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Introduction: Emergency health care providers (HCPs) regularly perform difficult medical resuscitations that require complex decision making and action. Critical incident debriefing has been proposed as a mechanism to mitigate the psychological effect of these stressful events and improve both provider and patient outcomes. The purpose of this updated systematic review is to determine if HCPs performing debriefing after critical incidents, compared to no debriefing, improves the outcomes of the HCPs or patients. Methods: We performed a librarian assisted systematic review of OVID Medline, CINAHL, OVID Embase and Google Scholar (January 2006 to February 2017) No restrictions for language were imposed. Two investigators evaluated articles independently for inclusion criteria, quality and data collection. Agreement was measured using the Kappa statistic and quality of the articles were assessed using the Downs and Black evaluation tool. Results: Among the 658 publications identified 16 met inclusion criteria. Participants included physicians, nurses, allied health and learners involved in both adult and pediatric resuscitations. Findings suggest that HCPs view debriefing positively (n=7). One moderate quality study showed that debriefing can enhance medical student and resident knowledge. Several studies (n=8) demonstrated at least some improvement in CPR and intubation related technical skills. Debriefing is also associated with improved short term patient survival but not survival to discharge (n=5). Two studies reported benefits to HCPs mental health as evidenced by improved ability to manage grief and decreased reported symptoms of Post-Traumatic Stress Disorder (PTSD). Conclusion: We found HCPs value debriefing after critical incidents and that debriefing is associated with improved HCP knowledge, skill and well-being. Despite these positive findings, there continues to be limited evidence that debriefing significantly impacts long term patient outcomes. Larger scale higher quality studies are required to further delineate the effect of structured debriefing on patient and provider outcomes.
To summarize and discuss logistic and administrative challenges we encountered during the Benefits of Enhanced Terminal Room (BETR) Disinfection Study and lessons learned that are pertinent to future utilization of ultraviolet (UV) disinfection devices in other hospitals
Multicenter cluster randomized trial
SETTING AND PARTICIPANTS
Nine hospitals in the southeastern United States
All participating hospitals developed systems to implement 4 different strategies for terminal room disinfection. We measured compliance with disinfection strategy, barriers to implementation, and perceptions from nurse managers and environmental services (EVS) supervisors throughout the 28-month trial.
Implementation of enhanced terminal disinfection with UV disinfection devices provides unique challenges, including time pressures from bed control personnel, efficient room identification, negative perceptions from nurse managers, and discharge volume. In the course of the BETR Disinfection Study, we utilized several strategies to overcome these barriers: (1) establishing safety as the priority; (2) improving communication between EVS, bed control, and hospital administration; (3) ensuring availability of necessary resources; and (4) tracking and providing feedback on compliance. Using these strategies, we deployed ultraviolet (UV) disinfection devices in 16,220 (88%) of 18,411 eligible rooms during our trial (median per hospital, 89%; IQR, 86%–92%).
Implementation of enhanced terminal room disinfection strategies using UV devices requires recognition and mitigation of 2 key barriers: (1) timely and accurate identification of rooms that would benefit from enhanced terminal disinfection and (2) overcoming time constraints to allow EVS cleaning staff sufficient time to properly employ enhanced terminal disinfection methods.
Whole apples have not been previously implicated in outbreaks of foodborne bacterial illness. We investigated a nationwide listeriosis outbreak associated with caramel apples. We defined an outbreak-associated case as an infection with one or both of two outbreak strains of Listeria monocytogenes highly related by whole-genome multilocus sequence typing (wgMLST) from 1 October 2014 to 1 February 2015. Single-interviewer open-ended interviews identified the source. Outbreak-associated cases were compared with non-outbreak-associated cases and traceback and environmental investigations were performed. We identified 35 outbreak-associated cases in 12 states; 34 (97%) were hospitalized and seven (20%) died. Outbreak-associated ill persons were more likely to have eaten commercially produced, prepackaged caramel apples (odds ratio 326·7, 95% confidence interval 32·2–3314). Environmental samples from the grower's packing facility and distribution-chain whole apples yielded isolates highly related to outbreak isolates by wgMLST. This outbreak highlights the importance of minimizing produce contamination with L. monocytogenes. Investigators should perform single-interviewer open-ended interviews when a food is not readily identified.
