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In A Third Way, Hillary Hoffmann and Monte Mills detail the history, context, and future of the ongoing legal fight to protect indigenous cultures. At the federal level, this fight is shaped by the assumptions that led to current federal cultural protection laws, which many tribes and their allies are now reframing to better meet their cultural and sovereign priorities. At the state level, centuries of antipathy toward tribes are beginning to give way to collaborative and cooperative efforts that better reflect indigenous interests. Most critically, tribes themselves are building laws and legal structures that reflect and invigorate their own cultural values. Taken together, and evidenced by the recent worldwide support for indigenous cultural movements, events of the last decade signal a new era for indigenous cultural protection. This important work should be read by anyone interested in the legal reforms that will guide progress toward that future.
Previous research has identified a lack of clarification regarding paramedic professional obligation to work. Understanding community expectations of paramedics will provide some clarity around this issue. The objective of this research was to explore the expectations of a sample of Australian community members regarding the professional obligation of paramedics to respond during pandemics.
The authors employed qualitative methods to gather Australian community member perspectives immediately prior to the onset of the COVID-19 pandemic. Focus groups were used for data collection, and a thematic analysis conducted.
The findings revealed nine key themes: context of obligation (normal operations versus crisis situation); hierarchy of obligation (individual versus organizational obligation); risk acceptability; acceptable occupational risk (it’s part of the job); access to PPE; legal and ethical guidelines; education and training; safety; and acceptable limitations to obligation. The factors identified as being acceptable limitations to professional obligation are presented as further sub-themes: physical health; mental health; and competing personal obligations.
The issue of professional obligation must be addressed by ambulance services as a matter of urgency, especially in light of the COVID-19 coronavirus pandemic. Further research is recommended to understand how community member expectations evolve during and after the COVID-19 coronavirus pandemic.
Addition of small amounts of niobium to uranium generally produces an alloy that has an increase in strength and greater corrosion and oxidation resistance. While many investigators have studied the physical metallurgy and mechanical properties of dilute uranium alloys, to date there have been no studies utilizing transmission electron microscopy to study the precipitation behavior of the U-6.3% Nb alloy.
The present investigation was undertaken in order to determine by TEM the mode of precipitation of the U-6.3% Nb alloy when aged at various times and temperatures. Samples in the form of charpy bars, were treated at 850°C for 30 min., and water quenched (γ - quenched). These samples were then aged for 180 min. at 250°C, 385 min. at 254°C, and 72 min. at 358°C, to give 100, 117, and 160 KSI-yield strength respectively. The resulting microstructures were examined in a Hitachi-Perkin Elmer H.U. 200 F electron microscope operated at 200 KV; employing a goniometer tilt stage.
Ga proverbial wisdom holds that “hate has no medicine,” but there is a sacred court in Accra where people can calm the animosity that emerges from social conflicts. A unique form of vernacular jurisprudence has emerged at the Nae We Shrine Tribunal, which manages the consequences of civil, criminal, and supernatural crimes without raising the ire of human rights activists. Using records from this shrine court, the authors of this article demonstrate how the Tribunal offers social and spiritual wellbeing in a manner that cannot be provided by the chiefly and state judicial systems.
To evaluate whether incorporating mandatory prior authorization for Clostridioides difficile testing into antimicrobial stewardship pharmacist workflow could reduce testing in patients with alternative etiologies for diarrhea.
Single center, quasi-experimental before-and-after study.
Tertiary-care, academic medical center in Ann Arbor, Michigan.
Adult and pediatric patients admitted between September 11, 2019 and December 10, 2019 were included if they had an order placed for 1 of the following: (1) C. difficile enzyme immunoassay (EIA) in patients hospitalized >72 hours and received laxatives, oral contrast, or initiated tube feeds within the prior 48 hours, (2) repeat molecular multiplex gastrointestinal pathogen panel (GIPAN) testing, or (3) GIPAN testing in patients hospitalized >72 hours.
A best-practice alert prompting prior authorization by the antimicrobial stewardship program (ASP) for EIA or GIPAN testing was implemented. Approval required the provider to page the ASP pharmacist and discuss rationale for testing. The provider could not proceed with the order if ASP approval was not obtained.
