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Despite the prevalence of quantitative approaches in applied linguistics (AL) and second language acquisition (SLA) research (Gass, 2009), evidence indicates a need for improvement in analyzing and reporting SLA data (e.g., Larson-Hall & Plonsky, 2015). However, to improve quantitative research, researchers must possess the statistical knowledge necessary to conduct quality research. This study assesses AL and SLA researchers’ knowledge of key statistical concepts on a statistical knowledge test. One hundred and ninety-eight AL and SLA researchers from North America and Europe responded to 26 discipline-specific questions designed to measure participants’ ability to (a) understand basic statistical concepts and procedures, (b) interpret statistical analyses, and (c) critically evaluate statistical information. Results indicate that participants generally understood basic descriptive statistics, but performance on items requiring more advanced statistical knowledge was lower. Quantitative research orientation, number of statistics courses taken, and frequent use of statistics textbooks had positive influences on researchers’ statistical knowledge.
In this large population study, we set out to examine the profile of mild behavioral impairment (MBI) by using the Mild Behavioral Impairment Checklist (MBI-C) and to explore its factor structure when employed as a self-reported and informant-rated tool.
A total of 5,742 participant-informant dyads participated in the study.
Both participants and informants completed the MBI-C. The factor structure of the MBI-C was evaluated by exploratory factor analysis.
The most common MBI-C items, as rated by self-reported and informants, related to affective dysregulation (mood/anxiety symptoms), being present in 34% and 38% of the sample, respectively. The least common items were those relating to abnormal thoughts and perception (psychotic symptoms) (present in 3% and 6% of the sample, respectively). Only weak correlations were observed between self-reported and informant-reported MBI-C responses. Exploratory factor analysis for both sets of respondent answers indicated that a five-factor solution for the MBI-C was appropriate, reflecting the hypothesized structure of the MBI-C.
This is the largest and most detailed report on the frequency of MBI symptoms in a nondementia sample. The full spectrum of MBI symptoms was present in our sample, whether rated by self-reported or informant report. However, we show that the MBI-C performs differently in self-reported versus informant-reported situations, which may have important implications for the use of the questionnaire in clinic and research.
Understanding the natural course of neuropsychiatric symptoms (NPS) in dementia is important for planning patient care and trial design, but few studies have described the long-term course of NPS in individuals.
Primary inclusion of 223 patients with suspected mild dementia from general practice were followed by annual assessment, including the Neuropsychiatric Inventory (NPI), for up to 12 years. Total and item NPI scores were classified as stable, relapsing, single episodic or not present based on 4.96 (s.d. 2.3) observations (98% completeness of longitudinal data) for 113 patients with Alzheimer's disease and 84 patients with LBD (68 dementia with Lewy bodies and 16 Parkinson's disease dementia).
We found that 80% had stable NPI total ≥1, 50% had stable modest NPI total ≥12 and 25% had stable NPI total ≥24 scores. Very severe NPS (≥48) were mostly single episodes, but 8% of patients with Alzheimer's disease had stable severe NPS. Patients with Alzheimer's disease and the highest 20% NPI total scores had a more stable or relapsing course of four key symptoms: aberrant motor behaviour, aggression/agitation, delusions and irritability (odds ratio 55, P < 0.001). This was not seen in LBD. Finally, 57% of patients with Alzheimer's disease and 84% of patients with LBD had reoccurring psychotic symptoms.
We observed a highly individual course of NPS, with most presenting as a single episode or relapsing; a stable course was less common, especially in LBD. These findings demonstrate the importance of an individualised approach (i.e. personalised medicine) in dementia care.
Declaration of interest
A.O.V.-M., L.M.G. and M.G.B. declare that they have no conflict of interest. C.B. has received grants and personal fees from Acadia and Lundbeck and personal fees from Heptares, Roche, Lilly, Otsuka, Orion, GSK and Pfizer. D.A. has received research support and/or honoraria from Astra-Zeneca, H. Lundbeck, Novartis Pharmaceuticals and GE Healthcare and serves as paid consultant for H. Lundbeck, Eisai and Axovant.
