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To determine feasibility and efficacy of an Emergency Department Violence Intervention Program (EDVIP) to reduce violence related injuries in youth.
One hundred and thirty youth aged 14–24 presenting to an emergency with violence related injury were randomized in parallel to receive EDVIP for 1 year (n = 65) or a waitlist control (n = 65). The primary outcome was to determine feasibility. Secondary outcomes are incidence, number/severity of repeat violence related injury, justice and education systems interactions, substance misuse and mental health presentations, and ED length of stay (LOS).
This study established feasibility in recruitment, outcomes collection and safety. Fidelity and adherence measures required optimization during the study. Efficacy analysis of EDVIP vs. the control group demonstrates an absolute decrease of 10.4% in repeat violence related injury (13.7% vs. 24.1%) (p = 0.15), reduction in new interactions in the justice system (OR = 0.36 (0.07–1.77)), improved engagement in education (11.8% EDVIP vs. 7.6% control, p = 0.42) and no change in repeat visits for substance or mental health. LOS decreased by 59.5 min (p = 0.21).
This program is feasible for ED implementation and for completion of a future RCT to measure effectiveness.
On many Australian commercial pig farms, groups of growing pigs are mass-medicated through their drinking water with selected antimicrobials for short periods to manage herd health. However, delivery of medication in drinking water cannot be assumed to deliver an equal dose to all animals in a group. There is substantial between-animal variability in systemic exposure to an antimicrobial (i.e. the antimicrobial concentration in plasma), resulting in under-dosing or over-dosing of many pigs. Three sources of this between-animal variability during a water medication dosing event are differences in: (1) concentration of the active constituent of the antimicrobial product in water available to pigs at drinking appliances in each pen over time, (2) medicated water consumption patterns of pigs in each pen over time, and (3) pharmacokinetics (i.e. oral bioavailability, volume of distribution and clearance between pigs and within pigs over time). It is essential that factors operating on each farm that influence the range of systemic exposures of pigs to an antimicrobial are factored into antimicrobial administration regimens to reduce under-dosing and over-dosing.
To sustainably improve cleaning of high-touch surfaces (HTSs) in acute-care hospitals using a multimodal approach to education, reduction of barriers to cleaning, and culture change for environmental services workers.
The study was conducted in 2 academic acute-care hospitals, 2 community hospitals, and an academic pediatric and women’s hospital.
Frontline environmental services workers.
A 5-module educational program, using principles of adult learning theory, was developed and presented to environmental services workers. Audience response system (ARS), videos, demonstrations, role playing, and graphics were used to illustrate concepts of and the rationale for infection prevention strategies. Topics included hand hygiene, isolation precautions, personal protective equipment (PPE), cleaning protocols, and strategies to overcome barriers. Program evaluation included ARS questions, written evaluations, and objective assessments of occupied patient room cleaning. Changes in hospital-onset C. difficile infection (CDI) and methicillin-resistant S. aureus (MRSA) bacteremia were evaluated.
On average, 357 environmental service workers participated in each module. Most (93%) rated the presentations as ‘excellent’ or ‘very good’ and agreed that they were useful (95%), reported that they were more comfortable donning/doffing PPE (91%) and performing hand hygiene (96%) and better understood the importance of disinfecting HTSs (96%) after the program. The frequency of cleaning individual HTSs in occupied rooms increased from 26% to 62% (P < .001) following the intervention. Improvement was sustained 1-year post intervention (P < .001). A significant decrease in CDI was associated with the program.
A novel program that addressed environmental services workers’ knowledge gaps, challenges, and barriers was well received and appeared to result in learning, behavior change, and sustained improvements in cleaning.
Background: Neonatal hypoxic ischemic encephalopathy (HIE) is a clinical phenomenon, that often results from pre or perinatal reduced cerebral blood flow and/or hypoxemia. However, in some cases, neonates present with HIE without significant risk factors or have an unusual clinical course. With the advent of advanced genetic testing, we aimed to explore if such infants had genetic risk factors predisposing them to an HIE-phenotype. Methods: We reviewed 206 charts of infants meeting local protocol criteria for moderate to severe HIE at Level III NICU’s in Calgary, Alberta. Of these, 27 patients had genetic testing such as microarray, whole exome sequencing, or gene panels. Results: Six/twenty-seven patients had genetic mutations; two CDKL5 mutations (protein kinase), one CFTR mutation (cystic fibrosis), one PDH deficiency, one CYP21A2 mutation (congenital adrenal hyperplasia), and one ISY1 (VUS; pre-mRNA splicing). Two patients had noted difficult deliveries and four had minor complications, but all were out of keeping with the severity of presumed HIE. Conclusions: This preliminary study demonstrates a possible association between genetic co-morbidities and predisposition towards HIE in the context of a relatively uneventful pre/perinatal course. Earlier identification of genetic etiology, recognized by a discrepancy between risk factors and clinical presentation, could aid in treatment decisions and outcome prognostication.
