Does Crop Diversity Influence Household Food Security and Women's Individual Dietary Diversity? A Cross-Sectional Study of Malawian Farmers in a Participatory Agroecology and Nutrition Project.

BACKGROUND: Agroecological methods have the potential to impact nutrition and food security, however, to date there is limited research evaluating this approach. OBJECTIVE: A 5-year participatory research project with farming households in north and central Malawi was designed to train farmers on agroecological practices, alongside raising awareness on nutrition and gender equity. This cross-sectional study aimed to explore the relationships between crop diversity, food security at the household level, and individual diversity for women, within the context of an agroecology, nutrition education, and farmer mentoring program. METHODS: Participating farmers were trained in and experimented with different farming methods. These farmers subsequently trained other farmers on these short-term agroecological practices and provided mentorship using community-based educational methods designed to address both household food security and nutrition. In year 4 of the intervention, a cross-sectional survey assessed farm practices, food security, and individual dietary diversity of 851 participating households. RESULTS: Households with lower crop diversity were significantly less likely to be food secure (odds ratios [OR] = 0.829, P < .001). Women in households with higher crop diversity were more likely to have higher individual dietary diversity (OR = 1.120, P < .01), eat vitamin A rich foods (OR = 1.176, P < .01), and legumes, nuts, and seeds (OR = 1.141, P < .01). CONCLUSIONS: These findings suggest that within a participatory agroecological training combined with community-based nutrition education with a focus on social equity, crop diversity is associated with less household food insecurity and poorer diet quality for rural farming households. Crop diversity may improve dietary diversity by making nutritious foods more available.

Effects of drought on the abundance and distribution of non-breeding shorebirds in central California, USA.

Conservation of migratory species requires anticipating the potential impacts of extreme climatic events, such as extreme drought. During drought, reduced habitat availability for shorebirds creates the potential for changes in their abundance and distribution, in part because many species are highly mobile and rely on networks of interior and coastal habitats. Understanding how shorebirds responded to a recent drought cycle that peaked from 2013 to 2015 in central California, USA, will help optimize management of wetlands and fresh water for wildlife. In the Central Valley, a vast interior region that is characterized by a mosaic of wetlands and agricultural lands, we found 22% and 29% decreases in the annual abundance of shorebirds during periods of 3-year drought (2013-2015) and 2-year extreme drought (2014-2015), respectively, when compared to non-drought years. Lower abundance of shorebirds coincided with significant decreases in the mean proportion flooded of survey units (7% and 9%, respectively) that were reliant on fresh water. Drought was associated with lower abundance within both the interior Central Valley and coastal San Francisco Bay for greater and lesser yellowlegs (Tringa melanoleuca and T. flavipes) and long- and short-billed dowitchers (Limnodromus scolopaceus and L. griseus). Only dunlins (Calidris alpina) had patterns of abundance that suggested substantial shifts in distribution between the Central Valley and coastal regions of San Francisco Bay and Point Reyes. Our results indicate that drought has the potential to reduce, at least temporally, shorebird populations and flooded habitat in the Central Valley, and the ability to respond to drought by taking advantage of nearby coastal habitats may limit the long-term effects of drought on some species. Successful conservation strategies must balance the impacts of reduced habitat availability at interior sites with the ability of some migratory shorebirds to adapt rapidly to shifting distributions of resources.

Development, Validation, and Interpretation of the PROMIS Itch Questionnaire: A Patient-Reported Outcome Measure for the Quality of Life Impact of Itch.

Current patient-reported outcome measures for itch are limited and may not capture its full impact on health-related quality of life. We sought to develop, calibrate, and validate banks of questions assessing the health-related quality of life impact of itch as part of the Patient-Reported Outcomes Measurement Information System. A systematic process of literature review, content-expert review, qualitative research, testing in a sample of 600 adults, classical test theory methods, and item response theory analyses were applied. Exploratory and confirmatory factor analyses were followed by item response theory model and item fit analyses. Four itch-related item banks were developed: (i) general concerns, (ii) mood and sleep, (iii) clothing and physical activity, and (iv) scratching behavior. Item response theory and expert content review narrowed the item banks to 25, 18, 15, and 5 items, respectively. Validity of the item banks was supported by good convergent and discriminant validity with itch intensity, internal consistency, and no significant floor or ceiling effects. In conclusion, the Patient-Reported Outcomes Measurement Information System Itch Questionnaire banks have excellent measurement properties and efficiently and comprehensively assess the burden of itch.

Geriatric Psychiatry Teaching in Canadian Medical Schools: a Cross-Sectional Study.

