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Background: Carbapenem-resistant Acinetobacter baumannii (CRAB), a multidrug-resistant gram-negative bacterium, can cause difficult-to-treat infections with mortality in approximately half of CRAB cases. CRAB can spread among healthcare facilities after transfer of an infected or colonized patient. Strategies to limit CRAB spread include adherence to contact precautions, environmental cleaning with bleach, and screening to identify colonized patients. During July–September 2018, the Connecticut Department of Public Health (DPH) worked with an acute-care hospital (hospital A) to contain an outbreak of OXA-23–producing CRAB (OXA-23 is an enzyme that confers resistance to carbapenems). During November 2018–March 2019, statewide CRAB surveillance identified additional cases of related OXA-23–producing CRAB at other healthcare facilities. DPH, Connecticut State Public Health Laboratory (SPHL), and the Antibiotic Resistance Laboratory Network (ARLN) investigated to prevent additional cases. Methods: Since January 2017, CRAB isolates have been routinely sent to SPHL and ARLN for carbapenemase gene detection and whole-genome sequencing (WGS) to determine isolate relatedness. During November 2018–March 2019, DPH collected patient healthcare history for patients with CRAB isolates to identify outbreaks and provide assistance in infection control and prevention to healthcare facilities reporting CRAB cases. Beginning May 2019, DPH and ARLN offered facilities screening to identify patients colonized with OXA-23–producing CRAB. Results: Of 10 OXA-23–producing CRAB isolates reported to DPH during November 2018–March 2019, 3 were closely related to the 9 isolates from hospital A’s outbreak by WGS (single-nucleotide polymorphism difference range, 1–16). One isolate was from a patient who had been admitted to hospital A during July 2018. All 3 patients with CRAB isolates shared a history of residence at long-term–care facility A (LTCF A). Two patients received a CRAB infection diagnosis upon admission to hospital B after transfer from LTCF A. Both LTCF A and hospital B performed environmental cleaning with bleach and placed CRAB-identified patients on contact precautions. LTCF A declined screening patients for CRAB, whereas hospitals B and C, which receive frequent transfers from LTCF A, screened all patients on admission from LTCF A. During May–September 2019, among 6 patients screened, 1 was colonized with OXA-23–producing CRAB and was placed on contact precautions. Conclusions: Transfer of patients who are infected or colonized with CRAB among hospitals and LTCFs can facilitate the regional spread of CRAB. Strategies for containing the spread of carbapenemase-producing organisms include adherence to contact precautions, colonization screening, interfacility communication, and collaboration with public health.
Alcohol misuse is common in bipolar disorder and is associated with worse outcomes. A recent study evaluated integrated motivational interviewing and cognitive behavioural therapy for bipolar disorder and alcohol misuse with promising results in terms of the feasibility of delivering the therapy and the acceptability to participants.
Here we present the experiences of the therapists and supervisors from the trial to identify the key challenges in working with this client group and how these might be overcome.
Four therapists and two supervisors participated in a focus group. Topic guides for the group were informed by a summary of challenges and obstacles that each therapist had completed at the end of therapy for each individual client. The audio recording of the focus group was transcribed and data were analysed using thematic analysis.
We identified five themes: addressing alcohol use versus other problems; impact of bipolar disorder on therapy; importance of avoidance and overcoming it; fine balance in relation to shame and normalising use; and ‘talking the talk’ versus ‘walking the walk’.
Findings suggest that clients may be willing to explore motivations for using alcohol even if they are not ready to change their drinking, and they may want help with a range of mental health problems. Emotional and behavioural avoidance may be a key factor in maintaining alcohol use in this client group and therapists should be aware of a possible discrepancy between clients’ intentions to reduce misuse and their actual behaviour.
Physical and emotional punishment of children is highly prevalent in the Asia-Pacific region. These actions predict a range of physical and emotional harms, prompting a worldwide effort to eliminate them. A key strategy in this effort is to change parental beliefs regarding the acceptability of physical and emotional punishment. The Positive Discipline in Everyday Parenting (PDEP) program was designed to change those beliefs by teaching parents about child development and strengthening their problem-solving skills. A sample of 377 parents in the Asia-Pacific region completed the program: 329 mothers and 47 fathers of children ranging in age from infancy to adolescence. The parents lived in Australia (n = 135), Japan (n = 172) or the Philippines (n = 70). In all three countries, parents’ approval of punishment in general, and physical punishment specifically, declined and they became less likely to attribute typical child behavior to intentional misbehavior. By the end of the program, at least 75% of parents in each country felt better prepared to respond nonviolently to conflict with their children.