In 2011, in the Interlake region of Manitoba, a human-made flood displaced 17 First Nation communities whose peoples have deep ancestral ties to their land. The human-made flood and forced displacement created devastating effects such as premature death, worsening chronic illnesses, depression, and loneliness. In 2015, a First Nations Elders gathering was held in Winnipeg to discuss ways to heal from the human-made flood with more than 200 attendees. A qualitative approach within a participatory framework was used to document Elders’ perspectives. Twenty-three Elders participated in video-recorded, semi-structured interviews in Ojibway and English. Small group discussions were documented and transcripts were transcribed verbatim. Elders’ recommendations towards reconciliation with minoayawin (well-being) were shared via a healing booklet and website. Elders shared their insights about their peoples’ and communities’ need to heal and offered these strategies to move forward: forgive, stand united, promote self-determination, reclaim cultural identity, and connect with the land.
Adélie penguins are renowned for their natal philopatry on land-based colonies, requiring small pebbles to be used for nests. We report on an opportunistic observation via aerial survey, where hundreds of Adélie penguins were documented displaying nesting behaviours on fast ice ~3 km off the coast of Cape Crozier, which is one of the largest colonies in the world. We counted 426 Adélie penguins engaging in behaviours of pair formation, spacing similarly to normal nest distributions and lying in divots in the ice that looked like nests. On our first visit, it was noticed that the guano stain was bright pink, consistent with krill consumption, but had shifted to green over the course of ~2 weeks, indicating that the birds were fasting (a behaviour consistent with egg incubation). However, eggs were not observed. We posit four hypotheses that may explain the proximate causes of this behaviour and caution against future high-resolution satellite imagery interpretation due to the potential for confusing ice-nesting Adélie penguins with the presence of emperor penguin colonies.
Introduction: Needle-related procedures are considered the most important source of pain and distress in children in hospital settings. Time constraints, heavy workload, busy and noisy environment represent barriers to the use of available interventions for pain management during needle-related procedures. Therefore, the use of a rapid, easy-to-use intervention could improve procedural pain management practices. The objective was to determine if a device combining cold and vibration (Buzzy) is non-inferior (no worse) to a topical anesthetic (Maxilene) for pain management in children undergoing needle-related procedures in the Emergency Department (ED). Methods: This study was a randomized, controlled, non-inferiority trial. We enrolled children aged between 4-17 years presenting to the ED and requiring a needle-related procedure. Participants were randomly assigned to the Buzzy or Maxilene group. The primary outcome was the mean difference in pain intensity during the procedure, as measured with the CAS (0-10). Secondary outcomes were procedural distress, success of the procedure at first-attempt and satisfaction of parents. Results: A total of 352 participants were enrolled and 346 were randomized (Buzzy = 172; Maxilene = 174). Mean difference in procedural pain scores between groups was 0.64 (95%CI -0.1 to 1.3), showing that the Buzzy device was not non-inferior to Maxilene according to a non-inferiority margin of 0.70. No significant differences were observed for procedural distress (p = .370) and success of the procedure at first attempt (p = .602). Parents of both groups were very satisfied with both interventions (Buzzy = 7.8 ±2.66; Maxilene = 8.1 ±2.4), but there was no significant difference between groups (p = .236). Conclusion: Non-inferiority of the Buzzy device over a topical anesthetic was not demonstrated for pain management of children during a needle-related procedure in the ED. However, considering that topical anesthetics are underused in the ED setting and require time, the Buzzy device seems to be a promising alternative as it is a rapid, low-cost, easy-to-use and reusable intervention.
This descriptive paper aims to describe the design and implementation of a community engaged primary healthcare strategy in rural Australia, the Primary Healthcare Registered Nurse: Schools-Based strategy. This strategy seeks to address the health, education and social inequities confronting children and adolescents through community engaged service provision and nursing practice.
There have been increasing calls for primary healthcare approaches to address rural health inequities, including contextualised healthcare, enhanced healthcare access, community engagement in needs and solutions identification and local-level collaborations. However, rural healthcare can be poorly aligned to community contexts and needs and be firmly entrenched in health systems, marginalising community participation.