OBJECTIVE: With a growing geriatric population and limited geriatric psychiatrists in Canada, it is crucial to provide sufficient training in geriatric psychiatry during medical school. The authors examined how geriatric psychiatry education is delivered in Canadian medical schools during clerkship. Factors that could be associated with increased geriatric psychiatry teaching in medical schools were examined. The authors were also interested in comparing Canadian to US findings. METHODS: A cross-sectional survey was distributed to the psychiatry medical education representatives attending the Canadian Organization of Undergraduate Psychiatry Educators (COUPE) semi-annual meeting in September 2017. RESULTS: All 17 (100%) medical schools completed the survey. Fifteen of the 17 schools (88%) have geriatric psychiatry-specific learning objectives. Five schools (29%) offer a clinical component in geriatric psychiatry. One school has an award for clerks (6%), and no awards exist for faculty. The number of lecture hours in geriatric psychiatry is moderately correlated with the presence of a geriatric component to psychiatry clerkship (Spearman's rho = 0.67, p = 0.003) and the length of the geriatric portion of clerkship (Spearman's rho = 0.64, p value = 0.006). Lecture hours are also moderately correlated with the presence of a geriatric fellowship (Spearman's rho = 0.68, p value = 0.003). CONCLUSIONS: Geriatric psychiatry clerkship education is inconsistent in Canada. There is virtually no recognition of excellence in teaching or undergraduate performance in this area in clerkship. Geriatric psychiatry may receive more frequent attention in Canadian medical schools than in US medical schools.

Waterbird response to variable-timing of drawdown in rice fields after winter-flooding.

Wetland loss and degradation have been extensive across the world, especially in California's Central Valley where over 90% of the natural wetlands have been converted to agricultural and urban uses. In the Central Valley today, a much smaller network of managed wetlands and flooded agricultural fields supports almost five million waterfowl and half a million shorebirds. Over 50% of waterbird habitat in the Central Valley is provided by flooded agricultural land, primarily rice (Oryza sativa). Each year non-breeding waterbird habitat decreases in the late winter as flooded agricultural fields are drained after waterfowl hunting season in late-January to prepare for the next crop. This study evaluated a practice called 'variable drawdown' that involves delaying the removal of water from rice fields by 1, 2, and 3 weeks to extend the availability of flooded habitat later into February and March. We studied waterbird response to variable drawdown in 2012 and 2013 at twenty rice farms throughout the northern half of the Central Valley. The staggered drawdown created a mosaic of water depths throughout the six-week study period. The 3-week delay in drawdown supported more dabbling ducks than earlier drawdowns in the first half of the study and more shorebirds and long-legged wading birds during the second half of the study. The timing of highest use of each drawdown treatment differed for each waterbird guild; dabbling ducks, geese and swans benefited at the beginning, then long-legged wading birds, followed by shorebirds. Despite the presence of appropriate water depths for shorebirds across the treatments during the entire study period, shorebird densities were highest near the end of the study when the 3-week-delayed drawdown was providing the majority of the habitat on the landscape. This suggests that shorebirds may have concentrated in our study fields due to decreasing availability of shallow water habitat elsewhere. The practice of variable drawdown successfully extended the availability of waterbird habitat provided by post-harvest flooded rice fields later into winter.

A Comprehensive Conceptual Model of the Experience of Chronic Itch in Adults.

BACKGROUND: Itch is common and often debilitating. Itch is best assessed by self-report, often using patient-reported outcome measures (PROMs). Current PROMs for itch are limited and may not capture its full impact on quality of life (QOL). OBJECTIVE: We sought to develop a comprehensive conceptual model of itch to improve the understanding of itch for clinicians and to serve as a framework for development of efficient and valid PROMs of itch. METHODS: Using mixed methods, including systematic review (n = 491 articles), semi-structured interviews (n = 33 adults with chronic itch with multiple etiologies), and grounded theory using a constant comparative approach, we developed a conceptual model of itch. RESULTS: We found the Wilson and Cleary model to be a reasonable framework for organizing our findings. It includes five primary components: biological and physiological variables, symptom status, functional status, general health perceptions, and QOL. We propose a causal relationship beginning with the biological and physiological driving factors, with direct and indirect impacts of itch and its sequelae, including pain and sleep disturbance. These can impair function, lead to task avoidance, stigma, social life and relationship problems, emotional disturbances, and treatment burden. Together, these sequelae alter one's perceptions of health, QOL, and treatment response. CONCLUSIONS: Our conceptual model demonstrates the profound patient-burden of itch and identifies unmet needs in the evaluation and management of itch.

