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This paper shows that global indeterminacy may characterize the three-dimensional vector field implied by the Lucas [(1988) Journal of Monetary Economics 22, 3–42] endogenous growth model. To achieve this result, we demonstrate the emergence of a family of homoclinic orbits connecting the steady state to itself in backward and forward time, when the stable and unstable manifolds are locally governed by real eigenvalues. In this situation, we prove that if the saddle quantity is negative, and other genericity conditions are fulfilled, a stable limit cycle bifurcates from the homoclinic orbit. Orbits originating in a tubular neighborhood of the homoclinic orbit are then bound to converge to this limit cycle, creating the conditions for the onset of global indeterminacy. Some economic intuitions related to this phenomenon are finally explored.
Modelling of experimental X-ray diffraction (XRD) patterns is used to determine the phase composition of partially dehydroxylated kaolinite samples. To identify unambiguously the presence of two or three phases in the heated kaolinite samples, the full range of their XRD patterns has to be analysed. Two different kaolinites, from Imerys (UK) and from Georgia (USA; KGa-21), were studied. The heating temperatures were selected to cover the entire range of dehydroxylation for both kaolinites (400–550°C for Imerys and 400–495°C for KGa-21). Two different dehydroxylation pathways were observed. At each stage of partial dehydroxylation, the kaolinite from Imerys consisted of the original, non-dehydroxylated kaolinite and of a fully dehydroxylated phase, metakaolinite. During partial dehydroxylation of kaolinite KGa-21, each product formed at a given heating temperature consisted of three phases: the original kaolinite; a dehydroxylated phase, metakaolinite; and a phase with diffraction features corresponding to a defective kaolinite-like structure. To determine the content of metakaolinite in a partially dehydroxylated specimen, its experimental XRD pattern was reproduced by the optimal summation of the diffraction patterns of the initial kaolinite and metakaolinite. A procedure that reveals the basic diffraction features of the third phase is suggested. The XRD patterns and thus the structures of the metakaolinites formed after dehydroxylation of the Imerys and KGa-21 samples differ substantially. The conventional determination of the initial kaolinite and metakaolinite contents in partially dehydroxylated kaolinite based on the analysis of basal reflections and weight losses may lead to overlooking the formation of the intermediate phases.
We argue that understanding of autism can be strengthened by increasing involvement of autistic individuals as researchers and by exploring cascading impacts of early sensory, perceptual, attentional, and motor atypicalities on social and communicative developmental trajectories. Participatory action research that includes diverse participants or researchers may help combat stigma while expanding research foci to better address autistic people's needs.
In her study of Greek offers, Bella uses experimental data collection methods to compare the use of politeness in offers directed at friends and offers made by students to their professors. Bella uses open role plays to establish the formulations her participants deem appropriate in the two situations, and retrospective verbal interviews to provide information about the motivations for their choice of politeness strategies. In the Greek context, offers have been defined as positive politeness devices, enhancing solidarity and reaffirming relationships, in line with the classification of Greece as a positive politeness culture. Bella’s study, however, illustrates that offers vary significantly according to the relationship between the interlocutors, with offers in asymmetrical situations characterised by a preference for negative politeness. These differences are reflected not only in the amount of directness expressed, but also through the degree of insistence. This sequential feature of offers is further illustrated on the basis of a naturally occurring interaction that validates the experimental data, while showing that politeness is an interactional phenomenon.
A high degree of vigilance and appropriate diagnostic methods are required to detect Clostridioides difficile infection (CDI). We studied the effectiveness of a multimodal training program for improving CDI surveillance and prevention. Between 2011 and 2016, this program was made available to healthcare staff of acute care hospitals in Catalonia. The program included an online course, two face-to-face workshops and dissemination of recommendations on prevention and diagnosis. Adherence to the recommendations was evaluated through surveys administered to the infection control teams at the 38 participating hospitals. The incidence of CDI increased from 2.20 cases/10 000 patient-days in 2011 to 3.41 in 2016 (P < 0.001). The number of hospitals that applied an optimal diagnostic algorithm rose from 32.0% to 71.1% (P = 0.002). Hospitals that applied an optimal diagnostic algorithm reported a higher overall incidence of CDI (3.62 vs. 1.92, P < 0.001), and hospitals that were more active in searching for cases reported higher rates of hospital-acquired CDI (1.76 vs. 0.84, P < 0.001). The results suggest that the application of a multimodal training strategy was associated with a significant rise in the reporting of CDI, as well as with an increase in the application of the optimal diagnostic algorithm.