This strategy has been designed to enhance nursing service and practice responsiveness to the rural context, primary healthcare principles, and community experiences and expectations of healthcare. The strategy is underpinned by a cross-sector collaboration between a local health district, school education and a university department of rural health. A research framework is being developed to explore strategy impacts for service recipients, cross-sector systems, and the establishment and maintenance of a primary healthcare nursing workforce.
Although in the early stages of implementation, key learnings have been acquired and strategic, relationship, resource and workforce gains achieved.
We investigated the risk factors and origins of the first known occurrence of VRE colonization in the neonatal intensive care unit (NICU) at the Canberra Hospital.
A retrospective case-control study.
A 21-bed neonatal intensive care unit (NICU) and a 15-bed special care nursey (SCN) in a tertiary-care adult and pediatric hospital in Australia.
All patients admitted to the NICU and SCN over the outbreak period: January–May 2017. Of these, 14 were colonized with vancomycin-resistant Enterococcus (VRE) and 77 were noncolonized.
Demographic and clinical variables of cases and controls were compared to evaluate potential risk factors for VRE colonization. Whole-genome sequencing of the VRE isolates was used to determine the origin of the outbreak strain.
Swift implementation of wide-ranging infection control measures brought the outbreak under control. Multivariate logistic regression revealed a strong association between early gestational age and VRE colonization (odds ratio [OR], 3.68; 95% confidence interval [CI], 1.94–7.00). Whole-genome sequencing showed the isolates to be highly clonal Enterococcus faecium ST1421 harboring a vanA gene and to be closely related to other ST1421 previously sequenced from the Canberra Hospital and the Australian Capital Territory.
The colonization of NICU patients was with a highly successful clone endemic to the Canberra Hospital likely introduced into the NICU environment from other wards, with subsequent cross-contamination spreading among the neonate patients. Use of routine surveillance screening may have identified colonization at an earlier stage and have now been implemented on a 6-monthly schedule.
Two proposed methods are described for obtaining the depth profiles (τ-profiles) of strains and stresses as a function of the 1/e penetration depth τ, using GIXD in the asymmetric geometry, without the need for layer removal. In the first, the ψ-method: ψ is varied, for a given reflection, while holding τ constant, by varying the wavelength λ and adjusting the incident angle α so as to maintain τ constant. This allows dϕ,ψ vs Sin2ψ plots to be obtained at constant τ. In the second, the ϕ-integral method: interplanar spacings dϕ,ψ are measured for ϕ values from 0 to 2π, at constant ψ and τ by holding α fixed. Two ψ values, i.e. two wavelengths, are needed to obtain the whole strain tensor, but if the sample is quasi-isotropic and the stress state is biaxial, only one wavelength is needed. A direct method is also described for obtaining the profiles as a function of depth z (z-profiles) from the corresponding τ-profiles using inverse Laplace transforms. Application of the method to the residual strain vs τ data of Doerner and Brennan for an Al film on Si is presented.
Methods are described which make use of x-ray absorbing masks to either limit beam penetration in the sample (Type I), or confine the diffracting volume within definite limits (Type II). The masks consist of a metal film of Au or U, containing many long, parallel apertures of effective width w and spacing c. The mask is either applied directly to the sample surface (Type I), or to a weakly absorbing film (Be or Kapton) on the sample surface (Type II). With the Type I mask, the diffracting volume can be limited to a surface layer whose maximum depth zm at ψ=0 varies linearly with w, irrespective of sample or wavelength. The masks can be used with ψ-tilts in an Ω-type goniometer, and strains and stresses can be determined by the Sin2ψ method. Depth profiles as a function of depth z (z-profiles) can be obtained with layer removal if gradients over the depth Zm can be neglected. With the Type n mask, the diffracting volume can be limited to a discrete subsurface layer whose average depth depends on (c+w) and the Bragg angle 2θ, and whose thickness depends on w and 2θ. z-Profiles can be obtained by varying the wavelength for a given reflection using a synchrotron source, without the need for layer removal. The methods have not yet been tested experimentally.