We studied nestedness and its relationships with beta-diversity in flea communities harboured by three closely related rodent species (Rhabdomys pumilio, Rhabdomys intermedius, Rhabdomys dilectus) at two spatial scales (within and among host populations) in South Africa and asked (a) whether variation in species composition of flea communities within and among host populations follows a non-random pattern; if yes, (b) what are the contributions of nestedness and species turnover to dissimilarity (= beta-diversity) among flea communities at the two scales; and (c) do the degree of nestedness and its contribution to beta-diversity differ among host species (social vs solitary) and between scales. We found that nestedness in flea assemblages was more pronounced (a) in social than solitary host species and (b) at lower (among host individuals within populations) than at higher scale (among host populations). We also found that higher degree of nestedness was associated with its higher contribution to beta-diversity. Our findings support earlier ideas that parasite community structure results from the processes of parasite accumulation by hosts rather than from the processes acting within parasite communities.
Although scholarly consensus suggests that dissent causes repression, the behaviors are endogenous: governments and dissidents act in expectation of each other’s behavior. Empirical studies have not accounted well for this endogeneity. We argue that preventive aspects of repression meaningfully affect the relationship between observed dissent and repression. When governments use preventive repression, the best response to dissent that does occur is unclear; observed dissent does not meaningfully predict responsive repression. By contrast, governments that do not engage in ex ante repression will be more likely to do it ex post. We follow U.S. voting scholarship and propose a new instrument to model the endogeneity: rainfall. We couple rainfall data in African provinces and U.S. states with data on dissent and repression and find that dissent fails to have a significant effect on responsive repression in states that engage in preventive repression.
Language-specific orthography (i.e., letters or bigrams that exist in only one language) is known to facilitate language membership recognition. Yet the contribution of continuous sublexical and lexical statistics to language membership decisions during visual word processing is unknown. Here, we used pseudo-words to investigate whether continuous sublexical and lexical statistics bias explicit language decisions (Experiment 1) and language attribution during naming (Experiment 2). We also asked whether continuous statistics would have an effect in the presence of orthographic markers. Language attribution in both experiments was influenced by lexical neighborhood size differences between languages, even in presence of orthographic markers. Sublexical frequencies of occurrence affected reaction times only for unmarked pseudo-words in both experiments, with greater effects in naming. Our results indicate that bilinguals rely on continuous language-specific statistics at sublexical and lexical levels to infer language membership. Implications are discussed with respect to models of bilingual visual word recognition.
In this pilot study, we evaluate an algorithm that uses predictive clinical and laboratory parameters to differentiate between patients with hospital-acquired infection (HAI) and patients without HAI. Seventy-four percent of the studied population of surgical patients could be reliably (negative predictive value of 98%) excluded from detailed assessment by the infection control practitioner.
Surveillance of hospital-acquired infections can be approximated by repeated surveys that are performed in a standardized, cost-effective manner. We developed an integrated software system for serial electronic hospital-wide point prevalence surveys using algorithms that proved highly sensitive and specific over a 5-year period in a large university medical center.
We present a novel multilayered architecture for memristive devices which provides an alternative to conventional conductive filament switching. In conventional resistive switching, conductive filaments form and extend stochastically under applied electrical bias, with longer filaments being subjected to magnified electric fields that amplify their growth rate, producing a spatially localized and highly non-uniform conduction front of filaments. This produces devices with large variations in resistive and capacitive properties that are difficult to tune. Here, we simulate a multilayered device structure with alternating ionic mobility that predicts the development of a quasi-uniform conduction front which amplifies memcapacitive properties of the device and reduces device-to-device variability. Furthermore, this novel structure is predicted to enable fine-tuned control of switching events, an important property for analog (multibit) memory and neuromorphic computing applications.