An average of 2.5 requests per day were received over the 3-month intervention period. The weekly rate of EIA and GIPAN orders per 1,000 patient days decreased significantly from 6.05 ± 0.94 to 4.87 ± 0.78 (IRR, 0.72; 95% CI, 0.56–0.93; P = .010) and from 1.72 ± 0.37 to 0.89 ± 0.29 (IRR, 0.53; 95% CI, 0.37–0.77; P = .001), respectively.
We identified an efficient, effective C. difficile and GIPAN diagnostic stewardship approval model.
Transition to a care home often follows a hospital admission and can be distressing. Care home settings play an important role in the care of many people at the end of life. This longitudinal study employed a narrative approach, aiming to explore the perspectives of older care home residents on transitions to, and life and death within, care homes. Five participants, aged 85 years and over, were recruited from two privately owned care homes in the South-West of England. All participants had a diagnosis of an advanced progressive condition (excluding advanced dementia), or were thought to be frail. Longitudinal interviews (19 in total) were conducted over a ten-month period. A structural narrative analysis was performed and participants’ narratives are presented under three headings, with one participant's story chosen to illustrate each narrative type: ‘becoming a care home resident’, ‘living in a care home’ and ‘death and dying’. Findings revealed that care home residents experience a loss of autonomy and a lack of agency; they are often excluded from decision-making. Older care home residents have few choices with regard to care at the end of life. Further work is required to improve transition into care homes, including support and advocacy during decision-making, which often takes place in hospitals at a time of crisis.
Hagstromite, Pb8Cu2+(Te6+O6)2(CO3)Cl4, (IMA2019-093) is a new tellurate mineral from Otto Mountain near Baker, California, USA. It occurs on quartz in association with cerussite, fuettererite and thorneite. It is a secondary oxidation zone mineral and is presumed to have formed by oxidation of earlier formed tellurides, chalcopyrite and galena. Hagstromite occurs as light yellow–green blades, up to ~100 μm long. Crystals are transparent with adamantine to silky lustre. The mineral is brittle with two cleavages providing splintery fracture; the Mohs hardness is probably between 2 and 3. The calculated density is 7.062 g cm–3. Hagstromite is optically biaxial (+), with calculated indices of refraction for α = 2.045, β = 2.066 and γ = 2.102; 2Vmeas = 76(1)°; and optical orientation X = b, Y = a and Z = c. The Raman spectrum of hagstromite exhibits similarities with those of agaite and thorneite and confirms the presence of CO32–. The electron microprobe analyses provided the empirical formula Pb8.07Cu2+0.98Te6+1.96C1.17Cl3.83O15.34. Hagstromite is orthorhombic, space group Ibam, with a = 23.688(17), b = 9.026(8), c = 10.461(8) Å, V = 2237(3) Å3 and Z = 4. The crystal structure of hagstromite (R1 = 0.0659 for 284 I > 2σI reflections) contains a novel Cu2+Te6+2O12 chain assembled of corner-sharing Cu2+O4 squares and Te6+O6 octahedra. The O atoms in the chains form bonds with Pb2+ cations, which in turn bond to Cl– and CO32– anions, thereby creating a framework structure.
