antioppressive understandings within their practice and workplace. Through an iterative flow of three sets of practices, the RE/UN/DIScover heuristic supports practitioners' efforts to respond in those challenging everyday moments where oppressive forms of power are imposed and embedded within systemic processes. With themselves and other colleagues, practitioners engage in compassionate REcover practices; use curious, critical reflection to UNcover full understandings of power dynamics, impacts, and meanings; and draw on creative courage to DIScover and enact socially just and humanizing responses. This paper describes how practitioners can use the RE/UN/DIScover heuristic in two common challenging moments of clinical practice: systemic practice impingements and implementing a new training or practice model. The heuristic seeks to support practitioners' efforts to preserve and expand socially just, relational spaces for themselves and those with whom they work within the context of systemic dehumanizing neoliberal forces.

Availability and Nutrient Composition of Vegetarian Items at US Fast-Food Restaurants.

BACKGROUND: Consumer demand for vegetarian options is growing. Fast-food restaurants have responded by adding high-profile vegetarian offerings, but little is known about the overall availability or nutrient profile of vegetarian options at these establishments, or how these items compare with nonvegetarian items. OBJECTIVE: The purpose of this study was to quantify trends in the availability and nutrient profile of vegetarian items in US fast-food restaurants from 2012 to 2018. DESIGN: This study was a longitudinal analysis of secondary data. We used nutrient data from the MenuStat database for menu offerings at 36 large US fast-food chain restaurants (2012 to 2018). Vegetarian items were identified through automated key word searches and item description hand-coding. OUTCOME MEASURES: Annual counts and proportions of vegetarian and nonvegetarian items by category, and annual trends and differences in predicted mean calories; saturated, unsaturated, and trans fats; sugar; nonsugar carbohydrates; protein; sodium between and within vegetarian and nonvegetarian items. STATISTICAL ANALYSIS PERFORMED: We report counts and proportions of vegetarian items by menu category, then use Tobit regression models to examine annual trends and differences in predicted mean nutrients between and within vegetarian and nonvegetarian items. Sensitivity analyses were calorie-adjusted. RESULTS: The annual proportion of vegetarian items remained consistent (approximately 20%), and counts increased (2012, n = 601; 2018, n = 713). Vegetarian items had significantly fewer calories (2018: -95 kcal) and, even after adjustment for calories, lower saturated fat (-1.6 g), unsaturated fat (-1.8 g), protein (-3.8 g), and sodium (-62 mg) annually (P < .05) compared with nonvegetarian items. Vegetarian items were significantly higher in sugar (2018: +2.0 g; P < .01) and nonsugar carbohydrates (2018: +9.7 g; P < .01), after calorie adjustment, compared with nonvegetarian items. CONCLUSIONS: Vegetarian items were generally lower in several overconsumed nutrients of public health concern (eg, sodium and saturated fat) than nonvegetarian items, but nutrient changes suggest surveillance remains important as vegetarian options increase in popularity.

Pseudo-set framing.

Pseudo-set framing-arbitrarily grouping items or tasks together as part of an apparent "set"-motivates people to reach perceived completion points. Pseudo-set framing changes gambling choices (Study 1), effort (Studies 2 and 3), giving behavior (Field Data and Study 4), and purchase decisions (Study 5). These effects persist in the absence of any reward, when a cost must be incurred, and after participants are explicitly informed of the arbitrariness of the set. Drawing on Gestalt psychology, we develop a conceptual account that predicts what will-and will not-act as a pseudo-set, and defines the psychological process through which these pseudo-sets affect behavior: over and above typical reference points, pseudo-set framing alters perceptions of (in)completeness, making intermediate progress seem less complete. In turn, these feelings of incompleteness motivate people to persist until the pseudo-set has been fulfilled. (PsycINFO Database Record

A "Just Sense of Well-Being": Social Work's Unifying Purpose in Action.

