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Introduction: By virtue of the nature of their work, emergency medicine physicians and residents experience high cognitive load and stress, which are known to affect physician performance and patient outcomes. However, the contribution of cognitive load has not previously been measured during the clinical work of emergency physicians. The objectives of this study were to measure cognitive load and stress in emergency physicians and residents during clinical work, evaluate the relative contribution of multiple factors on cognitive load, and to determine the effect of experience on these results. Methods: This observational study was conducted at an academic Canadian Urgent Care Centre from July to August 2018. Emergency medicine residents and staff physicians completed a survey while on shift to evaluate measures of cognitive load and acute stress. Patient acuity and the number of active patients for each physician, hours worked and patients in the waiting room were recorded. Correlational analyses and multivariable linear regression were performed to evaluate the effect of each predictor on measures of overall cognitive load. Results: A total of 131 questionnaires were completed by 42 physicians (87 questionnaires from 26 staff physicians and 44 questionnaires from 16 residents). Results showed that staff physicians carried a significantly higher patient load compared to residents (p < 0.001). There were no differences in mean overall cognitive load (p = 0.25), acute stress (p = 0.17) or measured subcomponents of cognitive load between the two groups. Perceived case difficulty and acute stress were strong predictors of overall cognitive load, while level of distraction did not correlate with the other outcomes. The number of patients in the waiting room predicted acute stress in staff physicians, while the number of higher acuity patients was a significant predictor in residents. Conclusion: Measures of overall cognitive load and acute stress were strongly correlated in the clinical setting. Different factors affect cognitive load and acute stress in staff physicians compared to residents. Appreciating these differences may help medical educators understand the cognitive challenges faced by learners in a clinical context, and aid in the design of cognitive and educational strategies to help mitigate these challenges and reduce stress.
To study potentially modifiable factors associated with the severity of agitation or aggression (A/A) symptoms among Alzheimer’s disease (AD) patients.
Data from the Impact of Cholinergic Treatment Use (ICTUS) study, European longitudinal prospective observational study.
Community dwelling outpatients included in 29 European memory clinics.
1375 participants with probable AD (Mini-Mental State Examination score of 10–26) with an informal caregiver.
At baseline and twice yearly over the two-year follow-up, patients underwent comprehensive clinical and neuropsychological assessments: sociodemographic data, cognitive status, functional impairment, and assessment of neuropsychiatric symptoms based on Neuro-Psychiatric Inventory (NPI). The ZARIT scale assessed the caregiver’s burden. The variable of interest was the severity of the item of A/A of the NPI. To study factors associated to the severity of A/A symptoms six months later, a multivariate mixed regression model was used.
Frequency of A/A symptom varied from 30% to 34% at each visit. Two factors were found to be independently associated with the severity of A/A: (1) the presence of affective disorder (anxiety, depression, and/or irritability) that increased the severity of the A/A by 0.89 point (coefficient:0.89; 95% Confidence Interval (CI) = [0.48,1.30], p < 0.001), and (2) a severe caregiver burden that increased the severity of the A/A by 1.08 point (coefficient:1.08; 95% CI = [0.69,1.47], p < 0.001).
Research should evaluate whether the identification and treatment of an affective disorder along with the evaluation and optimal management of the caregiver would have a positive impact on the course of A/A in mild to moderate AD patients.
To estimate the impact of comorbid diabetes on caregiver stress in Alzheimer's disease (AD) patients from the Impact of Cholinergic Treatment Use (ICTUS) study.
Using the Data from the ICTUS study, diabetes mellitus (DM) was recorded at baseline and caregiver burden was assessed twice per year using the Zarit Burden Interview (ZBI) scale. The three-factorial model of ZBI (the effect on the social and personal life of caregivers, the psychological burden and the feelings of guilt) was adopted. Linear mixed models were used to examine the relation between DM and the scores of ZBI.
The present analyses were conducted on 1,264 AD subjects. A total of 156 patients (12.3%) had DM with taking antidiabetic medication and/or self-report of a history. At baseline, the caregivers of patients with or without DM had similar ZBI global scores and similar scores of three different factors of ZBI. Unadjusted and adjusted models both indicated that ZBI global score increased over a 24-month follow-up without significant effect of DM. Similarly, unadjusted model showed that DM was not determining any significant difference in the score of any factor. However, adjusted model indicated that in diabetic patients, the scores of the social and personal life of caregivers and the psychological burden increased more slowly than those in non-diabetic patients (p = 0.04 and 0.01, respectively).
DM may affect the caregivers’ daily social and personal life and psychological burden in AD patients. It is necessary for further research.
School vision and mission statements are an explicit indication of a school's priorities. Research has found academic motivation, mental health promotion, and school belonging to be the most frequently cited themes in these statements. The present study sought to examine whether these themes relate to student academic achievement, as indicated by National Assessment Program — Literacy and Numeracy (NAPLAN) scores. A stratified sample of 287 secondary schools in Victoria, Australia was analysed using two language analytic approaches: qualitative emergent coding and supervised lexical analysis. The highest academic scores occurred when mental health promotion was included, though results depended to some extent on the analytic approach and the level of aggregation. Results do suggest that explicitly prioritising both academic performance and mental health is beneficial. Further, the study provides an approach for using language analysis to investigate multilevel constructs in schools.
