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What does it take for women to win political office? This book uncovers a gendered qualifications gap, showing that women need to be significantly more qualified than men to win elections. Applying insights from psychology and political science and drawing on experiments, public opinion data, and content analysis, Nichole M. Bauer presents new evidence of how voter biases and informational asymmetries combine to disadvantage female candidates. The book shows that voters conflate masculinity and political leadership, receive less information about the political experiences of female candidates, and hold female candidates to a higher qualifications standard. This higher standard is especially problematic for Republican female candidates. The demand for masculinity in political leaders means these women must “look like men” but also be better than men to win elections.
The objective of this study was to evaluate the effectiveness of a 911 trauma re-triage protocol implemented at a new community hospital in a region with a high volume of trauma and frequent transports by private vehicle.
This retrospective cohort study included all trauma patients ≥15 years old transferred via 911 trauma re-triage from a new community hospital over a 10-month period from August 2015 through April 2016. Criteria for 911 trauma re-triage were developed with input from local Emergency Medical Services (EMS) and trauma experts. An educational module, along with the criteria and implementation steps, was distributed to the emergency department (ED) personnel at the community hospital. Data were abstracted from the regional trauma registry, and the EMS patient care records were reviewed. Primary outcomes were: (1) median total transport time; and (2) proportion of patients who met the 911 re-triage criteria.
During the study period, 32 patients with traumatic injuries were transferred via 911 re-triage to the closest trauma center (TC). The median age of patients was 31 years (IQR 24-45 years) with 78% male and 66% suffering from a penetrating mechanism. The median prehospital provider scene time was 10 minutes (IQR 8-12 minutes) and transport time was seven minutes (IQR 6-9 minutes). Median total transport time was 17 minutes (IQR 15-20 minutes). Seventeen patients (53%) met 911 re-triage criteria as determined by study investigators. The most common criteria met was “penetrating injury to the head, neck, or torso” in 14 cases.
This study demonstrated that 911 re-triage was a feasible strategy to expeditiously transfer critical trauma patients to a TC within a mature trauma system in an urban-suburban setting with a median total transport time of 17 minutes.
This article analyses strategies for channelling a migrant population out of a country by indirect means. Specifically, we examine the response of the Ecuadorean state to the influx of Venezuelan newcomers since 2015. We argue that this response has been characterised by inaction, rooted not in policy failures or bad governance, but rather in a strategic governmental rationality. We show how migrants are ‘herded’ out of the country as a result of a form of indirect government that works differently from other ‘anti-immigrant’ policies like forced deportations or incarceration at the border, and yet produces similar outcomes.
Emergency Medical Services (EMS) systems have developed protocols for prehospital activation of the cardiac catheterization laboratory for patients with suspected ST-elevation myocardial infarction (STEMI) to decrease first-medical-contact-to-balloon time (FMC2B). The rate of “false positive” prehospital activations is high. In order to decrease this rate and expedite care for patients with true STEMI, the American Heart Association (AHA; Dallas, Texas USA) developed the Mission Lifeline PreAct STEMI algorithm, which was implemented in Los Angeles County (LAC; California USA) in 2015. The hypothesis of this study was that implementation of the PreAct algorithm would increase the positive predictive value (PPV) of prehospital activation.
This is an observational pre-/post-study of the effect of the implementation of the PreAct algorithm for patients with suspected STEMI transported to one of five STEMI Receiving Centers (SRCs) within the LAC Regional System. The primary outcome was the PPV of cardiac catheterization laboratory activation for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The secondary outcome was FMC2B.
A total of 1,877 patients were analyzed for the primary outcome in the pre-intervention period and 405 patients in the post-intervention period. There was an overall decrease in cardiac catheterization laboratory activations, from 67% in the pre-intervention period to 49% in the post-intervention period (95% CI for the difference, -14% to -22%). The overall rate of cardiac catheterization declined in post-intervention period as compared the pre-intervention period, from 34% to 30% (95% CI, for the difference -7.6% to 0.4%), but actually increased for subjects who had activation (48% versus 58%; 95% CI, 4.6%-15.0%). Implementation of the PreAct algorithm was associated with an increase in the PPV of activation for PCI or CABG from 37.9% to 48.6%. The overall odds ratio (OR) associated with the intervention was 1.4 (95% CI, 1.1-1.8). The effect of the intervention was to decrease variability between medical centers. There was no associated change in average FMC2B.
The implementation of the PreAct algorithm in the LAC EMS system was associated with an overall increase in the PPV of cardiac catheterization laboratory activation.
The issue of school attendance is currently the focus of intense activity in Schools & Local Educational Authorities in England. The latest figures from the Department for Schools, Children and Families shows the overall absenteeism as 6.26%, in England. It is thought approximately 1 to 5 percent of all school-aged children have school refusal (Fremont, 2003) and is one of the reason of School non attendance.