Cuyaite (IMA2019-126), Ca2Mn3+As3+14O24Cl, is a new arsenite mineral from near Cuya in the Camarones Valley, Arica Province, Chile. It is associated with anhydrite, native arsenic, arsenolite, calcite, claudetite, ferrinatrite, gajardoite-3R, leiteite, magnesiocopiapite, phosphosiderite, pyrite, realgar and talmessite and formed from the oxidation of As-bearing primary phases and alteration by saline fluids derived from evaporating meteoric water under hyperarid conditions. Cuyaite occurs as pale brown thin needles (elongated on ), typically in divergent sprays and subparallel intergrowths. The streak is white. Crystals are transparent with adamantine lustre; subparallel intergrowths exhibit silky lustre. The mineral has Mohs hardness of 2½, is brittle, exhibits no cleavage and has irregular fracture. The calculated density is 4.140 g cm–3. Cuyaite is optically biaxial (–), with α = 1.87(1), β = 1.956(calc) and γ = 1.98(1), determined in white light; 2Vmeas = 60(1)°; and orientation: X = b and Y ^ a = 53° in obtuse β. Electron microprobe analyses provided the empirical formula Ca2.03Mn3+0.95(As3+13.66Sb3+0.65)Σ14.31O24Cl0.88. The six strongest powder X-ray diffraction lines are [dobs Å(I)(hkl)]: 4.73(45)(111,
14), 3.035(28)(213), 3.004(37)(204), 2.931(90)(
15, 312) and 2.779(28)(020). Cuyaite is monoclinic, Pn, a = 14.7231(6), b = 5.58709(19), c = 17.4185(12) Å, β = 112.451(8)°, V = 1324.23(14) Å3 and Z = 2. In the crystal structure of cuyaite (R1 = 0.0369 for 2095 I > 2σI reflections), AsO3 pyramids share O corners to form a ‘loose’ 3D framework; Jahn–Teller distorted Mn3+O6 octahedra and CaO8 polyhedra link by edges and corners to form columns; the columns also link by edge- and corner-sharing to the AsO3 pyramids in the framework; Cl occupies channels along  in the framework. The Raman spectrum is consistent with the presence of multiple As3+O3 groups.
Generating feelings of satiety may be important in maintaining weight control. It has been hypothesised that the circulating concentration of glucose is a major determinant of satiety, yet the relationship between postprandial glycaemia and satiety is inconclusive. Our aim was to assess satiety following ingestion of beverages differing in glycaemic index (GI) containing either 50 g of sucrose (GI 65) or isomaltulose (PalatinoseTM) (GI 32). The beverages were matched for sweetness using a triangle sensory test. Seventy-seven participants were randomised to the order in which they received each beverage, 2 weeks apart. A standard lunch was given at 12.00 hours. Satiety was measured using 100-mm visual analogue scales (VAS) administered at 14.00 hours (baseline) and at 30, 60, 90, 120, 150 and 180 min after ingesting the beverage. Weighed diet records were kept from 17.00 to 24.00 hours. Mean differences for isomaltulose compared with sucrose AUC VAS were ‘How hungry do you feel?’ 109 (95 % CI –443, 661) mm × min; ‘How satisfied do you feel?’ 29 (95 % CI –569, 627) mm × min; ‘How full do you feel?’ −91 (95 % CI –725, 544) mm × min and ‘How much do you think you can eat?’ 300 (95 % CI –318, 919) mm × min. There was no between-treatment difference in satiety question responses or in dietary energy intake −291 (95 % CI −845, 267) kJ over the remainder of the day. In this experiment, feelings of satiety were independent of the GI of the test beverages. Any differences in satiety found between foods chosen on the basis of GI could be attributable to food properties other than the glycaemic-inducing potential of the food.
The Play of Wit and Science was written c.1540 by John Redford, choirmaster of St Paul’s. It participates in the genre of educational drama which emerged in the late Middle Ages in Northern European schools; works of classical drama were adapted for the tastes and talents of schoolboys, and Redford's play shares with other school plays ‘an interest in learning and entertainment’. That it does not tell a classical story, and is in English rather than Latin, may be because it was performed by the Children of Paul’s, choristers, not by the boys of Dean Colet's St Paul's Grammar School. The opening leaves are missing, but their action may be guessed from what survives: Wit, son of Dame Nature, has fallen in love with Lady Science, daughter of Reason and Experience. Through Wit's servant Confidence, Science sends Wit a garment of some kind as a sign of her favour, and Wit sends his portrait to Science. Reason sets Wit on a quest to prove that he is worthy of Science's hand: with the assistance of Instruction, Study, and Diligence, Wit must slay the Giant Tediousness and reach Mount Parnassus. The surviving script begins as Reason hands Wit a mirror, the glass of Reason, to aid in the quest. Wit makes various mistakes on his journey and ends up tricked and seduced by Idleness, who dresses him in a fool's coat whilst he sleeps. The jilted Lady Science, meanwhile, declines the services of Worship, Fame, Riches, and Favour: she then encounters Wit, and rejects him as the ‘fool’ he appears to be. He realises what has happened when he looks at himself in Reason's glass, repents and is punished by Shame, and then, restored to his proper appearance, slays the giant and wins his lady's hand.