“I deny nothing, but doubt everything,” Byron wrote of his religious views in 1811 (BLJ 2: 136). The complexity of Byron’s religious thought, with its apparent contradictions, its changing nature over time and the deliberate facetiousness with which he often addressed such topics, all make it difficult for commentators to categorize his views. Similarly, the modern loss of sensitivity to questions of theological detail that to Byron were clear and self-evident has meant that many conflicting labels have been applied to Byron’s references to religion in his verse and prose. This chapter considers Byron’s shifting and multiple religious identifications and sympathies, from his engagement with Calvinism to his deism, agnosticism, skepticism and sympathies with Catholicism and Islam, not only in relation to his biography but also within the complex landscape of religious belief and the politics of religion in the Romantic period.
The current study aimed to examine the correspondence between sales data and dietary recall data for sugary drinks in Canada.
Repeat cross-sectional analysis of sales data for sugary drinks sold in Canada from 2004 to 2015 from two sources: GlobalData (GD) and Euromonitor (EM). Sugary drinks included ten beverage categories containing free sugars. Analyses examined sales volumes over time, with adjustment for population growth. National intake estimates were drawn from the 2004 and 2015 Canadian Community Health Survey (CCHS) Nutrition.
In 2015, daily per capita sugary drinks consumption was estimated as 356 ml (GD) and 443 ml (EM) from sales data sources, and as 277 ml from dietary recall data. Both sales data sources and dietary recall data indicated that per capita sugary drinks consumption decreased from 2004 to 2015, although the magnitude of this change differed: −23 % (GD), −17 % (EM) and −32 % (CCHS Nutrition). Market sales data showed similar trends among categories of sugary drinks, with decreases in sales of traditional beverage categories (e.g. carbonated soft drinks) and increases in novel categories (e.g. sugar-sweetened coffee).
All data sources indicate a declining trend in sugary drinks consumption between 2004 and 2015, but with considerable differences in magnitude. Consumption estimates from sales data were substantially higher than estimates from dietary recall data, likely due to under-reporting of beverage intake through dietary recall and the inability of sales data to account for beverages sold but not consumed. Despite the observed decline, sugary drinks sales volumes remain high in Canada.
To examine the association between parenting styles and overall child dietary quality within households that are low-income and food-insecure.
Child dietary intake was measured via a 24 h dietary recall. Dietary quality was assessed using the Healthy Eating Index-2005 (HEI-2005). Parenting styles were measured and scored using the Parenting Styles and Dimensions Questionnaire. Linear regressions were used to test main and interaction associations between HEI-2005 scores and parenting styles.
Non-probability sample of low-income and food-insecure households in South Carolina, USA.
Parent–child dyads (n 171). Parents were ≥18 years old and children were 9–15 years old.
We found a significant interaction between authoritative and authoritarian parenting style scores. For those with a mean authoritarian score, each unit increase in authoritative score was associated with a higher HEI-2005 score (b = 3·36, P < 0.05). For those with an authoritarian score that was 1 sd above the mean authoritarian score, each unit increase in authoritative score was associated with a higher HEI-2005 score (b = 8.42, P < 0.01). For those with an authoritarian score that was −1 sd below the mean authoritarian score, each unit increase in authoritative score was associated with a lower HEI-2005 score; however, this was not significant (b = −1·69, P > 0·05). Permissive parenting style scores were negatively associated with child dietary quality (b = −2·79, P < 0·05).
Parenting styles should be considered an important variable that is associated with overall dietary quality in children living within low-income and food-insecure households.
Pregnancy and childbirth are a period of high risk for women with bipolar disorder and involve difficult decisions particularly about continuing or stopping medications.
To explore what clinical predictors may help to individualise the risk of perinatal recurrence in women with bipolar disorder.
Information was gathered retrospectively by semi-structured interview, questionnaires and case-note review from 887 women with bipolar disorder who have had children. Clinical predictors were selected using backwards stepwise logistic regression, conditional permutation random forests and reinforcement learning trees.
Previous perinatal history of affective psychosis or depression was the most significant predictor of a perinatal recurrence (odds ratio (OR) = 8.5, 95% CI 5.04–14.82 and OR = 3.6, 95% CI 2.55–5.07 respectively) but even parous women with bipolar disorder without a previous perinatal mood episode were at risk following a subsequent pregnancy, with 7% developing postpartum psychosis.
Previous perinatal history of affective psychosis or depression is the most important predictor of perinatal recurrence in women with bipolar disorder and can be used to individualise risk assessments.