To investigate if the current practice regarding the assessment and management of school refusal is compliant with the local CAMHS School refusal protocol.
20 case notes of clients diagnosed with anxiety based school refusal were reviewed against standards
Majority (80%) of the patients attended their first CAMHS Clinic during which evaluations of Child (100%), family (100%) & school factors (70%) contributing to School refusal was carried out. We found anxiety disorders (83%) & depression (66%) as the main contributing child factors. We also found that nearly half of the children had parental mental illness as a signification contributory factor.
Following the initial assessment, school reports including attendance were requested in 84% of the cases. Unfortunately 33% of the patients who attended the 1st clinic did not attend further appointments. All the patients (67%) were offered gradual return to school, attendance at pupil referral unit and home tuition.25% were offered family therapy and 16% of the patients have their parents referred to the adult mental health unit. Individual works including behavioural and cognitive approach was undertaken in 42% of the cases.
The transition from a child and adolescent to an adult mental health service is necessary for young people whose mental health problems are likely to be both severe and enduring.
Adolescents between the ages of 10 and 20 make up 13-15% of the total population of the UK and they form a significant social group with major health needs.
The issue of concern is that some young people fail to make the transition, usually for reasons of service design, configuration and ethos.
The Trust transition protocol was developed to ensure that young people with continuing mental health problems, are effectively supported during the transition from child and adolescent mental health services (CAMHS) to adult mental health services(AMH) or other adult services.
To determine the compliance with trust guidelines in transfer of care from CAMHS to Adult mental health.
Consider practical and administrative issues that come up when implementing the current protocol.
Review of case notes of clients transferred to AMH between March 08 - July 09.
12 cases identified
All transfer had detailed written referral letter.In three-quarters of cases a care coordinator in AMH was allocated within 2-3 weeks of the referral, following which a formal transfer meeting took place in 75% of cases and during the transfer any crisis was managed by the CAMHS team.
GP & CMHT received a detailed discharge letter in majority of cases.However only 1/2 of cases had a planning meeting, and attendance at meetings was incomplete.
Pathological gambling is characterized in DSM IV-TR as one of the disorders of impulse control. Problem gambling is also part of what is considered behavioural addictions with intrusive thoughts about the game, are spending more and more important to play etc.
There is no epidemiological study in France, that's why we make an epidemiological study on the prevalence of pathological gambling.
We wanted to study the prevalence of pathological gambling in a sample of 529 persons: 368 gamers of Pari Mutuel Urbain and La Française des Jeux, and 161 persons in the general population.
We used as instruments: SOGS for screening of pathological gambling, BIS-10 for impulsiveness's evaluation, HAD scale to assess anxiety and depression and ASRS for the evaluation of attention deficit disorder / hyperactivity disorder.
The results show that the rate of pathological gambling in general population is 1.24% (this result is similar to those found in other countries such as Quebec)
Men are overrepresented in the group of pathological gamblers (88.9%), also with consumption of alcohol and tobacco. Depression and anxiety are particularly high, 40% of JPs with an anxiety score significantly higher.
It would be necessary to establish follow-up studies of populations and patients as well as specific studies on people who frequent casinos, racetracks and Internet gambling. Almost 20% of players have a gambling problem or risk and these people do not consult despite their psychological problems, family, work, debts…
Gambling behaviors of young adults may begin in adolescence and continue or even worsen in adulthood (Goudriaan et al., 2009).
Even if the young adult population is not an homogeneous group, studies show that almost 5% of young people, against 1% in general population showed pathological gambling (Dyke, 2009)
Our objective was to study the presence of problem gambling among a population of young adults in professional-schools.
We included 629 people, average age 20 and 66.4% of men. We used a battery of assessment scales of consumption of alcohol, tobacco, cannabis, pathological gambling, compulsive shopping, video games addiction, anxiety and depression.
The results show a prevalence of 1.6% of young people with a score of pathological gambling in the Canadian Problem Gambling Index (CPGI) and 7% with a score of problematic use.
The findings regarding depression, anxiety and other dependencies will be discussed.
Cocaine users often experience transient psychotic symptoms following cocaine use (Smith et al. 2009). The severity of such psychotic symptoms is influenced by cocaine dose (Vorspan et al. 2011). Several authors observed a higher prevalence of childhood trauma in cocaine addicts than control subjects (Enoch et al. 2010).
Describe cocaine induced psychosis and evaluate if it is associated with childhood trauma.
Define the population of cocaine users who experiment cocaine induced psychotic symptoms.
