Incorporating Movements for Racial Justice into Planning and Management of U.S. National Parks

The National Park Service (NPS) is the federal land management agency responsible for 423 units across the United States. Many of these parks are considered iconic cultural and environmental landscapes. However, scholarship from a number of disciplinary approaches has positioned the national parks and their management as problematic, particularly from Indigenous and racial justice concerns. National parks, like many cultural landscapes in the U.S., are infused with racial relations, with unpleasant histories and contemporary experiences that have both subtle instances of marginalization and explicit episodes of material violence. Recent developments in racial justice movements raise fundamental questions for the social and political maintenance, stewardship, and sustainability of the NPS. In a critical approach that centers whiteness as a lens of institutional critique, we consider the ways that the NPS could more critically engage with racial justice approaches in its planning and management. After acknowledging that histories of U.S. national parks as spaces designed for White, upper class people led to the displacement and marginalization of Indigenous and people of color, we look to contemporary avenues for increased racial justice. Through both local, small-scale initiatives and agency-wide, national policies, we consider how racial justice movements are both expectant and galvanized in this moment, providing a setting for the NPS to redress and make amends for previous harms and missed opportunities. Specifically, we identify recent federal and institutional policy and legislation as promising mandates for progress. We identify specific place-based tactics used by individual NPS units, such as renaming parks and geographic features, or interpretation that is both more accurate and more inclusive of marginalized populations. Our research examines planning and management as potential strategic practices that can more fully highlight and progress racial justice. We offer a range of specific questions that might guide more inclusive planning and management work in the NPS. Finally, we encourage the NPS, as an institution, as well as individual park units, to support contemporary racial justice movements, while simultaneously adhering to the agency’s historical dual mandate.

Non-accidental Trauma in Infants: a Review of Evidence-Based Strategies for Diagnosis, Management, and Prevention

Purpose of Review To provide a resource for providers that may be involved in the diagnosis and management of infant non-accidental trauma (NAT). Recent Findings Infants are more likely to both suffer from physical abuse and die from their subsequent injuries. There are missed opportunities among providers for recognizing sentinel injuries. Minority children are overrepresented in the reporting of child maltreatment, and there is systemic bias in the evaluation and treatment of minority victims of child abuse. Summary Unfortunately, no single, primary preventative intervention has been conclusively shown to reduce the incidence of child maltreatment. Standardized algorithms for NAT screening have been shown to increase the bias-free utilization of NAT evaluations. Every healthcare provider that interacts with children has a responsibility to recognize warning signs of NAT, be able to initiate the evaluation for suspected NAT, and understand their role as a mandatory reporter.

Learning from the report of the independent medicines and medical devices safety review: “first do no harm”

This is a review of the learning points from the Independent Medicines and Medical Devices Safety Review, 1 chaired by Baroness Julia Cumberlege CBE DL. This system-wide review was initiated by the then Secretary of State for Health and Social Care, following patient-led campaigns. It looked at how the “healthcare system reacted as a whole, and how that response can be made more robust, speedy and appropriate”. We aim to highlight the learning points for doctors in Obstetrics and Gynaecology as these are relevant to our current practice and future changes in our healthcare system. These are: Aims of the review: why it was initiated and how it was conducted Overarching themes and missed opportunities to prevent avoidable harm Three clinical scenarios: their histories, issues and adverse events associated with their use and the current response in Scotland The hormone pregnancy test - Primodos The anti-epileptic drug - sodium valproate Surgical mesh for prolapse & incontinence The recommendations made by the review and implementation guidance Responses to the review, such as apologies issued by BSUG 2 /BAUS 3 /RCOG, 4 and compensations schemes such as the Scottish scheme as recommended by the review

Workplace neighbourhood built-environment attributes and sitting at work and for transport among Japanese desk-based workers

Workplace settings—both internal and external—can influence how workers are physically active or sedentary. Although research has identified some indoor environmental attributes associated with sitting at work, few studies have examined associations of workplace neighbourhood built-environment attributes with workplace sitting time. We examined the cross-sectional associations of perceived and objective workplace neighbourhood built-environment attributes with sitting time at work and for transport among desk-based workers in Japan. Data were collected from a nationwide online survey. The Abbreviated Neighborhood Environment Walkability Scale (n = 2137) and Walk Score® (for a subsample of participants; n = 1163) were used to assess perceived and objective built-environment attributes of workplace neighbourhoods. Self-reported daily average sitting time at work, in cars and in public transport was measured using a Japanese validated questionnaire. Linear regression models estimated the associations of workplace neighbourhood built-environment attributes with sitting time. All perceived workplace neighbourhood built-environment attributes were positively correlated with Walk Score®. However, statistically significant associations with Walk Score® were found for sitting for transport but not for sitting at work. Workers who perceived their workplace neighbourhoods to be more walkable reported a longer time sitting at work and in public transport but a shorter sitting time in cars. Our findings suggest that walkable workplace neighbourhoods may discourage longer car use but have workplaces where workers spend a long time sitting at work. The latter finding further suggests that there may be missed opportunities for desk-based workers to reduce sitting time. Future workplace interventions to reduce sitting time may be developed, taking advantage of the opportunities to take time away from work in workplace neighbourhoods.

Factors Associated with COVID-19 Testing among People who Inject Drugs: Missed Opportunities for Reaching those Most at Risk

People who inject drugs (PWID) are vulnerable to SARS-CoV-2 infection. We examined correlates of COVID-19 testing among PWID in the U.S.-Mexico border region and described encounters with services or venues representing potential opportunities (i.e., "touchpoints") where COVID-19 testing could have been offered. Between October, 2020 and September, 2021, participants aged ≥18 years from San Diego, California, USA and Tijuana, Baja California, Mexico who injected drugs within the last month completed surveys and SARS-CoV-2, HIV, and HCV serologic testing. Logistic regression was used to identify factors associated with COVID-19 testing prior to enrollment. Of 583 PWID, 30.5% previously had a COVID-19 test. Of 172 PWID who tested SARS-CoV-2 seropositive in our study (30.1%), 50.3% encountered at least one touchpoint within the prior six months where COVID-19 testing could have been offered. Factors independently associated with at least two fold higher odds of COVID-19 testing were living in San Diego (versus Tijuana), having recently been incarcerated or attending substance use disorder (SUD) treatment and having at least one chronic health condition. In addition, recent homelessness, having had at least one COVID-19 vaccine dose and having been tested for HIV or HCV since the pandemic began were independently associated with COVID-19 testing. We identified several factors independently associated with COVID-19 testing and multiple touchpoints where COVID-19 testing could be scaled up for PWID, such as SUD treatment programs and syringe service programs. Integrated health services are needed to improve access to rapid, free COVID-19 testing in this vulnerable population.