M87, in the Virgo cluster, allows us to study the interaction of a supermassive black hole (SMBH) with its hot gaseous atmosphere. Deep Chandra observations reveal a nearly circular shock front with a Mach number of 1.2 and a radius of 13 kpc which is driven by a central cavity inflated by an SMBH outburst began 12 million years ago. An outburst with an energy of a ~5×57 ergs and a duration of ~2 Myrs provides a good match to all the constraints. For an outburst repetition rate of about 12 Myrs (the outburst age), the outburst energy is sufficient to balance the radiative cooling of the gas. The outburst duration in M87 argues for a “gentle” (long duration) outburst that does not generate strong shocks and where much of the outburst energy is deposited in the cavities that then transfer energy to the surrounding gas as they buoyantly rise.
We analyse archival XMM-Newton observations of the massive galaxy group NGC 4839 falling into the Coma cluster core, which reveal a complex morphology for the merger. By comparing high quality X-ray maps of the merging subcluster with SPH simulations, we propose an infall scenario which qualitatively reproduces the observed structure of the NGC 4839 tail.
A cognitive behavioral model predicts that coping responses mediate the relationship between falls related psychological concerns and falls incidence, in community-dwelling older people. If empirical support could be found for this pathway then interventions could be developed to reduce falls risk by targeting coping strategies. Therefore, this study aimed to begin the process of testing whether coping responses mediate the association between falls self-efficacy (a principal element of falls related psychological concerns) and falls incidence, in community-dwelling older people.
In a cross-sectional design, 160 community-dwelling older people (31 male, 129 female; mean age 83.47 years) completed the Falls Efficacy Scale–International, the Revised-Ways of Coping Questionnaire, the Turning to Religion subscale of the COPE, and a falls questionnaire. Data were analyzed via mediation analysis using a bootstrapping approach.
Lower falls self-efficacy was associated with higher falls incidence, and more self-controlling coping was found to be a partial mediator of this association, with a confidence interval for the indirect effect of (0.003, 0.021) and an effect size of κ2
= 0.035. The association was not mediated by the other measured coping responses; namely, turning to religion, distancing, seeking social support, accepting responsibility, escape-avoidance, planful problem-solving, and positive reappraisal.
Self-controlling coping may mediate the association between falls self-efficacy and falling. If longitudinal studies confirm this finding then coping could be targeted in interventions to reduce falls.
OBJECTIVES/SPECIFIC AIMS: The Institute for Transnational Sciences (ITS) has developed novel methods to ethically engage stakeholders across the transnational research spectrum, up to and including public health practice and policy. METHODS/STUDY POPULATION: In 2014, the ITS co-founded The Research, Education, And Community Health (REACH), the mission of which was to facilitate communication, collaborative research, and service activities between faculty and scientists and area community leaders. The intent was to identify and meet the needs of our communities without gaps and/or redundancies, thus better leveraging time, funding, and efforts. RESULTS/ANTICIPATED RESULTS: REACH now boasts 23 Centers, Departments, and Institutes, as well as 39 community organizations, including public and mental health agencies, clinicians, policy makers, family service centers, cultural and faith-based organizations, business, and local schools/colleges. We offer 3 methods for consideration as best practices: (1) a comprehensive community health needs assessment, (2) an “Offer and Ask” community/campus partnership mechanism, and (3) Community Science Workshops, based on the European Union’s Science Shops. DISCUSSION/SIGNIFICANCE OF IMPACT: Results of REACH’s work have been used to provide guidance for enhanced, data-driven programs and allocation of resources for local and statewide initiatives. The organization has evolved into an independent coalition seeking 501(c)3 status and is planning to expand its scope to 5 counties. REACH thus serves as model for successful replication across applicable CTSA hubs.
Due to rising pressure to appear egalitarian, subtle discrimination pervades today's workplace. Although its ambiguous nature may make it seem innocuous on the surface, an abundance of empirical evidence suggests subtle discrimination undermines employee and organizational functioning, perhaps even more so than its overt counterpart. In the following article, we argue for a multidimensional and continuous, rather than categorical, framework for discrimination. In doing so, we propose that there exist several related but distinct continuums on which instances of discrimination vary, including subtlety, formality, and intentionality. Next, we argue for organizational scholarship to migrate toward a more developmental, dynamic perspective of subtle discrimination in order to build a more comprehensive understanding of its antecedents, underlying mechanisms, and outcomes. We further contend that everyone plays a part in the process of subtle discrimination at work and, as a result, bears some responsibility in addressing and remediating it. We conclude with a brief overview of research on subtle discrimination in the workplace from each of four stakeholder perspectives—targets, perpetrators, bystanders, and allies—and review promising strategies that can be implemented by each of these stakeholders to remediate subtle discrimination in the workplace.
