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The tailored activity program (TAP) is an evidence-based occupational therapist-led intervention for people living with dementia and their care partners at home, developed in the USA. This study sought to understand its acceptability to people living with dementia, their care partners, and health professionals, and factors that might influence willingness to participate prior to its implementation in Australia.
This study used qualitative descriptive methods. Semi-structured interviews were conducted with people living with dementia in the community (n = 4), their care partners (n = 13), and health professionals (n = 12). People living with dementia were asked about health professionals coming to their home to help them engage in activities they enjoy, whereas care partners’ and health professionals’ perspectives of TAP were sought, after it was described to them. Interviews were conducted face-to-face or via telephone. All interviews were recorded and transcribed. Framework analysis was used to identify key themes.
Analysis identified four key themes labelled: (i) TAP sounds like a good idea; (ii) the importance of enjoyable activities; (iii) benefits for care partners; and (iv) weighing things up. Findings suggest the broad, conditional acceptability of TAP from care partners and health professionals, who also recognised challenges to its use. People living with dementia expressed willingness to receive help to continue engaging in enjoyable activities, if offered.
While TAP appeared generally acceptable, a number of barriers were identified that must be considered prior to, and during its implementation. This study may inform implementation of non-pharmacological interventions more broadly.
We implemented universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing of patients undergoing surgical procedures as a means to conserve personal protective equipment (PPE). The rate of asymptomatic coronavirus disease 2019 (COVID-19) was <0.5%, which suggests that early local public health interventions were successful. Although our protocol was resource intensive, it prevented exposures to healthcare team members.
The coronavirus disease 2019 (COVID-19) has greatly impacted health-care systems worldwide, leading to an unprecedented rise in demand for health-care resources. In anticipation of an acute strain on established medical facilities in Dallas, Texas, federal officials worked in conjunction with local medical personnel to convert a convention center into a Federal Medical Station capable of caring for patients affected by COVID-19. A 200,000 square foot event space was designated as a direct patient care area, with surrounding spaces repurposed to house ancillary services. Given the highly transmissible nature of the novel coronavirus, the donning and doffing of personal protective equipment (PPE) was of particular importance for personnel staffing the facility. Furthermore, nationwide shortages in the availability of PPE necessitated the reuse of certain protective materials. This article seeks to delineate the procedures implemented regarding PPE in the setting of a COVID-19 disaster response shelter, including workspace flow, donning and doffing procedures, PPE conservation, and exposure event protocols.
Tragedy is one of the oldest metaphorical lenses of International Relations. The tragic vision of politics, from Thucydides to contemporary realist theorists, lies at the core of classical realism. However, it is striking how rarely the concept of tragedy has been applied to the discourse of humanitarian intervention. This lacuna is a weakness on both the intellectual and political levels, as nowhere are clashes between competing ethical perspectives more glaring. An examination of the concept of tragedy, as conceived from its Greek origins, can illuminate an understanding of the morally contradictory imperatives created by armed intervention. Using the Bosnian War as a case study, Greek classical tragedy provides a framework to grasp the agonising choices and insoluble ethical dilemmas brought about by humanitarian intervention, in contrast to mere narratives of salvation. The argument conveyed in this article seeks to reconcile a tragic vision with the idea of progress and political action. It concludes by suggesting that the fundamental lessons that lie at the heart of tragedy should be associated with another major concept in Greek culture, namely, the Aristotelian idea of phronesis or ‘practical wisdom’.
The US National Institutes of Health (NIH) established the Clinical and Translational Science Award (CTSA) program in response to the challenges of translating biomedical and behavioral interventions from discovery to real-world use. To address the challenge of translating evidence-based interventions (EBIs) into practice, the field of implementation science has emerged as a distinct discipline. With the distinction between EBI effectiveness research and implementation research comes differences in study design and methodology, shifting focus from clinical outcomes to the systems that support adoption and delivery of EBIs with fidelity.
Implementation research designs share many of the foundational elements and assumptions of efficacy/effectiveness research. Designs and methods that are currently applied in implementation research include experimental, quasi-experimental, observational, hybrid effectiveness–implementation, simulation modeling, and configurational comparative methods.
Examples of specific research designs and methods illustrate their use in implementation science. We propose that the CTSA program takes advantage of the momentum of the field's capacity building in three ways: 1) integrate state-of-the-science implementation methods and designs into its existing body of research; 2) position itself at the forefront of advancing the science of implementation science by collaborating with other NIH institutes that share the goal of advancing implementation science; and 3) provide adequate training in implementation science.
