Food prescription programs (Food Rx) have the potential to improve management of diet-related chronic diseases or underlying conditions such as type 2 diabetes (T2D), hypertension, and high body mass index (BMI) among food-insecure patients. The purpose of this study was to examine the effectiveness of a Food Rx program implemented in two community-based clinics in Florida. Data were collected through researcher-administered surveys (food insecurity, demographics, and socio-economic variables) and biometric data (HbA1c, blood pressure, and BMI). Key results include the following: (1) Hispanic patients are more likely to utilize the program than their Black and White counterparts (p < 0.001); (2) older patients (≥50 years) have a higher food redemption rate when compared to younger patients (36–49.9 years); (3) food redemption rate is negatively associated with food security scores indicating improvements in food security status over time (r2 = −0.184, p = 0.036); (4) diabetic patients with higher baseline HbA1c (>9%) have significant reductions in glycated hemoglobin (p = 0.011) over time as compared to patients with lower baseline values (<7%); and (5) patients enrolled in the program for at least 6 months have a significant reduction in systolic blood pressure (p = 0.051). Changes in BMI were not significantly associated with redemption rates. This study is significant as it offers insights into the potential benefits and challenges of implementing Food Rx programs to address diet-related chronic diseases among underserved populations.

Development projects present ambiguous ethical terrain for anthropologists to navigate. Particularly in relation to WaSH (Water, Sanitation, Hygiene) infrastructures which mediate human and environmental health. Our interdisciplinary team of anthropologists and engineers initially set out to design context-sensitive on-site wastewater treatment infrastructures for homes along Belize's Placencia Peninsula. The project's beginning coincided with the announcements of a government sponsored centralized wastewater infrastructure project and the construction of a cruise ship port on a nearby island, however. Soon the wastewater project's promises-economic opportunity, improved human and environmental health, modernization - came crashing into its pratfalls-exacerbating existing inequalities, loss of livelihoods, and diminished local governance. Our team was left with uncertain decisions about how to engage with improving infrastructure, given the emerging community dynamics. By detailing the imperfect trade-offs at play, we highlight ethical complexities inherent when communities' development futures are at stake. Anthropology's fraught history includes legacies of unintended harms from entanglement in others' inequities. However, avoiding involvement out of excessive caution risks leaving marginalized voices unheard and extant problems unresolved. This case immersed our team in the inherent optimism and ethical experimentation which underlie development contexts. Our analysis adopts the structure from Whiteford and Trotters' (2008) "Ethical-Problem Solving Guide" to reveal the layered tensions that underly critical WaSH infrastructures.

In 2019, interdisciplinary teams of anthropology and environmental engineering PhD students went to Placencia Village, Belize to study stakeholder-driven issues related to coastal resilience. Our team explored wastewater management on a few of the more than 400 small cayes peppering the Belize Barrier Reef. These islands have transitioned from temporary sites for overnight fishers to crowded tourism destinations. Wastewater management has struggled to keep pace with these changes, spurring concerns about the health of the reef. Our task was to construct contextualized system dynamic models which would be useful to those concerned. Along the way however, we ran into tensions related to the underlying logic, and representations of people, in mathematical descriptions of social and technical configurations. This article lays out the context and lessons learned from our encounter with interdisciplinary systems modeling.

On August 30th, 2023, over 90 members of the Placencia Peninsula community gathered for a collaborative workshop to address escalating threats to Belize’s coastline. Hosted by Fragments of Hope Ltd. and WWF Mesoamerica, the event introduced an international initiative, Strong Coasts, which studies Nature-Based Solutions to flooding and erosion risks. Through interactive presentations, discussions, and hands-on exercises, attendees shared diverse perspectives on protecting vital yet vulnerable ecosystems like mangroves and coral reefs. Five key areas of concern emerged from participants: governance gaps, unsustainable resource use, insufficient coastal protection, pollution, and habitat loss. Despite varied viewpoints, participants expressed unity around enhancing enforcement and community input in decisions impacting the peninsula. Participatory mapping activities visualized erosion patterns and changes in habitats, revealing how geography shapes local outlooks. In written reflections, people noted new insights gained while emphasizing the need for ongoing, cooperative efforts to implement solutions. This workshop report marks one of many step in the community collectively working to care for the threatened nature so central to health, livelihoods, and heritage along the peninsula. We are deeply grateful to all the participants who generously contributed their time, energy, and invaluable insights. As the Strong Coasts project moves forward, we are guided by the words of Jamaican philosopher Sylvia Wynter: “What we do to nature we do to ourselves. Let us walk gently through life.