International human rights treaties are argued to increase both the likelihood of domestic mobilized dissent and judicial constraint. These pressures pull leaders in conflicting directions: mobilized challenges undermine a leader’s position in power, increasing incentives to repress; courts raise the probability of litigation, decreasing incentives to repress. We argue authorities balance these pressures based on their job security. Politically insecure leaders, desperate to retain power, repress to control the destabilizing effects of dissent. Secure leaders are less likely to fall to citizen pressures, but the probability of facing an effective judiciary weighs heavily in their expected costs. Consequently, they repress less to avoid litigation. We find empirical support for the implications of our formal theory using data on commitment to the UN Convention Against Torture. Treaties have no effect on repression in states with insecure leaders but have a positive effect on rights protection in states headed by secure leaders.
Historically significant public events sometimes organize autobiographical memory, acting as temporal landmarks and providing the thematic content which defines the lifetime periods they spawn (Brown and Lee, 2010; Brown, Lee, Krslak, et al., 2009). We begin this chapter by briefly reviewing a research program that has demonstrated the existence of these historically defined autobiographical periods and that has allowed us to identify the conditions that bring them about. In this section, we also present data from four samples of World War II-generation adults, data which prove that historically defined autobiographical periods endure over time. Next, we consider the theoretical implications of these findings. In particular, we introduce a new approach to autobiographical memory called the transition theory. This approach assumes that autobiographical memory is organized by transitional events and that these transitions can be self-initiated or externally imposed. On this view, historically defined autobiographical periods are formed by externally imposed transitions. We develop this point in the third and final section of this chapter.
The living-in-history project
War, terrorism, and natural disasters can have far-reaching effects on the lives of those involved (Blaikie, Cannon, Davis, et al., 1994; Levy and Sidel, 1997; McNally, 2003). Collective memory for extraordinary social events can also play a critical role in the construction and maintenance of group identities and in the persistence of intergroup hostility (Bar-Tal, 2007; Cairns and Roe, 2003; Halbwachs, 1992; Hirst, Cuc, and Wohl, this volume). Our project examined the mnemonic impact of public events at the individual level in order to understand when autobiographical memory and historical events can become intertwined. More specifically, the program of research was undertaken to determine whether public events affect the organization of autobiographical memory and to specify the conditions that result in the creation of historically defined autobiographical periods. We were interested in this issue because we suspected that people who had “lived in history” might understand the recent past in a different way than those who had not, and that this understanding might ground current and future beliefs about that past. For this reason, we wanted to identify public events that caused people to “live in history” and to distinguish these epoch-defining events from other significant public events.
In this study, we have developed and characterized two previously unstudied alkoxysilane surface chemistries for use with superparamagnetic iron oxide (SPIO) nanoparticles as a magnetic resonance imaging contrast agent. We modified superparamagnetic iron oxide nanoparticles (SPIO) using aminopropyl triethoxysilane and two analogous alkoxysilanes, aminopropyl dimethylethoxysilane and aminopropyl methyldiethoxysilane, to compare a mono- and dialkoxysilane, respectively, to a more commonly used trialkoxysilane as two new SPIO surface chemistries capable of forming ultrathin functional surface coatings. The ligand densities of the mono- and dialkoxysilane-modified SPIO produced in this study are consistent with near monolayers of ligands on the SPIO surface. We studied the chemical stability of the mono-, di-, and trialkoxysilane-modified SPIO in neutral and acidic media to evaluate the viability of these surface chemistries for use in long-term intracellular applications. The mono- and dialkoxysilane-modified SPIO demonstrate comparable chemical stability to the trialkoxysilane-modified SPIO, indicating that the mono- and dialkoxysilane are both viable new SPIO surface chemistries for future applications requiring minimally thick alkoxysilane surface coatings.