To test modifications to nutrition label serving size information on understanding of energy (calorie) content among youth and young adults.
Participants completed two online experiments. First, participants were randomly assigned to view a beverage nutrition label with a reference amount of per serving (250 ml), per container (473 ml) or a dual-column format with both reference amounts. Participants were then randomized to view a cracker nutrition label which specified a single serving in small font, a single serving in large font, or the number of servings per bag with single serving information below. In both experiments, participants estimated energy content. Logistic regression analysis modelled correct energy estimation. Finally, participants reported their preference for serving size display format.
Canadian youth and young adults (n 2008; aged 16–24 years).
In experiment 1, participants randomized to view the nutrition label with per container or dual column were more likely to correctly identify energy content than those using per serving information (P<0·01). For experiment 2, the serving size display format had no association with correct energy estimation. The majority of participants (61·9 %) preferred the serving size format that included servings per package.
Labelling foods with nutrition information using a serving size reference amount for the entire container increased understanding of energy content. Consumers prefer nutrition labels that include more prominently featured serving size information. Additional modifications that further improve consumers’ accuracy should be examined. These results have direct implications for nutrition labelling policy.
The dynamic model Nitrogen Dynamics in Crop rotations in Ecological Agriculture (NDICEA) was used to assess the nitrogen (N), phosphorus (P) and potassium (K) balance of long-term organic cropping trials and typical organic crop rotations on a range of soil types and rainfall zones in the UK. The measurements of soil N taken at each of the organic trial sites were also used to assess the performance of NDICEA. The modeled outputs compared well to recorded soil N levels, with relatively small error margins. NDICEA therefore seems to be a useful tool for UK organic farmers. The modeling of typical organic rotations has shown that positive N balances can be achieved, although negative N balances can occur under high rainfall conditions and on lighter soil types as a result of leaching. The analysis and modeling also showed that some organic cropping systems rely on imported sources of P and K to maintain an adequate balance and large deficits of both nutrients are apparent in stockless systems. Although the K deficits could be addressed through the buffering capacity of minerals, the amount available for crop uptake will depend on the type and amount of minerals present, current cropping and fertilization practices and the climatic environment. A P deficit represents a more fundamental problem for the maintenance of crop yields and the organic sector currently relies on mined sources of P which represents a fundamental conflict with the International Federation of Organic Agriculture Movements organic principles.
Division XI, the predecessor to Division D until 2012, was formed in 1994 at the IAU General Assembly in The Hague by merging Commission 44 Astronomy from Space and Commission 48 High Energy Astrophysics. Historically, space astrophysics started with the high energy wavelengths (far UV, X-ray, and gamma-ray astronomy) which are only accessible from space. However, in modern astronomy, to study high energy astrophysical processes, almost all wavelengths are used (including gamma-ray, X-ray, UV, optical, infrared, submillimeter and radio). In addition other ground-based facilities, including gravitational wave antennas, neutrino detectors and high-energy cosmic ray arrays are joining in this era of multi-messenger astrophysics, as well as space missions with the primary goals to discover and study exoplanets, are under the umbrella of Division XI.
There has been increasing interest in the association between childhood
trauma and psychosis. Proposals for potential mechanisms involved include
affective dysregulation and cognitive appraisals of threat.
To establish if, within bipolar disorder, childhood events show a
significant association with psychosis, and in particular with symptoms
driven by dysregulation of mood or with a persecutory content.
Data on lifetime-ever presence of psychotic symptoms were determined by
detailed structured interview with case-note review (n =
2019). Childhood events were recorded using a self-report questionnaire
and case-note information.
There was no relationship between childhood events, or childhood abuse,
and psychosis per se. Childhood events were not
associated with an increased risk of persecutory or other delusions.
Significant associations were found between childhood abuse and auditory
hallucinations, strongest between sexual abuse and mood congruent or
abusive voices. These relationships remain significant even after
controlling for lifetime-ever cannabis misuse.
Within affective disorder, the relationship between childhood events and
psychosis appears to be relatively symptom-specific. It is possible that
the pathways leading to psychotic symptoms differ, with delusions and
non-hallucinatory symptoms being influenced less by childhood or early
Individuals with a mental health disorder appear to be at increased risk of medical illness.
To examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden.
Participants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria.
We found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset.
Bipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role.