Cetacean stranding reports in the North Aegean Sea were recorded since 1998 from Strimonikos Gulf in Chalkidiki up to Alexandroupoli on the Turkish border and in a few northern Aegean islands. On site, the specimens were examined to identify species, gender, approximate age and, when possible, cause for stranding. A total of 26 filled stomachs of five cetacean species collected since 2002 were analysed: bottlenose dolphins Tursiops truncatus (N = 8), common dolphins Delphinus delphis (N = 8), harbour porpoises Phocoena phocoena (N = 5), striped dolphins Stenella coeruleoalba (N = 4) and Risso's dolphins Grampus griseus (N = 1). From the analysed stomachs it was found that the bottlenose dolphins fed mainly on snake blenny Ophidion barbatum (34%), bogue Boops boops (22%) and round sardinella Sardinella aurita (13%); common dolphins on round sardinella (17%), picarels Spicara spp. (10%) and Cocco's lantern fish Lobianchia gemellaris (9%); harbour porpoises on Gobidae (four-spotted goby Deltentosteus quadrimaculatus 41% and black goby Gobius niger 37%) and round sardinella (7%); striped dolphins on Myctophydae (Madeira lantern fish Ceratoscopelus maderensis 51%), and on Pfeffer's enople squid Abraliopsis morisii (10%) and bogue (8%); and Risso's dolphin exclusively on Teuthidae (31%), the umbrella squid Histioteuthis bonellii (30%) and the reverse jewel squid H. reversa (14%). The present work represents the first attempt to investigate the diet up to species level for several cetaceans in Greek waters and for harbour porpoises stranded in the Mediterranean Sea.
The longue durée of human activity on the island of Pantelleria represents an important locus of ancient cultural interaction in the Strait of Sicily. This narrow channel in the central Mediterranean has played a major and continuous role in human relations between Italy, Sicily and North Africa since the Neolithic period. Use or control of the Pantelleria has been pivotal for a number of cultures over time, each leaving a lasting impression on the landscape and the people of the island (Figure 1). The volcanic geology of Pantelleria has determined the shape of its landscape and is responsible for the creation of the collapsed-caldera basin and lake that form the study area of this project. The Brock University Archaeological Project at Pantelleria (BUAPP) is working in the Lago di Venere area, examining past human activity on the north-eastern lake shore. A previous project in the Lago di Venere area (1998–2002) interpreted the site as a Punic and Roman sanctuary (Audino & Cerasetti 2004; Cerasetti 2006). Our project complements this and other archaeological investigations of the island's classical past, including the ongoing excavations on the Acropolis, near the main harbour, which have revealed the remains of the island's Punic and Roman centre (Schäfer et al. 2015).
Recent efforts at estimating bias and responsiveness in electoral systems typically proceed by assigning observations to subsamples according to which party controlled the redistricting process. We show this traditional procedure to introduce selection bias into the resulting estimates of bias and responsiveness and present an alternative strategy for estimating these parameters. Using data from the state legislatures, and employing two different measures of partisan control of redistricting, we obtain results that modestly differ from those obtained with the traditional approach. Measures of control of redistricting utilizing information about the partisan intent of redistricting commissions and tribunals are exogenous to the seats-votes relationship.
School belonging, at both a school and university level, has been well documented as a predictor of academic and psychosocial success. The construct has been examined by scholars in a variety of different professional disciplines (e.g., education, psychology, sociology) and continues to be consistently researched. Although significant contributions have been made in the field, there are still additional areas of investigation needed, as well as interventions that need to be designed and explored. The current article was designed to review the theoretical foundations of belonging, conceptualise school belonging with respect to how it is presented in the literature, discuss the key variables related to school belonging, present a summary of the predictors of school belonging, discuss school belonging in a university setting, and posit future directions for research.
The benefits of belonging and feeling connected to school for adolescent mental health and wellbeing are well documented, but how belonging is fostered is less understood. The present article puts forward a new conceptual framework of school belonging based on Bronfenbrenner's (1979) sociological model of human development, using evidence from a range of previous peer-reviewed studies to better understand the factors that occur across five levels that affect a students’ sense of school belonging (i.e., the individual level, the microsystem, the mesosystem, the exosystem, and the macrosystem). The conceptual framework is used to present a range of evidence-based school belonging strategies (some with examples) that schools can use to enhance student belonging. This article makes an original contribution to the field of psychological and educational research by presenting a socio-ecological framework to explore the themes that influence school belonging within a secondary school system. It broadens the frame of reference of school belonging beyond the individual student to consider features of the broader school system and environment.
