This study aimed to review the literature describing and quantifying time lags in the health research translation process. Papers were included in the review if they quantified time lags in the development of health interventions. The study identified 23 papers. Few were comparable as different studies use different measures, of different things, at different time points. We concluded that the current state of knowledge of time lags is of limited use to those responsible for R&D and knowledge transfer who face difficulties in knowing what they should or can do to reduce time lags. This effectively ‘blindfolds’ investment decisions and risks wasting effort. The study concludes that understanding lags first requires agreeing models, definitions and measures, which can be applied in practice. A second task would be to develop a process by which to gather these data.

The Answer Is 17 Years, What Is the Question

Representing Reality: Discourse, Rhetoric and Social Construction

The Human Microbiome.

The Gift Relationship From Human Blood To Social Policy

Diagnostic evaluation of psychiatric disorders in children and adolescents relies in part on subjective interpretations of information from a clinician. Clinicians must interpret and contextualize information obtained from family, caregivers, and educators in order to assign an appropriate diagnosis. However, environmental and sociocultural influences can make the diagnosis of psychiatric disorders challenging, and appreciating these influences should be a priority in academic psychiatry. This can be particularly true for the provision of a diagnosis of oppositional defiant disorder (ODD), conduct disorder (CD), and attentiondeficit/hyperactivity disorder (ADHD), as diagnosing these complex conditions can be nuanced. There is a growing body of evidence indicating that when compared to non-Hispanic white youth, some ethnic and racial minority youth are more likely to receive a diagnosis of a disruptive behavior disorder and are less likely to receive a diagnosis of ADHD [1–8]. When controlling for confounding variables such as adverse childhood experiences, prior juvenile offenses, genetics, and sociodemographics, these diagnostic and treatment disparities remain [6–8]. Although the cause of these diagnostic disparities is multifactorial, there is concern that unconscious biases may play a role in diagnostic decision-making. As a result of these biases, psychiatrists and trainees may judge and interpret behaviors seen in ODD, CD, and ADHD differently based on race or ethnicity, putting vulnerable populations at risk [5, 9]. Additionally, the current standard of practice is to routinely consider a broad differential of comorbid disorders when youth exhibit disruptive symptoms; however, biases may lead clinicians less likely to explore these potential explanations for behavior [10–12]. When a diagnosis of a disruptive behavior disorder is provided in place of ADHD (or ADHD is not included as a concurrent diagnosis), there are significant clinical implications, as this can limit access to medications, therapy, and other supportive services. This lack of services can put ethnic and racial minority children at risk for perpetuating the disparities which currently exist in the medical, educational, and juvenile justice systems. Recognizing the magnitude of this concern, this commentary reviews how unconscious bias can lead to diagnostic disparities in the assessment of disruptive behavior disorders and ADHD, the implications that these biases can have on ethnic and racial minority youth, and how this challenging clinical topic should be addressed in academic psychiatry.

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Unconscious Bias and the Diagnosis of Disruptive Behavior Disorders and ADHD in African American and Hispanic Youth.

Biobanks are considered to be key infrastructures for research development and have generated a lot of debate about their ethical, legal and social implications (ELSI). While the focus has been on human genomic research, rapid advances in human microbiome research further complicate the debate. We draw on two cystic fibrosis biobanks in Toronto, Canada, to illustrate our points. The biobanks have been established to facilitate sample and data sharing for research into the link between disease progression and microbial dynamics in the lungs of pediatric and adult patients. We begin by providing an overview of some of the ELSI associated with human microbiome research, particularly on the implications for the broader society. We then discuss ethical considerations regarding the identifiability of samples biobanked for human microbiome research, and examine the issue of return of results and incidental findings. We argue that, for the purposes of research ethics oversight, human microbiome research samples should be treated with the same privacy considerations as human tissues samples. We also suggest that returning individual microbiome-related findings could provide a powerful clinical tool for care management, but highlight the need for a more grounded understanding of contextual factors that may be unique to human microbiome research. We revisit the ELSI of biobanking and consider the impact that human microbiome research might have. Our discussion focuses on identifiability of human microbiome research samples, and return of research results and incidental findings for clinical management.