Healthcare workers (HCWs) are at risk of acquiring and transmitting respiratory viruses while working in healthcare settings.
To investigate the incidence of and factors associated with HCWs working during an acute respiratory illness (ARI).
HCWs from 9 Canadian hospitals were prospectively enrolled in active surveillance for ARI during the 2010–2011 to 2013–2014 influenza seasons. Daily illness diaries during ARI episodes collected information on symptoms and work attendance.
At least 1 ARI episode was reported by 50.4% of participants each study season. Overall, 94.6% of ill individuals reported working at least 1 day while symptomatic, resulting in an estimated 1.9 days of working while symptomatic and 0.5 days of absence during an ARI per participant season. In multivariable analysis, the adjusted relative risk of working while symptomatic was higher for physicians and lower for nurses relative to other HCWs. Participants were more likely to work if symptoms were less severe and on the illness onset date compared to subsequent days. The most cited reason for working while symptomatic was that symptoms were mild and the HCW felt well enough to work (67%). Participants were more likely to state that they could not afford to stay home if they did not have paid sick leave and were younger.
HCWs worked during most episodes of ARI, most often because their symptoms were mild. Further data are needed to understand how best to balance the costs and risks of absenteeism versus those associated with working while ill.
To reveal the factors that determine the different ranges of compositional variations in high- and low-temperature Al-rich K-dioctahedral micas, relationships between structural parameters and cation composition were analysed for: (1) a series of synthetic 2M1 muscovite–phengite–aluminoceladonite samples; and (2) Al-rich, K-dioctahedral 2M1 micas with previously published refined structural data. The dependences of the unit-cell parameters on cation composition and the variations in tetrahedral and octahedral lateral dimensions and sheet thicknesses, interlayer distances and tetrahedral rotation angles were analysed and compared with those found previously for the series 1M trans-vacant (tv) illite–1M aluminoceladonite. The similarities in the variations of unit-cell parameters with cation composition observed in 2M1 and 1M natural and synthetic K-dioctahedral micas imply that these variations are controlled by similar – albeit not identical – structural factors. A major structural factor is the readjustment of the differently sized tetrahedral and octahedral sheets, which is realized in a different manner in micas formed under different pressure and temperature conditions.
Emergencies and disasters need inter-discipline and inter-professional approaches because many problems in a disaster are due to poor coordination and collaboration. The disaster events during a decade in Indonesia highlighted the limitations of the healthcare system in responding to large-scale public health problems. Disaster health preparedness is the key to an effective response to any problems in community and family. Thus, education for health students has become a priority.
Preparing fourth-year health students to be aware of disaster health problems in family and community with an inter-professional approach.
Faculty of Medicine, Public Health, and Nursing UGM were prepared for the fourth year undergraduate health students through a semester “Emergency and Disaster Course” under Community Family and Healthcare with the Inter-professional Education Program, first given in 2016 for four hundred students. Mix method between class lecture, training skill, and simulation. The course goals are to (1) educate students on disaster health management, (2) understand the health preparedness and disaster family kit, and (3) define the principle of health worker’s role and collaboration in disaster.
The course was well received and at the 2017-2018 session was improved based on students and faculty feedback. Disaster knowledge of students changed. However, they still had a problem in communication between professions. And addition, they became aware of the function and each role of health profession competency during a disaster.
A course for fourth-year health students about emergency and disaster health management is extremely relevant because they will be health workers soon. They must have good awareness, knowledge, and attitude to cope with disaster health problems in the future.
Located in the Pacific Ring of Fire, Indonesia is prone to natural hazards, such as earthquakes, tsunamis, floods, and volcanic activity. Management in the health sector is a necessary foundation for dealing with a disaster. Management lessons and essential experiences identified from disasters are often forgotten. The faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada has been developing disaster health management since 2009 after Padang Earthquake, followed by Merapi Volcano Eruption (2009), Pidie Jaya Earthquake (2016), and Lombok Earthquake (2018). The latest series of earthquakes that struck Central Sulawesi has revealed management problems with respect to the communication process, the development of coordination, and information and data synchronization.