We have used ground-penetrating radar (GPR) to observe englacial structural control upon the development of an esker formed during a high-magnitude outburst flood (jökulhlaup). The surge-type Skeiðarárjökull, an outlet glacier of the Vatnajökull ice cap, Iceland, is a frequent source of jökulhlaups. The rising-stage waters of the November 1996 jökulhlaup travelled through a dense network of interconnected fractures that perforated the margin of the glacier. Subsequent discharge focused upon a small number of conduit outlets. Recent ice-marginal retreat has exposed a large englacial esker associated with one of these outlets. We investigated structural controls on esker genesis in April 2006, by collecting >2.5km of GPR profiles on the glacier surface up-glacier of where the esker ridge has been exposed by meltout. In lines closest to the exposed esker ridge, we interpret areas of englacial horizons up to ~30m wide and ~10–15m high as an up-glacier continuation of the esker sediments. High-amplitude, dipping horizons define the base of esker materials across many lines. Similar dipping surfaces deeper in the profiles suggest that: (1) the dipping surfaces beneath the esker are englacial tephera bands; (2) floodwaters were initially discharged along structurally controlled englacial surfaces (tephra bands); (3) the rapid increase in discharge resulted in hydrofracturing; (4) establishment of preferential flow paths resulted in conduit development along the tephra bands due to localized excavation of surrounding glacier ice; and (5) sedimentation took place within the new accommodation space to form the englacial structure melting out to produce the esker.
Stranded in Jamaica for a year in AD 1503, Christopher Columbus and crew became reliant on the Taíno village of Maima for provisions. Recent archaeological survey and excavations at this site document a sizeable hillside settlement established early in the White Marl period of Jamaican culture history with continued occupation up to Spanish contact. Beginning by 13th to 14th century AD, the people at Maima expanded their settlement capacity across the hillslope through construction of house terraces and platforms employing large volumes of limestone rock and gravel fill. Archaeological excavation on these features has exposed at least one circular, center-pole Taíno house with a surprisingly limited floor space. A review of Jamaican archaeology suggests both hillside terracing and small house form is characteristic of Jamaican Taíno village configuration more broadly. This pattern stands in contrast to other areas of Taíno settlement in the Caribbean, and to the small number of Spanish chronicles in which Taíno villages and houses are described.
In this study, we used an online survey to assess knowledge, attitudes, and practices related to environmental cleaning and other infection prevention strategies among environmental services workers (ESWs) at 5 hospitals. Our findings suggest that ESWs could benefit from additional education and feedback as well as new strategies to address workflow challenges.
Since the previous edition of these guidelines, significant changes have taken place in the training and assessment of surgeons and oncologists who treat patients with head and neck cancer. For those intending to become head and neck surgeons, a fellowship in head and neck surgery is virtually mandatory. This paper summarises the current career structure to specialise in head and neck oncology and surgery in the UK.
• Trainees applying for head and neck surgical oncology consultant posts should have completed additional training in the subspecialty.
It has been previously demonstrated that a cognitive bias against disconfirmatory evidence (BADE) is associated with delusions. However, small samples of delusional patients, reliance on difference scores and choice of comparison groups may have hampered the reliability of these results. In the present study we aimed to improve on this methodology with a recent version of the BADE task, and compare larger groups of schizophrenia patients with/without delusions to obsessive–compulsive disorder (OCD) patients, a population with persistent and possibly bizarre beliefs without psychosis.
A component analysis was used to identify cognitive operations underlying the BADE task, and how they differ across four groups of participants: (1) high-delusional schizophrenia, (2) low-delusional schizophrenia, (3) OCD patients and (4) non-psychiatric controls.