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Navigating social and ethical challenges of biobanking for human microbiome research

Advances in human microbiome research have generated considerable interest in elucidating the role of bacteria in health and the application of microbial ecosystem therapies and probiotics. Fecal transplants involve the introduction of gut microbes from a healthy donor's stool to the patient and have been documented as effective for treating Clostridium difficile infections (CDIs) and some other gastrointestinal disorders. However, the treatment has encountered regulatory hurdles preventing widespread uptake. We examined dominant representations of fecal transplants in Canadian media and found that fecal transplants are often represented as being inherently disgusting or distasteful (the "ick factor"). This "ick factor" is used to construct different messages about the treatment's social acceptability and legitimacy. We conclude that an over-emphasis on the "ick factor" constrains public discourse from a more nuanced discussion of the social challenges, scientific concerns, and regulatory issues surrounding the treatment.

Media Discourse on the Social Acceptability of Fecal Transplants

Healthcare institutions face widespread challenges of delivering high-quality and cost-effective care, while keeping up with rapid advances in biomedical knowledge and technologies. Moreover, there is increased emphasis on developing personalized or precision medicine targeted to individuals or groups of patients who share a certain biomarker signature. Learning healthcare systems (LHS) have been proposed for integration of research and clinical practice to fill major knowledge gaps, improve care, reduce healthcare costs, and provide precision care. To date, much discussion in this context has focused on the potential of human genomic data, and not yet on human microbiome data. Rapid advances in human microbiome research suggest that profiling of, and interventions on, the human microbiome can provide substantial opportunity for improved diagnosis, therapeutics, risk management, and risk stratification. In this study, we discuss a potential role for microbiome science in LHSs. We first review the...

Human Microbiome and Learning Healthcare Systems: Integrating Research and Precision Medicine for Inflammatory Bowel Disease

The cultural psychology of romantic relationships is relatively understudied. To redress this lacunae, the present study examined the Japanese concept of ‘amae’, or the state of expecting a close other's indulgence when one behaves inappropriately, within the day-to-day relationships of 30 Japanese undergraduate romantic couples. For 2 weeks, both partners completed daily diaries that assessed their amae behaviour (requesting, receiving, and providing amae), relationship quality, conflict, and motivation to enhance closeness. Results revealed that amae behaviour was associated with greater relationship quality and less conflict. The motivation to enhance closeness partially mediated the association of amae with relationship quality.

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Day-to-day experiences of amae in Japanese romantic relationships

Purpose: A growing body of scientific evidence supports the role of food and diet in the pathogenesis and management of inflammatory bowel diseases (IBD). However, little is known about the role of food and diet from the perspectives of pediatric patients and their parents. This study aimed to explore how children and adolescents with IBD and their parents coped with the illness through food and diet in their daily lives. Methods: We conducted semi-structured interviews with 28 children and adolescents with IBD, 26 parents and one grandparent. Results: Two major themes, dietary strategies and family food practices, were identified through thematic analysis. There were three types of dietary strategies: food avoidance and moderation; following a specific diet; and healthy eating. For family food practices, two subthemes were identified: impact on grocery shopping, meal planning, and cooking; and maintaining routine and normality. Conclusions: Our findings have important implications for the clinical care of pediatric IBD. Notably, IBD not only influenced the food practices of the pediatric patients, but also their parents and other family members. Healthcare professionals should consider the family unit when giving nutritional advice or developing nutritional guidelines. Personalized nutritional counselling and ongoing nutritional assessment are also warranted.

Kim H. Chuong

Papers

Navigating social and ethical challenges of biobanking for human microbiome research

Media Discourse on the Social Acceptability of Fecal Transplants

Human Microbiome and Learning Healthcare Systems: Integrating Research and Precision Medicine for Inflammatory Bowel Disease

Day-to-day experiences of amae in Japanese romantic relationships

Dietary strategies and food practices of pediatric patients, and their parents, living with inflammatory bowel disease: a qualitative interview study.