Diabetes-induced CVD is the most significant complication of prolonged hyperglycaemia. The aim of this study was to determine whether resveratrol, a polyphenol antioxidant compound, when administered at a dose that can be reasonably obtained through supplementation could prevent the development of cardiovascular complications in older, obese, diabetic rats. Diabetes was induced in 6-month old, obese, male Wistar rats via a single intravenous dose of streptozotocin (65 mg/kg). Randomly selected animals were administered resveratrol (2 mg/kg) via oral gavage daily for 8 weeks. Body weights, blood glucose levels, food intake and water consumption were monitored, and assessments of vascular reactivity, tactile allodynia and left ventricular function were performed. Resveratrol therapy significantly improved tactile allodynia and vascular contractile functionality in diabetic rats (P<0·05). There were no significant changes in standardised vasorelaxation responses, plasma glucose concentrations, water consumption, body weight, left ventricular hypertrophy, kidney hypertrophy, heart rate or left ventricular compliance with resveratrol administration. Resveratrol-mediated improvements in vascular and nerve function in old, obese, diabetic rats were associated with its reported antioxidant effects. Resveratrol did not improve cardiac function nor mitigate the classic clinical symptoms of diabetes mellitus (i.e. hyperglycaemia, polydypsia and a failure to thrive). This suggests that supplementation with resveratrol at a dose achievable with commercially available supplements would not produce significant cardioprotective effects in people with diabetes mellitus.
We consider the effect of evaporation on the aggregation of a number of elastic objects due to a liquid’s surface tension. In particular, we consider an array of spring–block elements in which the gaps between blocks are filled by thin liquid films that evaporate during the course of an experiment. Using lubrication theory to account for the fluid flow within the gaps, we study the dynamics of aggregation. We find that a non-zero evaporation rate causes the elements to aggregate more quickly and, indeed, to contact within finite time. However, we also show that the final number of elements within each cluster decreases as the evaporation rate increases. We explain these results quantitatively by comparison with the corresponding two-body problem and discuss their relevance for controlling pattern formation in elastocapillary systems.
We study the evolution of a thin, axisymmetric, partially wetting drop as it evaporates. The effects of viscous dissipation, capillarity, slip and diffusion-dominated vapour transport are taken into account. A matched asymptotic analysis in the limit of small slip is used to derive a generalization of Tanner’s law that takes account of the effect of mass transfer. We find a criterion for when the contact-set radius close to extinction evolves as the square root of the time remaining until extinction – the famous
-law. However, for a sufficiently large rate of evaporation, our analysis predicts that a (slightly different) ‘
-law’ is more appropriate. Our asymptotic results are validated by comparison with numerical simulations.
A series of recent instrumental advances have facilitated the application of atom probe tomography (APT) to the characterization of an increasingly wide range of materials and devices. Whereas APT was previously mostly limited to the analysis of alloys, advances in areas such as laser pulsing and detectors have enabled characterization of semiconductors and brittle materials. Most recently, ultraviolet laser pulsing has facilitated the analysis of materials previously considered not viable for the atom probe, such as minerals and large bandgap insulator materials. The development of in situ gas reaction cells fully integrated in atom probe instruments has enabled the characterization of surface reactions of materials exposed to highly controlled environments. Finally, current work toward an integrated cryo-transfer system is anticipated to create new directions for APT research.
We aimed to obtain a better understanding of how different aspects of patient functioning affect key cost and caregiver outcomes in Alzheimer's disease (AD).
Baseline data from a prospective observational study of community-living AD patients (GERAS) were used. Functioning was assessed using the Alzheimer's Disease Cooperative Study – Activities of Daily Living Scale. Generalized linear models were conducted to analyze the relationship between scores for total activities of daily living (ADL), basic ADL (BADL), instrumental ADL (IADL), ADL subdomains (confirmed through factor analysis) and individual ADL questions, and total societal costs, patient healthcare and social care costs, total and supervision caregiver time, and caregiver burden.
Four distinct ADL subdomains were confirmed: basic activities, domestic/household activities, communication, and outside activities. Higher total societal costs were associated with impairments in all aspects of ADL, including all subdomains; patient costs were associated with total ADL and BADL, and basic activities subdomain scores. Both total and supervision caregiver hours were associated with total ADL and IADL scores, and domestic/household and outside activities subdomain scores (greater hours associated with greater functional impairments). There was no association between caregiver burden and BADL or basic activities subdomain scores. The relationship between total ADL, IADL, and the outside activities subdomain and outcomes differed between patients with mild and moderate-to-severe AD.
Identification of ADL subdomains may lead to a better understanding of the association between patient function and costs and caregiver outcomes at different stages of AD, in particular the outside activities subdomain within mild AD.
We investigate the effect of mass transfer on the evolution of a thin, two-dimensional, partially wetting drop. While the effects of viscous dissipation, capillarity, slip and uniform mass transfer are taken into account, other effects, such as gravity, surface tension gradients, vapour transport and heat transport, are neglected in favour of mathematical tractability. Our focus is on a matched-asymptotic analysis in the small-slip limit, which reveals that the leading-order outer formulation and contact-line law depend delicately on both the sign and the size of the mass transfer flux. This leads, in particular, to novel generalisations of Tanner's law. We analyse the resulting evolution of the drop on the timescale of mass transfer and validate the leading-order predictions by comparison with preliminary numerical simulations. Finally, we outline the generalisation of the leading-order formulations to prescribed non-uniform rates of mass transfer and to three dimensions.