Water and sanitation (wastewater) infrastructure in the United States is aging and deteriorating, with massive underinvestment over the past several decades. For many years, lack of attention to water and sanitation infrastructure has combined with racial segregation and discrimination to produce uneven access to water and wastewater services resulting in growing threats to human and environmental health. In many metropolitan areas in the U.S., those that often suffer disproportionately are residents of low-income, minority communities located in urban disadvantaged unincorporated areas on the margins of major cities. Through the process of underbounding (the selective expansion of city boundaries to exclude certain neighborhoods often based on racial demographics or economics), residents of these communities are disallowed municipal citizenship and live without piped water, sewage lines, and adequate drainage or flood control. This Perspective identifies the range of water and sanitation challenges faced by residents in these communities. We argue that future investment in water and sanitation should prioritize these communities and that interventions need to be culturally context sensitive. As such, approaches to address these problems must not only be technical but also social and give attention to the unique geographic and political setting of local infrastructures.

Women make up 15% of the total number of practicing gastroenterology (GI) physicians in the US. Despite this disparity, only 33% of the current GI fellows are female. Increasing female GIs is a major goal of all four GI societies. It is known that gender disparity exists in the field of gastroenterology, and women are underrepresented in the leadership ranks and trainee level at academic programs. Whether an increase in female leadership in academic medicine is associated with an increase in female program directors and trainees is unknown. The aim of this study was to assess this relationship in GI. Data were collected via a standardized protocol from all 173 US gastroenterology fellowship programs up until October 2018 from program websites and supplemented by online surveys completed by program coordinators. Any missing information was collected by calling the program coordinators. Data were collected on gender and academic rank of the program director, associate program director, division chief, chair of medicine, program size, academic center affiliation, number, and academic rank of female faculty and geographic region. The association was assessed using a Chi-square test or independent samples t test. In leadership positions, men were listed as comprising 86% of chairs, 82% of division chiefs, 76% of program directors and 63% of associate program directors. Forty-three percent of programs did not have female representation at any leadership level. The presence of a female program director or female associate program director was associated with an increase in the number of female fellows (4.03 vs 3.20; p = 0.076; 4.26 vs 3.36; p = 0.041), respectively. Overall, the presence of a female in any leadership position led to an increase in the number of female fellows (4.04 females vs 2.87 females; p = 0.007) enrolled in a program. If a GI division chief was male, the program director was more likely to be male as well (81% male vs. 18.8% female). Conversely, having a female division chief was likely to lead to a more equitable program director representation, 54% female to 48% male (p value < 0.0001, OR 5.03 95% CI 2.04–12.3). Furthermore, if either the internal medicine department chair or GI chief was female, the proportion of female program directors increased to 41% as compared to 19% if both were male (p value < 0.0001, OR 2.99 95% CI 1.34–6.6). Women are significantly underrepresented in the number of practicing gastroenterologists, at all levels of leadership in GI fellowship programs, and at the fellow level. Increasing the number of women in fellowship leadership positions is associated with an increase in female program directors and trainees. Per our knowledge, this is the first study to examine the relationship between female leadership in fellowship programs and the gender of trainees. Increasing female representation in leadership positions would not only address current gender disparity, but it may also increase the number of female future GI trainees.

Introduction:Provider-patient language discrepancies can lead to misunderstandings about follow-up care instructions and decreased adherence to treatment that may contribute to disparities in health outcomes among patients with limited English proficiency (LEP). This observational study aimed to understand how emergency department (ED) staff went about treating patients with LEP and examine the impact of consistent interpretation modality on overall patient satisfaction and comprehension. Method:A cross-sectional study was conducted among Spanish-speaking patients with LEP presenting to the ED. A survey was administered at two different time points: after patients provided their history of present illness and after the patient received information regarding follow-up treatment. Results:Analysis of average visual analog scale (VAS) scores by consistency of interpretation suggested higher overall scores among participants that received care via the same communication modalities during both the history of present illness and at disposition, when compared with patients that did not. At both time points, video-based interpretation was associated with higher VAS scores in comparison to other modalities, whereas phone-based interpretation was associated with lower VAS scores. Conclusion:Providing consistent modes of interpretation to patient's with LEP throughout their ED visits improved their overall satisfaction of care provided and understandings of discharge instructions.

