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To better understand barriers and facilitators that contribute to antibiotic overuse in long-term care and to use this information to inform an evidence and theory-informed program.
Information on barriers and facilitators associated with the assessment and management of urinary tract infections were identified from a mixed-methods survey and from focus groups with stakeholders working in long-term care. Each barrier or facilitator was mapped to corresponding determinants of behavior change, as described by the theoretical domains framework (TDF). The Rx for Change database was used to identify strategies to address the key determinants of behavior change.
In total, 19 distinct barriers and facilitators were mapped to 8 domains from the TDF: knowledge, skills, environmental context and resources, professional role or identity, beliefs about consequences, social influences, emotions, and reinforcements. The assessment of barriers and facilitators informed the need for a multifaceted approach with the inclusion of strategies (1) to establish buy-in for the changes; (2) to align organizational policies and procedures; (3) to provide education and ongoing coaching support to staff; (4) to provide information and education to residents and families; (5) to establish process surveillance with feedback to staff; and (6) to deliver reminders.
The use of a stepped approach was valuable to ensure that locally relevant barriers and facilitators to practice change were addressed in the development of a regional program to help long-term care facilities minimize antibiotic prescribing for asymptomatic bacteriuria. This stepped approach provides considerable opportunity to advance the design and impact of antimicrobial stewardship programs.
Dysregulated physiological stress reactivity has been suggested to impact the development of children and adolescents with important health consequences throughout the life span. Both environmental adversity and genetic predispositions can lead to physiological imbalances in stress systems, which in turn lead to developmental differences. We investigated genetic and environmental contributions to autonomic nervous system reactivity to a psychosocial stressor. Furthermore, we tested whether these effects were consistent with the differential susceptibility framework. Composite measures of adverse life events combined with socioeconomic status were constructed. Effects of these adversity scores in interaction with a polygenic score summarizing six genetic variants, which were hypothesized to work as susceptibility factors, were tested on autonomic nervous system measures as indexed by heart rate and heart rate variability. Results showed that carriers of more genetic variants and exposed to high adversity manifested enhanced heart rate variability reactivity to a psychosocial stressor compared to carriers of fewer genetic variants. Conversely, the stress procedure elicited a more moderate response in these individuals compared to carriers of fewer variants when adversity was low.
The evaluation tool was first derived from the formerly Consortium of British Humanitarian Agencies’ (CBHA; United Kingdom), now “Start Network’s,” Core Humanitarian Competency Framework and formatted in an electronic data capture tool that allowed for offline evaluation. During a 3-day humanitarian simulation event, participants in teams of eight to 10 were evaluated individually at multiple injects by trained evaluators. Participants were assessed on five competencies and a global rating scale. Participants evaluated both themselves and their team members using the same tool at the end of the simulation exercise (SimEx).
All participants (63) were evaluated. A total of 1,008 individual evaluations were completed. There were 90 (9.0%) missing evaluations. All 63 participants also evaluated themselves and each of their teammates using the same tool. Self-evaluation scores were significantly lower than peer-evaluations, which were significantly lower than evaluators’ assessments. Participants with a medical degree, and those with humanitarian work experience of one month or more, scored significantly higher on all competencies assessed by evaluators compared to other participants. Participants with prior humanitarian experience scored higher on competencies regarding operating safely and working effectively as a team member.
This study presents a novel electronic evaluation tool to assess individual performance in five of six globally recognized humanitarian competency domains in a 3-day humanitarian SimEx. The evaluation tool provides a standardized approach to the assessment of humanitarian competencies that cannot be evaluated through knowledge-based testing in a classroom setting. When combined with testing knowledge-based competencies, this presents an approach to a comprehensive competency-based assessment that provides an objective measurement of competency with respect to the competencies listed in the Framework. There is an opportunity to advance the use of this tool in future humanitarian training exercises and potentially in real time, in the field. This could impact the efficiency and effectiveness of humanitarian operations.
EvansAB, HulmeJM, NugusP, CranmerHH, CoutuM, JohnsonK. An Electronic Competency-Based Evaluation Tool for Assessing Humanitarian Competencies in a Simulated Exercise. Prehosp Disaster Med. 2017;32(3):253–260.