As implementation methodologies mature, both implementation science and the CTSA program would greatly benefit from cross-fertilizing expertise and shared infrastructures that aim to advance healthcare in the USA and around the world.
Aging is associated with numerous stressors that negatively impact older adults’ well-being. Resilience improves ability to cope with stressors and can be enhanced in older adults. Senior housing communities are promising settings to deliver positive psychiatry interventions due to rising resident populations and potential impact of delivering interventions directly in the community. However, few intervention studies have been conducted in these communities. We present a pragmatic stepped-wedge trial of a novel psychological group intervention intended to improve resilience among older adults in senior housing communities.
A pragmatic modified stepped-wedge trial design.
Five senior housing communities in three states in the US.
Eighty-nine adults over age 60 years residing in independent living sector of senior housing communities.
Raise Your Resilience, a manualized 1-month group intervention that incorporated savoring, gratitude, and engagement in value-based activities, administered by unlicensed residential staff trained by researchers. There was a 1-month control period and a 3-month post-intervention follow-up.
Validated self-report measures of resilience, perceived stress, well-being, and wisdom collected at months 0 (baseline), 1 (pre-intervention), 2 (post-intervention), and 5 (follow-up).
Treatment adherence and satisfaction were high. Compared to the control period, perceived stress and wisdom improved from pre-intervention to post-intervention, while resilience improved from pre-intervention to follow-up. Effect sizes were small in this sample, which had relatively high baseline resilience. Physical and mental well-being did not improve significantly, and no significant moderators of change in resilience were identified.
This study demonstrates feasibility of conducting pragmatic intervention trials in senior housing communities. The intervention resulted in significant improvement in several measures despite ceiling effects. The study included several features that suggest high potential for its implementation and dissemination across similar communities nationally. Future studies are warranted, particularly in samples with lower baseline resilience or in assisted living facilities.
To investigate the association of prenatal alcohol exposure (PAE) and early neurodevelopment in the first 2 years of life, adjusting for maternal socio-demographic and psychosocial factors, in the Drakenstein Child Health Study (DCHS), a South African birth cohort study.
The DCHS comprises a population-based birth cohort of 1143 children, of which a subsample completed the Bayley Scales of Infant Development-III (BSID-III) at 6 (n = 260) and 24 months of age (n = 734). A subset of alcohol-exposed and -unexposed children was included in this analysis at age 6 (n = 52 exposed; n = 104 unexposed) and 24 months (n = 92 exposed; n = 184 unexposed). Multiple hierarchical regression was used to explore the associations of PAE with motor and language development.
PAE was significantly associated with decreased gross motor [odds ratio (OR) = 0.16, 95% confidence interval (CI) = 0.06–0.44, p = 0.001] or fine motor (OR = 0.16, 95% CI = 0.06–0.46, p = 0.001) functioning after adjusting for maternal socio-demographic and psychosocial factors at 6 months of age only. No significant effects were found in either receptive or expressive communication and cognitive outcomes at either time points.
PAE has potentially important consequences for motor development in the first 2 years of life, a period during which the most rapid growth and maturation occur. These findings highlight the importance of identifying high-risk families in order to provide preventive interventions, particularly in antenatal clinics and early intervention services.
In 2010, an important earthquake devastated Haiti and caused thousands of deaths. In a social context where women are particularly vulnerable, this cross-sectional study examined the associations between sexual assaults experienced by women before the earthquake, the earthquake exposure, the traumatic consequences, and their satisfaction of social support received.
A total of 660 women aged 18 to 86 completed questionnaires assessing exposure to the earthquake, sexual assault victimization, peritraumatic distress, Posttraumatic stress disorder (PTSD), depression, and social support. A moderated moderation model was computed to examine associations between exposure to the earthquake, sexual assault, social support, and traumatic consequences.
Results showed that 31.06% of women were victims of sexual assault before the earthquake. They presented higher prevalence of peritraumatic distress, PTSD, and depression symptoms, compared to non-victims. The moderated-moderation model showed that sexual assault and exposure to the earthquake were positively associated with traumatic consequences (respectively, B = 0.560, p < 0.001; B = 0.196, p < 0.001), while social support was negatively associated with them (B = −0.095, p < 0.05). Results showed a triple interaction: women victim of sexual assault who were satisfied with received social support are less likely to develop traumatic consequences after being exposed to the earthquake(B = −0.141, p < 0.01).