As in past studies, two components emerged and were labelled ‘evidence integration’ (the degree to which disambiguating information has been integrated) and ‘conservatism’ (reduced willingness to provide high plausibility ratings when justified), and only evidence integration differed between severely delusional patients and the other groups, reflecting delusional subjects giving higher ratings for disconfirmed interpretations and lower ratings for confirmed interpretations.
These data support the finding that a reduced willingness to adjust beliefs when confronted with disconfirming evidence may be a cognitive underpinning of delusions specifically, rather than obsessive beliefs or other aspects of psychosis such as hallucinations, and illustrates a cognitive process that may underlie maintenance of delusions in the face of counter-evidence. This supports the possibility of the BADE operation being a useful target in cognitive-based therapies for delusions.
The presence of 10 virulence genes was examined using polymerase chain reaction (PCR) in 365 European O157 and non-O157 Escherichia coli isolates associated with verotoxin production. Strain-specific PCR data were analysed using hierarchical clustering. The resulting dendrogram clearly separated O157 from non-O157 strains. The former clustered typical high-risk seropathotype (SPT) A strains from all regions, including Sweden and Spain, which were homogenous by Cramer's V statistic, and strains with less typical O157 features mostly from Hungary. The non-O157 strains divided into a high-risk SPTB harbouring O26, O111 and O103 strains, a group pathogenic to pigs, and a group with few virulence genes other than for verotoxin. The data demonstrate SPT designation and selected PCR separated verotoxigenic E. coli of high and low risk to humans; although more virulence genes or pulsed-field gel electrophoresis will need to be included to separate high-risk strains further for epidemiological tracing.
During the 1960s and 1970s, aerial reconnaissance on the northern side of the confluence of the Rivers Trent, Tame, and Mease in Staffordshire revealed a cluster of features indicative of prehistoric ceremonial activity. Some of the features within the cluster are morphologically unique, but a lack of previous investigation meant that their dating, phasing, and function were unknown. This paper details the results of a multi-disciplinary approach to addressing these questions about the complex and to place it into its contemporary landscape context. The results indicate that the complex represents numerous phases of symbolic and ceremonial activity extending from the late Neolithic and into the early Bronze Age. Furthermore, it has shown how these structures fit within a wider landscape of ceremonial activity extending back to the earlier Neolithic and continuing into the Bronze Age.
A key component of social work ethics is social justice and equitable access to resources. Increasingly, this includes access to technology. This study addresses issues related to the ‘digital divide’ by testing a peer tutor model (Technology and Aging Project, TAP2) to teach adults aged 60 and older how to use information and communication technologies (ICTs) such as email, the internet, online chat rooms and discussion groups, internet-based support groups, and voice technology and webcams. Participants from the control group of a previous programme, TAP1 (N=19) participated in a six-month computer training programme. Six participants who had successfully completed the TAP1 training were selected to be peer tutors. Data were collected from tutors and learners at baseline, three months, six months and nine months (three months after the end of training). The current study reports on learner outcomes only. Measures include computer, social support, and mental health-related outcomes. Learners reported a significant and consistent increase over time in their confidence completing certain computer-related tasks and their overall use of ICTs. Mental health and social support outcomes did not change. Overall, the peer tutor model appeared to be at least as effective as the previous staff-directed model.
Recent studies have suggested a particular relationship between the degree of covalent bonding in TiAl and the mobility of dislocation[1,2]. Ultimately such electronic effects In ordered compounds must dictate the dislocation core structures and at the same time the dislocation mobility within a given compound. However, direct modelling of line defects Is beyond the capability of todays electronic structure techniques. Alternatively, significant steps toward extending our understanding of the flow behaviour of structural intermetallics may come through general application of empirical interatomic potential methods for calculating the structure and mobility of defects. Toward this end, we have constructed semi-empirical interatomic potentials within the embedded atom formalism for L1O and B2 type structures. These potentials have been determined by fitting to known bulk structural and elastic properties of TIAl and NiAl, using least squares procedures. Simple expressions that relate the parameters of the potentials to the bulk properties are used in the fitting procedure. Calculations of dislocation core structures and planar fault energies using these potentials are considered. The differences between the optimized bulk properties predicted from the potentials and the values for these properties are discussed in terms of non-spherical nature of the electron density distribution. Empirical methods which incorporate these effects into interatomic potentials are briefly discussed.