We did a transversal retrospective study. 100 outpatient cocaine users were evaluated with Scale for the Assessment of Positive Symptoms of Crack Induced Psychosis (SAPS-CIP) and Childhood Trauma Questionnaire (CTQ). Informations were obtained about lifetime cocaine use (age of onset, DSM IV dependence criteria, route of administration, daily dose, days of use per month).
We did not observe any link between SAPS-CIP and CTQ or CTQ and cocaine consumption. About cocaine consumption, more often patients took cocaine during the worst period, higher is the SAPS-CIP score. If patients are (or were) dependent to cocaine, they have higher scores on SAPS-CIP. Moreover, if patients took cocaine intravenously, they have higher scores on SAPS-CIP than if they took it by snorting, or smoking.
In the conditions of our study, childhood trauma isn’t a mediator for cocaine induced psychosis. About psychotic symptoms, they seem to be more severe among daily cocaine dependents who take it intravenously.
Driving is an essential activity of daily living for many patients. A diagnosis of dementia is likely to affect one's ability to continue driving safely due to cognitive decline. It is the role of the memory services team to inform the patient of the above, assess their risk and advise patients about their driving accordingly. Furthermore given that there are currently no gold standard assessment tools available, the method by which patient risk is assessed is often left of the discretion of the assessor. This literature review looks at assessment of driving to see if there is an effective method that could be adopted by memory service assessors.
To review literature with regards to assessing competency of driving in patients with dementia (pre and post disclosure).
To see if there are effective measures, tools or assessment criteria that can effectively determine if a patient is competent to continue driving.
PubMed and OvidSP search using ‘driving assessment’ and ‘dementia’ as search criteria for journal publications in English over the past five years.
The search gave 60 papers from pubmed and 14 from OvidSP. 12 papers met the criteria for selection.
There are many different tools that can be used to assess cognition, each with varying ability to identify those patients who are at risk when continuing to drive. The problem lies not only in detecting those at risk but there is also the issue over validation for the tests that are available
Memory services constitute a significant part of old age psychiatry. Part of the memory assessment includes discussion of driving status as legally there is a requirement to disclose a dementia diagnosis to the DVLA (Driving and Vehicle Licensing Agency). At assessment a driving assessment can be undertaken to establish whether a patient is safe to continue driving.
To establish if discussions regarding driving are taking place in memory assessment clinics, and if available guidance regarding dementia diagnosis and driving are followed. To then re-audit the department following dissemination of results from the initial audit.
Standards set were 100% of patients would have documented discussion of driving. 60 patients were randomly selected from 423 referrals to memory assessment clinic between August 2012 and January 2013. Their electronic records were accessed and audited for evidence regarding documented discussion of driving. The same process was repeated following dissemination of results, with 40 patients records audited between March and May 2014. Data was collected from Bristol Activity of Daily Living Scale (BADLS) and trust pro-forma.
Patients given a diagnosis of mild cognitive impairment were excluded. Of others, 55% of patients in the first audit and 56% of patients in the second audit had documented discussions regarding driving status.
Standards were not met in either audit for a multitude of reasons, including restructuring of services. Recommendations include improvement of information collection tools and further audit, allowing for a longer length of time for implementation of changes.
Memory services provide assessment to patients with memory difficulties. One important topic discussed is driving. This audit looks into whether discussions surrounding driving are documented in the patient's notes.
The objective was to see if discussions are held about driving with patients at memory clinics.
A similar audit was carried out in the south of the county. It was hoped that the findings and recommendations had been implemented in the North of the county, and improvements made.
Standards were set that 100% of patients seen by memory services would have a documented discussion about driving at the initial and/or disclosure appointment. A period of 6 months, August 2012 to January 2013 was selected. 423 patients were referred and 60 patient's notes were randomly selected using a random integer set generator to look at.
We are currently in the process of collecting and analyzing results. The results will be available before the conference.
By the time people with memory impairment access memory services they are likely to have been driving for most of their lives; it has provided them with independence and access to means. Despite this, requirements are set out by Driver and Vehicle Licensing Agency UK that they must be informed when the licence holder has been diagnosed with dementia. They can suspend a licence based on their assessment, for the safety of the patient and the public. It is therefore of vital importance that these discussions are taking place.
Older adults often have atypical presentation of illness and are particularly vulnerable to influenza and its sequelae, making the validity of influenza case definitions particularly relevant. We sought to assess the performance of influenza-like illness (ILI) and severe acute respiratory illness (SARI) criteria in hospitalized older adults.
Prospective cohort study.
The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network undertakes active surveillance for influenza among hospitalized adults.
Data were pooled from 3 influenza seasons: 2011/12, 2012/13, and 2013/14. The ILI and SARI criteria were defined clinically, and influenza was laboratory confirmed. Frailty was measured using a validated frailty index.