Two different inversion methods, the inverse Laplace method and the linear constrained numerical method, for retrieving the z-profiles of diffraction data from experimentally obtained τ-profiles were compared using tests with a known function as the original z-profile. Two different real data situations were simulated to determine the effects of specimen thickness and missing τ-profiles data at small τ-values on the retrieved z-profiles. The results indicate that although both methods are able to retrieve the z-profiles in the bulk specimens satisfactorily, the numerical method can be used for thin film samples as well. Missing τ-profile data at small τ values causes error in the retrieved z-profiles with both methods, particularly when the trend of the τ-profile at small τ is significantly changed because of the missing data
Intrinsic stresses as a function of σ, the 1/e penetration depth were measured for a smooth, 1μm thick, fine grained, cylindrical post magnetron sputtered molybdenum film deposited on a vycor glass substrate in the dynamic deposition mode. Using grazing incidence diffraction and the Mo (321) reflection, lattice spacing profiles were determined for τ values from 200-4400 Å. The in-plane intrinsic stresses parallel and perpendicular to the post axis were determined employing the ϕ-integral method and assuming elastic isotropy. The results were related to the surface structure and composition profiles via atomic force microscopy (AFM) and auger electron spectroscopy (AES) respectively.
Depth profiles of intrinsic in-plane, biaxial stresses were obtained as a function of τ, the 1/e penetration depth, in a 1.0 um thick planar d. c. magentron sputter deposited molybdenum film using asymmetric grazing incidence x-ray diffraction (GIXD). τ was varied between 20 and 276 Å. The stresses σ11 and σ22 were characterized in the directions parallel and perpendicular to the long axis of the cathode respectively using a cos2φ method. The results show that starting from τ=17Å, σ11 and σ22 are compressive and become rapidly more compressive with a minimum at τ ∼ 20 - 40 Å thereafter increasing gradually toward tensile values. The reasons for the shape of the stress gradient are not well understood but may be related to the relaxation of the stresses at the tops of the columnar Zone T-type microstructure and to the oxygen gradient in the film.
A method for using grazing incidence x-ray diffraction (GIXD) for profiling composition changes with depth of photovoltaic quality thin films is presented. The average thickness of the first layer in a multi-layer film of CuIn2Se3.5/CuInSe2/Mo and the variation in solid solution composition of a Cu(In1-xGax)Se2 (CIGS) film with depth are solved using this method. The phase volume fraction and the phase composition profiles are developed from peak intensity and d-spacing measurements respectively at a series of fixed incident angles corresponding to a set of increasing 1/e penetration depths, τ. Inverse Laplace and numerical methods are applied to the τ profiles converting them to true depth profiles. Vegard's law is applied to the d-spacing vs z-profile to obtain x in the formula Cu(In1-xGax)Se2. The results show that an ∼1 μm thick layer of CuIn2Se3.5 is present on the surface of the multi-layer film and that the CIGS film consists of a Ga rich surface layer ∼2000 Å thick followed by a gradual decrease in Ga content with increasing depth. This gradient appears to be desirable for producing photovoltaic quality CIGS films.
A numerical procedure known as the constrained linear inversion method is employed for obtaining the z-profiles of diffraction data from their τ-profiles. The method was first tested with known z-profiles and gave good agreement with the starting z-profiles even with up to 5% random noise introduced into the τ-profile or up to 10% error in specimen thickness. The procedure was then applied to an experimentally obtained strain profile and a non-oscillatory z-profile was calculated. Although the z-profile obtained could not be verified by an independent method, the success of tests with known z-profiles leads to increased confidence in the numerical method described.
Residual strains in a hot-pressed α-Al2O3/25 wt % β-SiC (whisker) composite were determined at temperatures from 25 to 1000°C in 250°C increments. The data collected from the (146) reflections of Al2O3 and the (511+333) reflections of SiC whiskers indicates that residual strains in both phases decrease linearly with temperature; the composite's extrapolated zero-strain temperature is determined to be 1471°C and comparable to the value ~1350 °C obtained by Majumdar et al. from neutron data. The lattice thermal expansion of the whiskers agrees well with literature, data for the monolithic β-SiC form.