Dynamic conservation for migratory species.

In an era of unprecedented and rapid global change, dynamic conservation strategies that tailor the delivery of habitat to when and where it is most needed can be critical for the persistence of species, especially those with diverse and dispersed habitat requirements. We demonstrate the effectiveness of such a strategy for migratory waterbirds. We analyzed citizen science and satellite data to develop predictive models of bird populations and the availability of wetlands, which we used to determine temporal and spatial gaps in habitat during a vital stage of the annual migration. We then filled those gaps using a reverse auction marketplace to incent qualifying landowners to create temporary wetlands on their properties. This approach is a cost-effective way of adaptively meeting habitat needs for migratory species, optimizes conservation outcomes relative to investment, and can be applied broadly to other conservation challenges.

Davanloo's Technique of Total Removal of Resistance and Optimum Mobilization of the Transference Component of the Resistance.

Davanloo's Intensive Short-Term Dynamic Psychotherapy (IS-TDP) is a unique brief dynamic psychotherapy characterized by relentless therapist intervention. While Davanloo has published extensively on his findings, there has been a paucity of publications on his most recent work involving the Montreal Closed Circuit Training Program. The purpose of this article is to highlight Davanloo's current understanding of his technique as well as his newest research findings. This will be done contextually, by highlighting case vignettes from the Montreal Closed Circuit Training Program. A special focus will be placed on the handling of resistance and Davanloo's concept of the "Transference Component of the Resistance" or TCR. This work was presented at Davanloo's 35th Annual Metapsychology Meeting in Montreal in October, 2014.

The Major Mobilization of the Unconscious and the Total Removal of Resistance in Davanloo's Intensive Short-term Dynamic Psychotherapy Part I: An Introduction.

Davanloo's Intensive Short-term Dynamic Psychotherapy has been the subject of various reviews. Davanloo has published extensively on his early work, but there have been no publications on his most recent work-most notably his Montreal Closed-circuit training program. This program focuses on his most recent discoveries and techniques and is a unique, videotaped supervisory program. It focuses on self-assessment and peer-assessment. It is also a unique format in which to review Davanloo's theoretical conceptions of resistance and the transference component of the resistance. This paper will review the early work of Davanloo as well as his most recent research findings. A case from the Montreal Closed-circuit training program will be reviewed in detail to highlight these findings.

The Major Mobilization of the Unconscious and the Total Removal of Resistance in Davanloo's Intensive Short-term Dynamic Psychotherapy Part II: Treating the Transference Neurosis.

Davanloo's Intensive Short-term Dynamic Psychotherapy has been the subject of various reviews. The first article in this series focused on a review of Davanloo's early work as well as a discussion of some of his most recent research findings. A case from the Montreal closed circuit training program was reviewed. This second article will focus on Davanloo's views on the transference neurosis and how its development should be avoided at all costs. There will be further exploration of the case presented in Part I from the Montreal closed circuit training program. There will also be a special focus on detecting the transference neurosis when present and the technical interventions needed to lay the foundations for removing it.

Delirium secondary to pregabalin.

Fibromyalgia is a common and disabling disease, and treatment can be challenging. More recently, pregabalin has been approved to treat pain associated with fibromyalgia. However, it can have serious neuropsychiatric sequelae. Several case reports have documented delirium secondary to pregabalin, usually in older patients with multiple medical comorbidities and concurrent medications. We describe a case of delirium in a young patient without significant medical problems and in the absence of other potentially causal medications. In this case, pregabalin appears to be the single causal etiology for delirium. We recommend clinicians to consider the causal role it may play in any patient who presents with delirium.

Differentiating the dementias. Revisiting synucleinopathies and tauopathies.

Dementia is a common, chronic and progressive illness. Many different types of dementia exist. It is important to have knowledge of the various dementia presentations so that the clinician can differentiate one type from another. Past and current approaches of classifying dementias are reviewed in this paper. The past cortical/subcortical scheme is reviewed as well as the current synucleinopathy/tauopathy scheme. This paper focuses on the most common synucleinopathies and tauopathies including Alzheimer's Dementia, Dementia with Lewy Bodies, Parkinson's Disease, Frontotemporal Dementia, Progressive Supranuclear Palsy, Multiple System Atrophy and Corticobasal Ganglionic Degeneration. We systematically approach each dementia and review cognitive, psychiatry and neurological features of each. We also compare and contrast each dementia and the synucleinopathies and taupoathies alike. Our goal is to provide the clinician with sufficient knowledge to competently and confidently diagnose a patient who presents with progressive cognitive decline and deterioration in functioning.