To show the importance of effective management in a health cluster, including what went well, what went poorly, and what will happen from the acute phase until the transition phase.
Disaster health management implementation was compared from Padang to the Central Sulawesi’ earthquake. Then health cluster management was compared in Lombok and Central Sulawesi. Indicators were coordination, communication, data information, and organization.
There has been good progress for disaster health management in Indonesia. The health cluster approach makes coordination, data collected, and communication much easier. However, it also needs to focus on disaster planning, training, or simulation for the district health office while enhancing district response capacity. Although the challenges have changed in the last few decades, additional research is planned to limit management difficulties in the health cluster.
Indonesia’s road traffic fatality rate stands at 15.3 per 100,000 people, compared to 17 in the Southeast Asia region. Traffic fatalities are predicted to increase by 50%, becoming the third leading contributor to the global burden of disease by 2020. Indonesian police reported that 575 people died and 2,742 road accidents occurred during Eid-al-Fitr 2015. The problem is increasing rapidly in Indonesia, particularly during Ramadan. Policy makers need to recognize this growing problem as a public health crisis to prevent mass casualty incidents.
To assess the health system preparedness with regard to road traffic accidents during 2017 Eid-al-Fitr homecoming in West Java, Central Java, East Java, and Lampung.
The project started with an interview and observation followed by stakeholder analysis to assess the level of preparedness. This qualitative and quantitative research was conducted one month prior to Eid-al-Fitr homecoming 2017. The instruments were evaluated for policy, organization, communication, procedure, contingency plan, logistics, facility and human resources, financing, monitoring, evaluation, coordination, and socialization.
The levels of preparedness were moderate (B) for West Java, East Java, and Lampung, but high (A) for Central Java. Levels of preparedness based on district health office indicators were high for coordination, but low for a contingency plan. Levels of preparedness based on hospitals and primary health care were high for logistics and human resources, but low for a contingency plan and financing.
The findings indicated a moderate level (B) of health sector preparedness. Benchmark information from this research will provide information for further training in contingency planning, particularly for the district health office.
The effort of medical and health services distribution requires data. However, the data and information were ignored in an emergency situation. For improving the distribution of data and information, the Center of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada (UGM) developed forms based on Health Crisis Response Guideline by Ministry of Health 2016 and the World Health Organization (WHO).
Describing the implementation and development of forms based on Lombok and Central Sulawesi earthquake in 2018 for health cluster.
The form contains (1) a volunteer registration form; (2) a monitoring potential outbreak disease form; (3) health problem in health cluster daily report form; (4) a chronological situation form. This will be implemented in health policymaking by the Sulawesi district health office (DHO) and will be regularly analyzed in every week.
North Lombok DHO, Central Sulawesi health office, and volunteers accepted these forms well. Periodically volunteers had reported their activity to DHO. All these reports contain many health indicators including environmental health. Reproductive health and health promotion. Implementation of this form in the other type of disaster in Indonesia is suggested.
First, these forms are important to attach to the guideline of health crisis response in order to be accessed by all DHO. Second, all forms are printed documents. It needs to develop into data input and analysis applications.
Intracardiac teratomas are rare primary tumours. We report the case of an infant prenatally diagnosed with an isolated multi-cystic mass developed in the right ventricle causing neonatal refractory ventricular arrhythmia. Despite rescue extracorporeal support and partial surgical resection, he died as almost all the previous reported perinatal intracardiac teratomas whatever the prenatal tolerance and the size of the tumour. The common poor outcome of fetal intracardiac teratomas should be known when counselling parents during pregnancy.
According to European Guidelines for Legionnaires’ Disease prevention and control, travel-associated Legionnaires’ disease (TALD) cases are managed differently if classified as sporadic or as part of a cluster and more stringent control measures are deployed after clusters are identified. In this study, we propose to modify the current cluster definition: ‘two or more cases of Legionnaires’ disease (LD) who stayed at, or visited, the same commercial accommodation site 2–10 days before onset of illness and whose onset is within the same 2-year period’ with a new cluster definition, i.e. accommodation sites associated with multiple cases regardless of the time elapsed between them. TALD cases occurred in Italy and in the Balearic Islands between 2005 and 2015 were analysed applying the current European Legionnaires’ Disease Surveillance Network (ELDSNet) cluster definition. In a sample of selected accommodation sites with multiple cases, a microbiological study was also conducted. Using the new definition, 63 additional sites (16.4% increase) and 225 additional linked cases (19.5% increase) were identified. Legionella pneumophila sg1 was isolated from 90.7% of the selected accommodation sites. The use of the here proposed TALD cluster definition would warrant a full investigation for each new identified case. This approach should therefore increase the number of sites that will require a risk assessment and, in the presence of an increased risk, the adoption of LD control measures to hopefully prevent additional cases.