The present study aimed to determine the relationship among food insecurity, social support and mental well-being in sub-Saharan Africa, a region presenting the highest prevalence of severe food insecurity and a critical scarcity of mental health care.
Food insecurity was measured using the Food Insecurity Experience Scale (FIES). Social support was assessed using dichotomous indicators of perceived, foreign perceived, received, given, integrative and emotional support. The Negative and Positive Experience Indices (NEI and PEI) were used as indicators of mental well-being. Multilevel mixed-effect linear models were applied to examine the associations between mental well-being and food security status, social support and their interaction, respectively, accounting for random effects at country level and covariates.
Nationally representative adults surveyed through Gallup World Poll between 2014 and 2016 in thirty-nine sub-Saharan African countries (n 102 235).
The prevalence of severe food insecurity was 39 %. The prevalence of social support ranged from 30 to 72 % by type. In the pooled analysis using the adjusted model, food insecurity was dose-responsively associated with increased NEI and decreased PEI. Perceived, integrative and emotional support were associated with lower NEI and higher PEI. The differences in NEI and PEI between people with and without social support were the greatest among the most severely food insecure.
Both food insecurity and lack of social support constitute sources of vulnerability to poor mental well-being. Social support appears to modify the relationship between food security and mental well-being among those most affected by food insecurity in sub-Saharan Africa.
Behavioral and psychological symptoms of dementia (BPSD) are nearly universal in dementia, a condition occurring in more than 40 million people worldwide. BPSD present a considerable treatment challenge for prescribers and healthcare professionals. Our purpose was to prioritize existing and emerging treatments for BPSD in Alzheimer's disease (AD) overall, as well as specifically for agitation and psychosis.
International Delphi consensus process. Two rounds of feedback were conducted, followed by an in-person meeting to ratify the outcome of the electronic process.
2015 International Psychogeriatric Association meeting.
Expert panel comprised of 11 international members with clinical and research expertise in BPSD management.
Consensus outcomes showed a clear preference for an escalating approach to the management of BPSD in AD commencing with the identification of underlying causes. For BPSD overall and for agitation, caregiver training, environmental adaptations, person-centered care, and tailored activities were identified as first-line approaches prior to any pharmacologic approaches. If pharmacologic strategies were needed, citalopram and analgesia were prioritized ahead of antipsychotics. In contrast, for psychosis, pharmacologic options, and in particular, risperidone, were prioritized following the assessment of underlying causes. Two tailored non-drug approaches (DICE and music therapy) were agreed upon as the most promising non-pharmacologic treatment approaches for BPSD overall and agitation, with dextromethorphan/quinidine as a promising potential pharmacologic candidate for agitation. Regarding future treatments for psychosis, the greatest priority was placed on pimavanserin.
This international consensus panel provided clear suggestions for potential refinement of current treatment criteria and prioritization of emerging therapies.
Delirium is very frequent in older patients presenting to the emergency department (ED), but is often undetected. The purpose of this study was to evaluate the performance of the French version of the 4 A’s Test (4AT-F) for the detection of delirium and cognitive impairment in older patients.
The study was conducted in four Canadian ED. Participants (n= 320) were independent or semi-independent patients (able to perform ≥5 activities of daily living) aged 65 and older and had an 8-hour exposure to the ED environment. The Telephone Interview for Cognitive Status (TICS-m), the Confusion Assessment Method (CAM) as well as the 4AT-F were administered to patients at the initial interview. The CAM and 4AT-F were then administered twice a day during the patients’ ED or hospital stay. The 4AT-F’s sensitivity and specificity were compared to those of the CAM (for delirium), and to that of the TICS (for cognitive impairment).
Our results suggest that the 4AT-F has a sensitivity of 84% (95% CI: [76, 93]) and a specificity of 74% (95% CI: [70, 78]) for delirium, as well as a sensitivity of 49% (95% CI: [34, 64]) and a specificity of 87% (95% CI: [82, 92]) for cognitive impairment.
The 4AT-F is a fast and reliable screening tool for delirium and cognitive impairment in ED. Due to its quick administration time, it allows a systematic screening of patients at risk of delirium, without significantly increasing the workload of the ED staff.