Of 11,379 adult inpatients (7,254 aged ≥65 years), 4,942 (2,948 aged ≥65 years) had laboratory-confirmed influenza. Their median age was 72 years (interquartile range [IQR], 58–82) and 52.6% were women. The sensitivity of ILI criteria was 51.1% (95% confidence interval [CI], 49.6–52.6) for younger adults versus 44.6% (95% CI, 43.6–45.8) for older adults. SARI criteria were met by 64.1% (95% CI, 62.7–65.6) of younger adults versus 57.1% (95% CI, 55.9–58.2) of older adults with laboratory-confirmed influenza. Patients with influenza who were prefrail or frail were less likely to meet ILI and SARI case definitions.
A substantial proportion of older adults, particularly those who are frail, are missed by standard ILI and SARI case definitions. Surveillance using these case definitions is biased toward identifying younger cases, and does not capture the true burden of influenza. Because of the substantial fraction of cases missed, surveillance definitions should not be used to guide diagnosis and clinical management of influenza.
It has long seemed plausible that the languages of hunter-gatherer societies might be systematically different from those of food producers. Compared to food-producing societies, hunter-gatherer societies are usually smaller and less complex, with lower population density. They are often based on kinship as a main organizing factor and usually lack large-scale sociopolitical organization with its concomitant traits such as language standardization.
Rumen sensors provide specific information to help understand rumen functioning in relation to health disorders and to assist in decision-making for farm management. This review focuses on the use of rumen sensors to measure ruminal pH and discusses variation in pH in both time and location, pH-associated disorders and data analysis methods to summarize and interpret rumen pH data. Discussion on the use of rumen sensors to measure redox potential as an indication of the fermentation processes is also included. Acids may accumulate and reduce ruminal pH if acid removal from the rumen and rumen buffering cannot keep pace with their production. The complexity of the factors involved, combined with the interactions between the rumen and the host that ultimately determine ruminal pH, results in large variation among animals in their pH response to dietary or other changes. Although ruminal pH and pH dynamics only partially explain the typical symptoms of acidosis, it remains a main indicator and may assist to optimize rumen function. Rumen pH sensors allow continuous monitoring of pH and of diurnal variation in pH in individual animals. Substantial drift of non-retrievable rumen pH sensors, and the difficulty to calibrate these sensors, limits their application. Significant within-day variation in ruminal pH is frequently observed, and large distinct differences in pH between locations in the rumen occur. The magnitude of pH differences between locations appears to be diet dependent. Universal application of fixed conversion factors to correct for absolute pH differences between locations should be avoided. Rumen sensors provide high-resolution kinetics of pH and a vast amount of data. Commonly reported pH characteristics include mean and minimum pH, but these do not properly reflect severity of pH depression. The area under the pH × time curve integrates both duration and extent of pH depression. The use of this characteristic, as well as summarizing parameters obtained from fitting equations to cumulative pH data, is recommended to identify pH variation in relation to acidosis. Some rumen sensors can also measure the redox potential. This measurement helps to understand rumen functioning, as the redox potential of rumen fluid directly reflects the microbial intracellular redox balance status and impacts fermentative activity of rumen microorganisms. Taken together, proper assessment and interpretation of data generated by rumen sensors requires consideration of their limitations under various conditions.
Nutritional therapy is a cornerstone of burns management. The optimal macronutrient intake for wound healing after burn injury has not been identified, although high-energy, high-protein diets are favoured. The present study aimed to identify the optimal macronutrient intake for burn wound healing. The geometric framework (GF) was used to analyse wound healing after a 10 % total body surface area contact burn in mice ad libitum fed one of the eleven high-energy diets, varying in macronutrient composition with protein (P5−60 %), carbohydrate (C20−75 %) and fat (F20−75 %). In the GF study, the optimal ratio for wound healing was identified as a moderate-protein, high-carbohydrate diet with a protein:carbohydrate:fat (P:C:F) ratio of 1:4:2. High carbohydrate intake was associated with lower mortality, improved body weight and a beneficial pattern of body fat reserves. Protein intake was essential to prevent weight loss and mortality, but a protein intake target of about 7 kJ/d (about 15 % of energy intake) was identified, above which no further benefit was gained. High protein intake was associated with delayed wound healing and increased liver and spleen weight. As the GF study demonstrated that an initial very high protein intake prevented mortality, a very high-protein, moderate-carbohydrate diet (P40:C42:F18) was specifically designed. The dynamic diet study was also designed to combine and validate the benefits of an initial very high protein intake for mortality, and subsequent moderate protein, high carbohydrate intake for optimal wound healing. The dynamic feeding experiment showed switching from an initial very high-protein diet to the optimal moderate-protein, high-carbohydrate diet accelerated wound healing whilst preventing mortality and liver enlargement.