As in the past, the primary activity of the IAU Working Group on Cartographic Coordinates and Rotational Elements has been to prepare and publish a triennial (“2009”) report containing current recommendations for models for Solar System bodies (Archinal et al. (2011a)). The authors are B. A. Archinal, M. F. A'Hearn, E. Bowell, A. Conrad, G. J. Consolmagno, R. Courtin, T. Fukushima, D. Hestroffer, J. L. Hilton, G. A. Krasinsky, G. Neumann, J. Oberst, P. K. Seidelmann, P. Stooke, D. J. Tholen, P. C. Thomas, and I. P. Williams. An erratum to the “2006” and “2009” reports has also been published (Archinal et al. (2011b)). Below we briefly summarize the contents of the 2009 report, a plan to consider requests for new recommendations more often than every three years, three general recommendations by the WG to the planetary community, other WG activities, and plans for our next report.
The perception that NPA measures with restrictive effects on international trade violate GATT obligations is based on the presumption that the respective provisions of the GATT are applicable to NPA measures. This chapter briefly reviews this basic presumption, taking into account that the WTO forms part of the highly fragmented system of international law. While the applicability of WTO law will usually not be under dispute, the applicability of other international law may in some cases be controversial. This situation is particularly relevant to NPA measures.
The national or – in the case of the EC – supra-national, NPA to which a measure is linked inherently relates to a matter other than the tradable good. Depending on its objectives, an NPA measure will usually relate to a subject matter or policy other than trade, for instance, to an aspect of environmental or social policy. Even if the particular aspect at issue is of a strictly national nature, as a corollary of the more and more dense system of international law, the aspect at issue or related aspect may likewise be subject to other public international law, for example, under an international or bilateral treaty. This is particularly true for NPA measures of an environmental nature, but likewise, for example, for national NPA measures touching upon matters of human rights.
The legal analysis de lege lata has shown that perhaps contrary to the conventional view, the WTO Agreements offer considerable flexibility concerning NPA measures. Since states will often find it sufficient to publish information on PPMs on products or to adopt other information requirements that producers must adhere to, the TBT Agreement is of great importance. Although this has not yet been confirmed in dispute settlement, the TBT Agreement has enormous potential to render a large number of NPA measures, namely, labelling requirements concerning unincorporated PPMs, legal under WTO law. Also, even though most NPA measures would fall foul of GATT obligations, the general exceptions offer scope for finding many genuine NPA measures legal. The adjudicatory bodies will most probably proceed in interpreting the general exceptions with an evolutionary approach. Since several provisions in Article XX contain generic terms, as is most obvious in the case of the moral exception, many NPA measures that are used to implement internationally recognized public policies can be justified. Of equal importance are the findings on the principle of special and differential treatment for developing countries. This principle, if taken seriously, establishes that NPA measures take into account adequately the concerns of affected developing countries. Only if the conditions emerging from this principle are fulfilled, may NPA measures be covered by one or another of the particular exceptions.
This book is a revised and updated version of my Ph.D. dissertation, which was accepted by the Law Faculty of the University of Berne in 2008. The sub-title of my dissertation, ‘A contribution to the debate on the impact of WTO law on national regulation pursuing social goals’, shows the broader context of my doctoral research which led to this book. As a member of the project group ‘Social regulation and world trade’ at the Collaborative Research Centre ‘Transformations of the State’, I placed a strong focus on the interplay of national social regulation and international trade, and, in particular, on the status of national regulatory measures under the law of the WTO. I found that despite a decades-long debate, the status of such measures – both from a legal and a political perspective – still remains unresolved. Existing regulatory measures show, that despite legal uncertainty, states do not totally refrain from exercising their power to enact such measures. However, there can be no doubt that the existence of the WTO Agreements and the heated legal and political debates on the legality of certain measures of national social regulation, which have been taking place at an international and, above all, at a transnational level, may lead to a chilling effect on the exercise of national powers. These, however, are still necessary to solve certain problems in cases where no capable institutions at other governance levels are in place.