By demonstrating the role of sexual assault in the development of mental health problems after the Haitian earthquake, this study shows the importance for clinicians to investigate interpersonal trauma experienced before or following natural disasters among survivors. Results also indicate the key role of family and communities to help survivors build resilience and coping strategies with their social support.
For over 120 years, the shell middens of western Scotland and the series of open-air sites on Oronsay have been the focus of debate in European Mesolithic studies. This paper challenges the significance of Oronsay in light of results from the geophysical survey and test-excavation of a new limpet and periwinkle shell midden dated to the late 5th or start of the 4th millennium cal bc at Port Lobh, Colonsay that offers fresh evidence to re-evaluate critically the role of Oronsay and coastal resources in island settlement models ahead of the Mesolithic–Neolithic transition. Test excavations recovered a marine molluscan assemblage dominated by limpet and periwinkle shells together with crab, sea urchin, a fishbone assemblage composed mainly of Gadidae, some identifiable bird and mammal bone, carbonised macroplant remains, and pumice as well as a bipolar lithic assemblage and coarse stone implements. Novel seasonality studies of saithe otolith thin-sections suggest wintertime tidal fishing practices. At least two activity events may be discerned, dating from the late 5th millennium cal bc. The midden could represent a small number of rapidly deposited assemblages or maybe the result of stocastic events within a more extended timeframe. We argue that alternative research questions are needed to advance long-standing debates about seasonal inter-island mobility versus island sedentism that look beyond Oronsay to better understand later Mesolithic occupation patterns and the formation and date of Oronsay middens. We propose alternative methodological strategies to aid identification of contemporaneous sites using geophysical techniques and lithic technological signatures.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Wind energy is an environmentally sustainable, cost-effective and renewable source of energy with high potential for expansion. As wind energy production expands, turbines are becoming larger, taller and more numerous, covering a larger geographical range and with greater concentration in high resource areas, thereby leading to greater public opposition from those whose interests or values are impacted. Their concerns include impacts on birds and other wildlife, aesthetics and viewsheds, noise and vibrations, human health, property values and the industrialization of rural and pristine landscapes. Due to limited systematic or consensus-based research on several of these topics, the prevalence and severity of the impacts of these are themselves often a source of dispute. Because of the broader political climate, many of the specific concerns about the adverse impacts of wind turbines on nearby residents have been swept up into a broader resistance to wind energy, based in skepticism about climate change, collusion of government and industry, concerns about cost-effectiveness or support for oil and gas development. A highly variable and inconsistent regulatory environment also exacerbates conflicts, with the greatest control sometimes situated at the local level, which leads to case-bycase decision making that suffers from limited technical capacity and is subject to greater local pressure. In many areas, pro-wind and anti-wind advocates have become locked in a fight where both sides ultimately deny the evidence, experiences and realities of the other.
In the face of these growing conflicts, some models for collaborative resolution are emerging. Collaboration between the wind industry and wildlife advocates, such as that pursued by the American Wind Wildlife Institute (see case study) and the Bats and Wind Energy Cooperative, has gone a long way toward understanding, mitigating and reducing wind energy's impact on wildlife. Improved early engagement of stakeholders in state and local siting policy and decision-making, joint fact-finding on areas of uncertainty, clarified regulatory frameworks and expanded public dialogue on energy needs and trade-offs also hold promise for managing wind energy siting disputes.
The Scale of Wind Energy
Wind energy is the fastest growing energy source in the world and has seen enormous growth in the United States over the past few decades.
Electricity and natural gas transmission systems are the backbone needed to deliver energy resources to the distribution systems that provide electricity and natural gas to consumers. They are also the part of our energy infrastructure that affects the most people because electricity transmission and distribution and natural gas pipelines cover millions of miles near homes, along highways, across farms and tribal land and through our parks and cities (see Figures 5.1 and 5.2).