This plot summary indicates something of the character of Redford's play, which combines an allegorised anatomy of the process of learning with the romance narrative of the young knight setting forth on the adventure by which he grows up and earns a lady's love: ‘The essential metaphor is one of chivalric quest’.
Treatment resistant schizophrenia (TRS) is one of the most disabling of psychiatric disorders, affecting about 1/3 of patients. First-line treatments include both atypical and typical antipsychotics. The original atypical, clozapine, is a final option, and although it has been shown to be the only effective treatment for TRS, many patients do not respond well to clozapine. Clozapine use is related to adverse events, most notably agranulocytosis, a potentially fatal blood disorder which affects about 1% of those prescribed clozapine and requires regular blood monitoring. This as a barrier to prescription and there is a long delay in access for TRS patients, of five or more years, from first antipsychotic prescription. Better tools to predict treatment resistance and to identify risk of adverse events would allow faster and safer access to clozapine for patients who are likely to benefit from it. The CRESTAR project (www.crestar-project.eu) is a European Framework 7 collaborative project that aims to develop tools to predict i) treatment response, particularly patients who are less likely to respond to usual antipsychotics, indicating treatment with clozapine as early as possible, ii) patients who are at high or low risk of adverse events and side effects, iii) extreme TRS patients so that they can be stratified in clinical trials for novel treatments. CRESTAR has addressed these questions by examining genome-wide association data, genome sequence, epigenetic biomarkers and epidemiological data in European patient cohorts characterized for treatment response, and adverse drug reaction using data from clozapine therapeutic drug monitoring and linked National population medical and pharmacy databases, to identify predictive factors. In parallel CRESTAR will perform health economic research on potential benefits, and ethics and patient-centred research with stakeholders.
While evidence-based psychiatric practices (EBPs) are assumed to be more efficient, savings and sustainability are elusive during times of economic instability. This presentation uses two-years of penetration and cost-related data from46 community mental health providers to document EBP penetration and sustainability during a period of serious funding contraction.
This study sought to identify specific elements that contribute to EBP-related savings and sustainability in urban, rural and blended environments.
This study identifies critical organizational practices that sustain EBPs during difficult economic times.
Using existing claims data on the State of Michigan website, researchers used a stratified regression analysis to identify critical variables contributing to increased use of EBPs and decreased use of high-cost services. Follow-up qualitative data were collected from administrators of high and low penetration organizations to provide insight into within-agency strategies that contribute to EBP implementation and sustainability.
Findings identify direct and indirect contributors to sustainability and efficiency when implementing evidence-based practices. Direct contributors include unit-cost funding and the number of EBPs implemented. Indirect contributors include organizational promotion activities that create an atmosphere of excellence. Findings vary across urban, rural and blended environments.
Evidence-based practices require a strong organizational commitment to remain viable during difficult financial times.
On considère généralement que les enfants autistes développent peu de conduites d’imitation et il s’agit d’ailleurs d’un des critères diagnostiques classiques. On connaît notamment leurs difficultés spécifiques constatables dans les formes différées d’imitation, comme le jeu de faire semblant et le jeu social d’imitation, et leur indifférence manifeste à toute situation les éloignant de leurs objectifs immédiats. Il s’avère pourtant qu’ils se montrent ultérieurement capables d’imiter et d’utiliser l’imitation pour s’adapter. Alors qu’ils semblent durablement ne pas se préoccuper de l’opinion d’autrui et construire leurs désirs sans médiateurs sociaux, il arrive souvent qu’à l’adolescence se déclare ce besoin de se calquer sur d’autres érigés en modèles absolus. Alors que pendant longtemps, les personnes Asperger ne se montrent aucunement sensibles aux effets de mode et ne se fient qu’à leurs propres jugements, celles qui témoignent de leur parcours décrivent souvent l’émergence secondaire d’un profond souci de normalité plus que d’originalité, les amenant à copier l’apparence, les attitudes, les inflexions de la voix de ceux qui leur donnent le sentiment d’avoir parfaitement confiance en eux. Elles sont généralement conscientes de leur aspect caméléon et peuvent se soumettre à un entraînement intensif pour s’exercer et mettre en application leur apprentissage des normes sociales les plus reconnues. Elles n’en éprouvent aucune gêne et s’enorgueillissent plutôt des résultats obtenus. Par ce mimétisme délibéré, elles se livrent ainsi à une forme caricaturale de « désirabilité sociale », mais peut-on considérer que s’agit-il alors d’un accès tardif à un désir mimétique au sens où l’entend R. Girard ? La question mérite d’être posée.