Maternal protein restriction in rat pregnancy is associated with altered feeding behaviour in later life. When allowed to self-select their diet, rats subject to prenatal undernutrition show an increased preference for fatty foods. The main aim of the present study was to evaluate the contribution of folic acid in the maternal diet to programming of appetite, since disturbances of the folate and methionine–homocysteine cycles have been suggested to impact upon epigenetic regulation of gene expression and hence programme long-term physiology and metabolism. Pregnant rats were fed diets containing either 9 or 18 % casein by weight, with folate provided at either 1 or 5 mg/kg diet. Adult male animals exposed to low protein (LP) in fetal life exhibited increased preference for high-fat food. Providing the higher level of folate in the maternal diet prevented this effect of LP, but offspring of rats fed 18 % casein diet with additional folate behaved in a similar manner to LP-exposed animals. Among day 20 gestation fetuses, it was apparent that both protein restriction and maternal folate supplementation could have adverse effects upon placental growth. Examination of methionine–homocysteine and folate cycle intermediates, tissue glutathione concentrations and expression of mRNA for methionine synthase, DNA methyltransferase 1 and methyltetrahydrofolate reductase revealed no gross disturbances of folate and one-carbon metabolism in either maternal or fetal tissue. The present findings indicated that any role for DNA methylation in programming of physiology is not related to major perturbations of folate metabolism, and is likely to be gene-specific rather than genome-wide.
During the past decade, hospital emergency preparedness has become a focus of local, state, and federal governments seeking to address emergencies or disasters that affect the public health. Integral to hospital emergency preparedness are numerous legal challenges that hospitals and their health care personnel face during declared states of emergencies. In this article, we evaluate legal requirements for hospital emergency preparedness, key legal concerns that hospitals should consider in emergency preparedness activities, and how the changing legal landscape during emergencies necessitates real-time decision making. We then analyze legal issues including negligence, discrimination, and criminal culpability that may arise during or after medical triage. Finally, we examine the legal risks of evading preparedness, specifically asking how a hospital and its personnel may be held liable for failing to plan or prepare for an emergency. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S37–S44)
The relationship between multiplicity of infection and the yield of organisms and of polysaccharide was studied in BHK 21 cells infected with TRIC organisms. Although an increase in themultiplicity of infection resulted in an increase in the absolute number of organisms per culture, there was a decrease in relation to the number of infecting organisms. The amount of polysaccharide produced was independent of multiplicity of infection; it was not limited by the concentration of glucose in the medium. Polysaccharide leaked from cells and was slowly broken down in the culture medium.
Hypertension is a major risk factor for the development of CVD. Epidemiological studies have shown that low birth weight increases the risk of developing hypertension in adulthood. Hypertension increases the risk of suffering IHD and early findings provide evidence that hearts from prenatally protein-restricted, hypertensive, male offspring are more susceptible to cardiac dysfunction following ischaemic events. Hypertension and abnormalities in cardiac function following ischaemia–reperfusion in the human population are treated therapeutically with β-adrenergic antagonists. We hypothesised that increased susceptibility to myocardial ischaemia–reperfusion injury in prenatally programmed offspring may be due to sympathetic hyperactivity. Pregnant Wistar rats were fed control or low-protein (maternal low protein; MLP) diets throughout gestation. At age 6 months, hearts were rapidly excised and retro-perfused using the Langendorff apparatus, to assess isolated cardiac function following stimulation with increasing doses of the non-specific β-agonist isoproterenol. Baseline heart rates were similar in control and MLP-fed offspring. With significant diet × sex interactions (P < 0·01) maximum heart rate response following isoproterenol infusion was significantly longer in MLP than control. Prenatal diet had no effect on maximal left ventricular developed pressure (LVDP) response, but the LVDP isoproterenol response was significantly longer in duration in MLP-exposed male offspring (diet × sex P < 0·001). Myocardial mRNA expression of β2-adrenergic receptors was increased in 2-week-old female MLP offspring only (P < 0·049). In conclusion, maternal protein restriction programmes cardiac sympathetic activity in a sex-specific manner, and may explain increased susceptibility to ischaemia–reperfusion injury in males subject to fetal undernutrition.
As young stars form, they interact with their environment in many ways. We study the radiative interaction of a young star with its surrounding cluster environment. The change in gas temperature caused by a forming star can trigger the formation or inhibit the growth of nearby star forming cores. We calculate the gas temperature around a single star by balancing the dust-gas collisional heating, molecular cooling, and cosmic ray heating rates for a grid of models with various luminosities and density distributions. In the future, this work can be used in large-scale simulations of clustered star formation to study the effect of using a gas temperature which depends not only on density, but also on radiative environment.