For over a century the social work profession has had a dual purpose, to promote both human well-being and social justice, but we have not found research that explores how social workers understand and work toward both purposes across multiple practice roles and settings. Authors of this article conducted qualitative research to examine how 18 social workers in various roles and settings understand and implement both purposes in their practice. Instead of a dual purpose, participants described a unifying purpose: a "just sense of well-being" that transcends role and setting. Valuing the dignity and worth of all human beings frames and fuels their work toward a just sense of well-being through three interactive themes: challenging injustice on every level; constructing justice through relationship and resource organizing; and constructing justice through the creation of accepting environments where professionals, clients, and community members can reflect and question, and change mind-sets and actions. Participants provided an array of possibilities for action with clients, professionals, and public leaders within organizations and communities. The implication here is that social workers are charged to reinvigorate purpose and values back into practice with value-based assessment thinking that frames possibilities for action across methods and settings.

The Effect of Background Music in Shark Documentaries on Viewers' Perceptions of Sharks.

Despite the ongoing need for shark conservation and management, prevailing negative sentiments marginalize these animals and legitimize permissive exploitation. These negative attitudes arise from an instinctive, yet exaggerated fear, which is validated and reinforced by disproportionate and sensationalistic news coverage of shark 'attacks' and by highlighting shark-on-human violence in popular movies and documentaries. In this study, we investigate another subtler, yet powerful factor that contributes to this fear: the ominous background music that often accompanies shark footage in documentaries. Using three experiments, we show that participants rated sharks more negatively and less positively after viewing a 60-second video clip of swimming sharks set to ominous background music, compared to participants who watched the same video clip set to uplifting background music, or silence. This finding was not an artifact of soundtrack alone because attitudes toward sharks did not differ among participants assigned to audio-only control treatments. This is the first study to demonstrate empirically that the connotative attributes of background music accompanying shark footage affect viewers' attitudes toward sharks. Given that nature documentaries are often regarded as objective and authoritative sources of information, it is critical that documentary filmmakers and viewers are aware of how the soundtrack can affect the interpretation of the educational content.

Behavioral economics. Avoiding overhead aversion in charity.

Donors tend to avoid charities that dedicate a high percentage of expenses to administrative and fundraising costs, limiting the ability of nonprofits to be effective. We propose a solution to this problem: Use donations from major philanthropists to cover overhead expenses and offer potential donors an overhead-free donation opportunity. A laboratory experiment testing this solution confirms that donations decrease when overhead increases, but only when donors pay for overhead themselves. In a field experiment with 40,000 potential donors, we compared the overhead-free solution with other common uses of initial donations. Consistent with prior research, informing donors that seed money has already been raised increases donations, as does a $1:$1 matching campaign. Our main result, however, clearly shows that informing potential donors that overhead costs are covered by an initial donation significantly increases the donation rate by 80% (or 94%) and total donations by 75% (or 89%) compared with the seed (or matching) approach.

Case-matched analysis comparing outcomes of revisional versus primary laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common approaches used to revise post-bariatric patients with inadequate weight loss or significant weight regain. Previous studies have analyzed the outcomes of open revisional RYGB versus primary RYGB, but no case-control matched analysis comparing revisional LRYGB versus primary LRYGB has been performed. METHODS: Our cohort includes 37 consecutive patients who underwent revisional LRYGB because of unsatisfactory weight loss or weight regain matched in a 1:2 ratio with 74 control patients who underwent primary LRYGB. Matching included the following parameters: age, gender, preoperative body mass index and comorbidities (diabetes, obstructive sleep apnea, and hypertension). RESULTS: The revisional group had longer length of stay compared with the primary group (3.8 vs. 2.4 days, P = 0.02) and a higher conversion to laparotomy rate (10.8 vs. 0 %, P = 0.01). The revisional group had a higher 30-day morbidity compared with the primary group (27 vs. 8.1 %, P = 0.02). There were no deaths in both groups. The two groups had similar 30-day readmission and 30 day reoperation rates. At 3, 6, and 12 months of follow-up, the revisional LRYGB group had significantly lower percent of excess weight loss (EWL) than the primary LRYGB group (3 months, 30 vs. 38.4, P = 0.001; 6 months, 36.3 vs. 52.9, P = 0.001; 12 months, 46.5 vs. 68.2, P = 0.001). CONCLUSIONS: Revisional LRYGB is characterized by lower EWL and higher morbidity than primary LRYGB. However, our data suggest that revisional LRYGB is still capable of providing significant weight loss in these high-risk patients.