Divers dispositifs d’accompagnement des patient(e)s anorexiques et de leurs familles sont proposés par les équipes de soins. Les groupes de parents et les thérapies familiales sont les plus courants, les groupes de patient(e)s sont moins répandus mais depuis quelques années ont été mis en place des groupes multifamiliaux associant plusieurs familles et plusieurs patient(e)s à des fréquences variées. Nous tenterons de rendre compte d’un « montage » peu décrit dans la littérature que nous avons mis en place au CHU d’Amiens depuis quelques années : un groupe de parents et un groupe d’adolescents anorexiques sont ainsi réunis successivement et alternativement un samedi matin par mois avec un même thérapeute qui assure un rôle de « go-between », mais aussi de facilitateur de pensée du trouble. Les notes prises dans l’après-coup des rencontres offrent un matériau permettant de mettre en valeur les axes de réflexion qui circulent dans chaque groupe et d’un groupe à l’autre à la demande des participants. Les adolescent(e)s reprennent certes à leur compte les stéréotypes largement utilisés pour caractériser leurs symptômes, mais parviennent secondairement à forger d’autres représentations plus inédites ou moins « avouables » du piège anorexique. Ils/elles souhaitent que leurs parents prennent conscience de leur accrochage nostalgique à l’enfance et de leur propension excessive à répondre aux attentes de leurs proches venant faire obstacle à leurs revendications adolescentes. Par contre, l’évocation de la fierté tirée de leur volonté inflexible et de la poursuite d’un idéal de minceur auquel les autres ne parviennent pas à accéder est plus difficilement transmissible. Les parents se soutiennent mutuellement, font d’abord état du bouleversement survenu dans la vie familiale depuis l’éclosion de cette maladie qui leur semble venue de nulle part, avant de pouvoir questionner timidement leurs principes éducatifs, leurs propres adolescences sans vagues, voire même le culte de l’esprit de famille et la position sacrificielle qu’il implique.
The provision of support for people with autism spectrum disorder (ASD) within the community is improving as a consequence of policy and legislative changes. However, specialist services are not currently provided in prisons.
This aim of the study was to determine the extent of ASD and co-occurring mental health problems among prisoners. We tested the hypothesis that ASD traits would be unrecognised by prison staff and would be significantly associated with increased rates of anxiety, depression and suicidality.
ASD traits were measured among 240 prisoners in a resettlement prison in London, UK using the 20-item Autism Quotient (AQ-20). Anxiety, depression and suicidality were assessed using the Mini International Neuropsychiatric Interview (MINI).
There were 39 participants (16%) with an AQ-20 score ≥10; indicating significant autistic traits. Mental health data were available for 37 ‘high autistic trait’ participants and another 101 prisoners with no/low ASD traits. There was a significant positive association between AQ-20 and suicidality scores (r=.29, p=0.001). Participants with ASD traits had significantly higher suicidality scores (means=15.1 vs. 5, p= 0.001) and chi-square analysis showed that they were more likely to have a high suicidality rating (27% vs. 8%, p=0.003) than those without ASD traits. Moreover, those with ASD were significantly more likely to be experiencing a current episode of depression (30% vs. 6%, p<0.001) or Generalised Anxiety Disorder (GAD) (27% vs. 11% p=0.019).
Our initial data suggests that severity of ASD traits is a risk factor for suicidality and common mental health problems among prisoners.