Biomass burning; greenhouse gas emissions; emission mitigation
A review of available literature published on biomass burning and trace gas emissions in Africa reveals household biofuel use, land use and land-use change to be the most important trace gas emission sources in Africa, contributing about 4% to the overall global CO2 budget. This may not be significant in so far as altering global climate through temperature rise is concerned. However, through the contribution of about 35% of the global photochemical ozone formation, biomass burning in Africa significantly influences important atmospheric processes. Although the total greenhouse gas emissions from Africa are very low compared to those of other continents, countries on the continent could still contribute to global greenhouse gas mitigation efforts through ways that could simultaneously deliver urgent development needs.
Many African governments have for long underplayed their countries' contribution to regional and global greenhouse gas (GHG) emission levels. The general assumption that their countries contribute insignificant amounts of these gases – responsible for the earth's warming – has influenced their hard stance, witnessed at international negotiations, against any meaningful roles in concerted efforts to mitigate GHG emissions. But intensive atmospheric research work on Africa over the past two decades (e. g., SAFARI 2000, www.safari2000.org) have confirmed the significant contribution that biomass burning has made to the regional and global tropospheric trace gas budgets. The land-use and energy sectors dominate African GHG emissions (UNEP, 1998).
The observational evidence for kinematic substructure in Local Group dSphs is reviewed. The properties of these substructures are consistent with their being disrupted star clusters. The persistence of cold substructure argues strongly against the presence of dark matter cusps in the haloes of dSphs. A formation scenario for dSphs is described involving the merger of star clusters in the potential well of a low-mass dark matter halo.
In this chapter we will consider three additional spatial particles that involve verticality – above, under and below. The analysis of spatial scenes related to these forms, in conjunction with over, will demonstrate that this subset of spatial particles acts as a particular lexical contrast set. Hence, in semantic terms, the four English lexemes over, above, under and below represent a systematic means of dividing up the vertical axis into four distinct spatial locations. Moreover, the analysis for each of these forms provides further evidence for our representation of proto-scenes for English spatial particles as most appropriately being characterized as involving both a functional component and a conceptual-spatial configuration between a TR and a LM. Our goal, then, in this chapter is to show that working out an appropriate analysis of the distinction between the proto-scenes associated with over versus above and under versus below underscores the efficacy of the model developed in the first four chapters.
Linguists have long recognized that languages readily add new lexical items to the existing inventory of certain classes of words (open-class words), while being more resistant to adding a new lexical item to the existing set of other classes of words (closed-class words). We argued in chapter 3 that spatial particles represent a closed class of lexemes. They have this status because, in their spatial-physical uses, spatial particles operate within a stable, self-contained conceptual domain (Talmy, 2000).
A number of spatial particles appear to mediate relations in which the dimensions of the LM are essentially irrelevant. As we saw in our discussions of over, the extendedness or dimensionality of the LM appears to have no particular bearing on the relationship mediated by over. In contrast, in this chapter we will explore a set of spatial particles, in, into, out, out of and through, which are sensitive to certain dimensions of the LM, namely the dimensions which collectively give rise to the notion of boundedness.
We define a bounded LM as one that possesses an interior, a boundary and an exterior. Canonically, we think of bounded LMs as three-dimensional objects, such as boxes or rooms. Entities that are typically thought of as having a one-dimensional or two-dimensional structure are not typically conceptualized as a bounded LM; for instance, they are not typically thought of as possessing an interior. However, as we have seen in our previous discussions, humans have the capacity for construing spatial scenes from a variety of perspectives; this ability appears to extend to how the dimensionality of any given entity is construed for the purposes at hand. The linguistic evidence shows that the conceptualization of a particular LM as bounded is determined not in absolute terms by its geometry (although clearly this does play some part), but rather by virtue of the way in which humans experience and interact with the LM in question.
Linguists, psychologists and philosophers have long observed the importance of space and spatial experience for both language and thought. In this book, we examine the nature of human spatio-physical experience and how human conceptualization of spatial relations is reflected in the English language. In particular, we are interested in how spatial concepts are systematically extended to provide a wide array of non-spatial meanings. We do so through a study of English spatial particles, an important subset of which are prepositions.
The central notion we explore is that of a spatial scene, a conceptualized relation grounded in spatial interaction and experience, involving entities that are related in a particular spatio-configurational way. For instance, in a spatial scene described by: The cup is on the table, the cup is in contact with the upper side of the table. A distinct spatio-configuration is described by the following: The coffee is in the cup. This scene involves the coffee being located inside (as opposed to outside) the cup. However, spatial scenes do not involve only spatio-physical relations or configurations. It turns out that particular spatial relations have non-trivial consequences that are meaningful to humans. The spatial scene involving on also involves a support function between the table and the cup: unless enough of the cup's base is situated on the table, the cup will fall and smash on the floor.