We propose a body-fitted mesh approach based on a semi-Lagrangian streaming step combined with an entropy-based collision model. After determining the order of convergence of the method, we analyse the flow past a circular cylinder in the lower subcritical regime, at a Reynolds number
, in order to assess the numerical performances for wall-bounded turbulence. The results are compared to experimental and numerical data available in the literature. Overall, the agreement is satisfactory. By adopting an efficient local refinement strategy together with the enhanced stability features of the entropic model, this method extends the range of applicability of the lattice Boltzmann approach to the solution of realistic fluid dynamics problems, at high Reynolds numbers, involving complex geometries.
In this investigation, we reported the increase in emergency department and inpatient admission cases during the month of November 2012 post Hurricane Sandy as compared with baseline (November 2010, 2011, and 2013) for elderly patients aged 65 and up.
Medical claims data for patients aged 65 and over treated at emergency department and inpatient health care facilities in New Jersey were analyzed to examine the surge in frequencies of diagnoses treated immediately following Hurricane Sandy. The differences were quantified using gap analysis for 2 years before and 1 year after the event.
There was an average increase of 1700 cases for the month of November 2012 relative to baseline for the top 15 most frequently diagnosed emergency department medical conditions. On a daily basis, a volume increase by an average 57 cases could be expected, including significant numbers of limb fractures and other trauma cases for these most frequently encountered medical conditions.
Understanding the surge level in medical services needed in emergency departments and inpatient facilities during a natural disaster aftermath is critical for effective emergency preparation and response for the elderly population. (Disaster Med Public Health Preparedness. 2018;12:730-738)
Palliative medicine is a growing field in Israel, and its training program is still in process. The current study aimed to evaluate students’ attitudes regarding a course in palliative care established in a division of oncology.
Some 45 medical students in their 5th to 6th years participated in a one-week course on palliative care. At the end of each training week, students were asked to complete a questionnaire, evaluating their attitudes regarding different aspects of the program content, such as its importance and relevance to their training as physicians, as well as the contribution of specific parts of the program to their knowledge regarding palliative care.
The overall satisfaction of the 45 students was high. The most contributory parts of the course were the multidisciplinary team and the complementary and alternative medicine. Participating in the staff meetings and accompanying physicians in their daily work were scored as the least contributory parts.
Significance of results
This preliminary study demonstrated students’ overall high satisfaction with the newly established palliative care course and their need for more practical skills. Future studies should investigate and evaluate educational programs in palliative care in order to establish suitable training for medical students.
The Hubble Source Catalog (HSC) combines lists of sources detected on images obtained with the WFPC2, ACS and WFC3 instruments aboard the Hubble Space Telescope (HST) and now available in the Hubble Legacy Archive. The catalogue contains time-domain information for about two million of its sources detected using the same instrument and filter on at least five HST visits. The Hubble Catalog of Variables (HCV) aims to identify HSC sources showing significant brightness variations. A magnitude-dependent threshold in the median absolute deviation of photometric measurements (an outlier-resistant measure of light-curve scatter) is adopted as the variability detection statistic. It is supplemented with a cut in χred2 that removes sources with large photometric errors. A pre-processing procedure involving bad image identification, outlier rejection and computation of local magnitude zero-point corrections is applied to the HSC light-curves before computing the variability detection statistics. About 52 000 HSC sources have been identified as candidate variables, among which 7,800 show variability in more than one filter. Visual inspection suggests that ∼70% of the candidates detected in multiple filters are true variables, while the remaining ∼30% are sources with aperture photometry corrupted by blending, imaging artefacts or image processing anomalies. The candidate variables have AB magnitudes in the range 15–27m, with a median of 22m. Among them are the stars in our own and nearby galaxies, and active galactic nuclei.