The investment needed to expand and modernize this infrastructure to meet today's and tomorrow's evolving needs is daunting. Almost 50 percent of the existing US natural gas transmission system is more than 50 years old and in imminent need of repair or replacement. Furthermore, new sources of natural gas and oil from the “fracking” boom of the past 15 years have required the construction of new pipelines, and the ongoing shift from coal to natural gas for electricity generation is driving demand for more production and more pipelines. On the transmission side, the Edison Electric Institute estimates that the electricity transmission and distribution system needs $900 billion in new investment by 2030. The need for new transmission lines, in particular, is being driven in part by the growing costeffectiveness of remote renewable energy sources such as wind and solar, from which electricity must be carried over long distances to major population centers.
Different regulatory frameworks govern siting decisions for electricity transmission and for natural gas pipelines. In the case of transmission lines, the overlapping authorities over siting of local, state and federal government have in many cases added to the sources of conflict. In contrast, some cite the more streamlined and clear jurisdiction of the federal government in pipeline siting as a model for resolving siting conflicts more effectively.
The source of some of the most intractable conflicts has been and continues to be the disconnect between the costs and the benefits of interstate transmission and pipeline projects. Those living along the lengthy transmission and pipeline corridors often do not enjoy the benefits of lower cost or cleaner power that is carried by these projects.
This book has sought to offer a snapshot of energy siting conflicts and collaborative opportunities in the United States across gas and oil, wind, transmission and disposal of nuclear waste. While each energy type and its production (or disposal) is governed by various jurisdictions, with different impacts and benefits, they also share commonalities. Our central question has been the following: in what ways can collaboration and conflict resolution be used to ameliorate the conflicts that inevitably arise? In our concluding chapter, we offer some overarching ideas and tools for consideration.
Quasi-judicial Decision Making as the De Facto Method of Dispute Resolution
We recognize that the US system— however much bargaining and collaboration may take place in and between formal processes— is a quasi-judicial system. Most of our present processes seek to adjudicate between competing claims at all levels of government. There are boards, commissions, committees and key decision makers that head up complex agencies with multiple interests even within them. These formal bodies seek to gather evidence, weigh benefits and costs and reach authoritative decisions. For wind siting, local and county boards play an important role, along with statewide energy siting boards of some kind (in many cases). For pipelines across state lines, the Federal Energy Regulatory Commission (FERC) and state utility commissions play a fundamental role, while states alone play a more central role in decision making for high-voltage electricity transmission infrastructure. For oil and gas drilling, private property rights fundamentally determine siting, along with the various ways to adjudicate conflicts that have been created over time. For nuclear waste, while the Department of Energy has an important role, the US Congress is still actively engaged in where, how and when it should be stored. While these adjudicatory systems vary across energy types and jurisdictions, they all share assumptions that key agencies can set the general rules while interveners of various kinds can collectively bring the necessary information, potential impacts and interests to the table to be sorted out by various boards and commissions. And, should these fail to resolve issues, the courts always remain as a backstop to conflict.
Why Is Energy Development and Production Important in Regard to Land Use?
Gas and oil wells dot landscapes from Pennsylvania to Texas, bringing both wealth and controversy around air and water quality, wildlife habitat and community change. The advent of nuclear power in the 1950s started a boom of uranium mining, refining and energy production but brought with it the difficult problem of where and how to safely store potently lethal postenergy production nuclear waste for millennia. Appalachia has been shaped for over a century by coal extraction. More recently, the rapid expansion of wind and solar energy has given rise to host of new companies, beneficiaries and conflicts. Wind development, particularly in the more densely populated landscapes of the northeast, has generated conflicts among environmental groups, local citizens at odds with local impact versus global need. Around the country, there is a raised awareness that “clean” energy has its costs too.
Energy extraction and production have powerfully shaped the US landscape over the last hundred years. Blessed with extraordinary natural resources, the United States built the largest economy in the world. While we think of land use primarily as a local function shaped by the creation of housing, office space, tracks and roads, energy production is also a powerful player in land use.
The United States is one of the largest producers of energy in the world. In 2013, it was the world's largest producer of natural gas (30,005,254 million cubic feet) and oil (2,720,782 thousand barrels) and the second largest producer of coal (nearly 1 billion short tons) and renewable energy (at 9.33 quadrillion Btu). Fossil fuels are the main source of energy in the United States. Fossil fuel resources comprised approximately 82 percent of total US energy consumption in 2013 (with nuclear energy comprising 8 percent and renewable energy 10 percent). Beyond generating energy, these natural resources are essential to creating other products, such as oil to make asphalt and coal for steel. Energy production in its many forms cuts across locales and states, and it affects landscapes substantially, if unevenly, across the United States.