Using a database to demonstrate the clinical nurse specialist's contribution to patient care.

Specialist nurse roles appear to beunder threat in the UK and the role of the clinical nurse specialist has been subject to scrutiny recently. A trust developed a database so that data on the CNS workload and contribution to patient care could be collected and analysed. This showed the components of the role and the dear benefits to patient care.

The common factors model: implications for transtheoretical clinical social work practice.

Direct practice social workers today are challenged to address the requirements of the complex array of professional, organizational, institutional, and regulatory demands placed on them in the broader socioeconomic context of fewer resources and diminished public support for social welfare services in the United States. The common factors model provides an accessible, transtheoretical, empirically supported conceptual foundation for practice that may help to resolve this conundrum and support effective practice. Common factors are conditions and processes activated and facilitated by strategies and skills that positively influence practice outcomes across a range ofpractice theories. The model provides an expanded conceptualization of the "active ingredients" required for change to include a focus on conditions and processes as well as practice strategies and to focus on all who are involved in the work. The model is described and implications for practice are discussed.

The safety of baclofen in pregnancy: intrathecal therapy in multiple sclerosis.

Intrathecal baclofen is a GABA-receptor agonist and one of the mainstay treatments of severe spasticity due to multiple sclerosis (MS). The authors report a case on the use of intrathecal baclofen administered using a Medtronic Synchromed II infusion pump. A healthy male infant (2.68 kg, Apgars 9 and 10) was born at 36 weeks gestation by cesarean section, under general anesthetic. This is the fifth reported case of intrathecal baclofen administered during pregnancy and adds to the knowledge that thus far it is relatively safe in pregnancy and may in fact be safer for the infant than oral baclofen. This is the first case report of the use of intrathecal baclofen in pregnancy and MS.

A novel cause of intrathecal baclofen overdosage: lessons to be learnt.

CASE PRESENTATION: A serious intrathecal baclofen overdose occurred in a 45-year-old woman with primary progressive multiple sclerosis following a catheter dye study with concomitant change in baclofen concentration. The pump and catheter were emptied of baclofen 2000 microg/mL, refilled and primed with baclofen 1000 microg/mL. No correction was made for the ;dead space' between the reservoir and catheter access port, which contained baclofen 2000 microg/mL. Failure of the priming bolus to account for the residual baclofen concentration within the dead space resulted in a serious overdose.Action: Amendments are being made to both our local and the Medtronic protocols. CONCLUSION: We hope that by reporting this incident the risk of this potentially fatal error re-occurring is minimized.

Disease-modifying drugs in multiple sclerosis.

This article is a description of practice and a comment on the evolution of a disease-modifying drug (DMD) treatment service for multiple sclerosis (MS) in a tertiary referral centre. It is hoped it will help other MS nurses who are involved in the establishment of DMD clinics in their area. It aims to offer an update on practical management of DMDs that may prove useful for any nurse involved in caring for people with MS. It describes lessons learnt in the establishment and growth of the service and protocols put in place to ensure best practice. The importance of partnership in care with patients and multidisciplinary collaboration is highlighted, while the pivotal role of the MS nurse in the delivery of an effective service is emphasised.

Nursing at a specialist diagnostic clinic for multiple sclerosis.

People with multiple sclerosis (MS) need support, information, education and guidance in order to adapt effectively to the impact of the disease (Sheridan, 1997). The care received at the time of diagnosis is central to this adaptation process as the information given and received may impact on the person with MS for the rest of his/her life. In order to achieve effective coping strategies, the person with MS needs to develop a collaborative relationship with the team of healthcare professionals. At the National Hospital for Neurology and Neurosurgery (NHNN), University College London Hospital (UCLH), the MS team believes that the foundations of this relationship should be cemented at the diagnostic stage. This article describes a diagnostic model that facilitates accurate timely diagnosis of MS and the role of the MS nurse in providing expert clinical assessment, guidance, support and education in order to help the patient adjust to the disease.