Press Ganey survey data are used by institutions to understand patient experiences in the emergency department (ED). The present mixed-methods retrospective cohort study examined the effects of hallway placement, pain management reporting, communication approaches, time spent in the ED, and other demographic variables on predicting satisfaction ratings of doctors, nurses, and overall ED care. A total of 4940 patient responses between January 1, 2012, and December 31, 2017, were analyzed from 2 EDs associated with an academic institution and tertiary care center. Consensus coding was used to qualitatively capture patient responses that relate to communication issues pertaining to care/empathy and understandings of ED procedures. After controlling for multiple factors, hallway placement, pain management, and understanding of ED procedures were associated with higher odds of negative ratings for doctors, nurses, and overall assessment. Issues with patient communication, particularly regarding understanding of ED procedures, were found to be a strong predictor of negative ratings of doctors, nurses, and overall care. These findings point to the improvements in communication as a potential point of intervention in mitigating negative patient experiences.

INTRODUCTION: Subcapsular liver hematoma (SLH) is a rare complication that occurs in about 1 in 45,000 pregnancies almost exclusively in the setting of preeclampsia or HELLP syndrome. Subcapsular and intraparenchymal hemorrhage can lead to hepatic capsular rupture which is associated with significant maternal and fetal mortality. We present a rare case of a pregnant woman who developed HELLP syndrome complicated by ruptured subcapsular liver hematoma. CASE DESCRIPTION/METHODS: A 33-year-old woman at 31 weeks of pregnancy presented with generalized abdominal pain. She was hypertensive and urinalysis showed proteinuria thus the clinical scenario was concerning for preeclampsia. Development of non-reassuring fetal heart tones led to an emergent C-section with delivery of a healthy infant. Within hours she became hypotensive and somnolent requiring vasopressors and intubation. The patient developed significantly elevated liver enzymes (peak ALT 15,463 U/L and AST 36,653 U/L), hyperbilirubinemia, oliguric renal failure, and hemolysis. A CT abdomen was obtained which demonstrated hepatomegaly with an extensive subcapsular and intraparenchymal hematoma and large volume hemoperitoneum, consistent with hepatic capsular rupture. Angiography showed extravasation of contrast from a branch of the right hepatic artery, which was embolized. The hospital course was complicated by disseminated intravascular coagulation, liver and bowel necrosis due to microthrombi requiring multiple laparotomies and resections, and persistent respiratory and renal failure. Ultimately the patient expired as a result of these complications. DISCUSSION: SLH can lead to rupture of the Glisson capsule and subsequent intraperitoneal bleeding and hemorrhagic shock. Hemodynamically stable patients can be managed conservatively. Unstable patients require hepatic artery embolization or surgical ligation, hepatic resection, or in severe cases liver transplantation. This case demonstrates a severe episode of hepatic rupture complicated by disseminated intravascular coagulation and thrombosis leading to patient mortality.

After a massive hurricane devastated Belize's south coast in 2001, “sustainable tourism” was the national government's answer to spurring economic redevelopment. Since then, the communities of the Placencia Peninsula, in particular, have engaged in rapid tourism development as an economic strategy for securing local livelihoods, culminating in the arrival of mass cruise tourism in 2016. In a region where environmental resources and services shape the backbone of the tourism industry, controversies have erupted around current and future impacts of tourism on the environment. One of the more polarizing debates to emerge surrounds the role of wastewater management, which is not centralized in the region and has resulted in discharges of untreated or partially treated wastewater into local waterways where many residents and nongovernmental organizations perceive negative consequences for both human and environmental health. Friction between local residents and government technocrats on how to address the issue reveals how infrastructure planning can become a technopolitical practice in which cost–benefit analyses in the form of life cycle costing and environmental impact assessment, presented through the rhetoric of sustainability, are used to influence how water and wastewater are governed in Placencia. More broadly, our findings suggest that the micropolitics of infrastructure design and development can be a powerful force that organizes technocratic governance.

This paper provides empirical and experimental assessments of thematic knowledge discourses based on two case studies in the US Virgin Islands and Florida. We utilize a latent semantic indexing analysis over natural language corpus to classify and categorize knowledge categories. We computed TF*IDF scores and associated co-occurrence Jaccard similarity scores to construct semantic knowledge networks. Using network analysis, we computed structural metrics over four composite groups: neighbor-based, centrality, equivalence and position. The analysis show that structural network characteristics of environmental knowledge can exponentially predict associations between knowledge categories. We show that connectivity play a critical role on acquisition, representation, and diffusion patterns of knowledge within local communities. We provide evidence of a global prevalence of a shared knowledge core. We show that core social-ecological attributes of knowledge follow scale-free, power law distributions and stable, equilibrium network structures. We identify two distinct models of bidirectional translation: a bottom-up and a top-down.