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Examination of the elbow starts with standing the patient and observing the carrying angle and looking for deformity and scars. The process flows best when movements are performed next, followed by palpation. If there is tenderness over the epicondyles, then provocation tests are performed, on the lateral side for tennis elbow and on the medial side for golfer’s elbow. Lastly, instability tests are performed. The pivot shift test is explained in more detail later in this chapter.
Antibiotics are frequently prescribed in nursing homes; national data describing facility-level antibiotic use are lacking. The objective of this analysis was to describe variability in antibiotic use in nursing homes across the United States using electronic health record orders.
A retrospective cohort study of antibiotic orders for 309,884 residents in 1,664 US nursing homes in 2016 were included in the analysis. Antibiotic use rates were calculated as antibiotic days of therapy (DOT) per 1,000 resident days and were compared by type of stay (short stay ≤100 days vs long stay >100 days). Prescribing indications and the duration of nursing home-initiated antibiotic orders were described. Facility-level correlations of antibiotic use, adjusting for resident health and facility characteristics, were assessed using multivariate linear regression models.
In 2016, 54% of residents received at least 1 systemic antibiotic. The overall rate of antibiotic use was 88 DOT per 1,000 resident days. The 3 most common antibiotic classes prescribed were fluoroquinolones (18%), cephalosporins (18%), and urinary anti-infectives (9%). Antibiotics were most frequently prescribed for urinary tract infections, and the median duration of an antibiotic course was 7 days (interquartile range, 5–10). Higher facility antibiotic use rates correlated positively with higher proportions of short-stay residents, for-profit ownership, residents with low cognitive performance, and having at least 1 resident on a ventilator. Available facility-level characteristics only predicted a small proportion of variability observed (Model R2 version 0.24 software).
Using electronic health record orders, variability was found among US nursing-home antibiotic prescribing practices, highlighting potential opportunities for targeted improvement of prescribing practices.
Communication is recognised as an important factor in interprofessional collaboration and teamwork. The delivery of optimal person-centred care ‘requires healthcare professionals to effectively communicate, cooperate and collaborate with each other’ (Stanley & Stanley 2019). Interprofessional communication can ensure that information is shared with a collective purpose and clearly defined goals. Thomson and colleageues(2015) demonstrated that having a shared purpose to pursue quality improvement as well as collaboration provides a framework for interprofessional, person-centred care that is highly dependent on effective communication. This chapter outlines the principles of interprofessional communication as well as five competencies that can contribute to collaborative practice. Handover frameworks are explored, along with the value of teamwork. The chapter also examines how nurses and other health professionals recognise and understand conflict as it discusses strategies for managing difficult situations. Finally, professional development is explored through peer learning, mentoring and supervision, with some examples of how this can be achieved.
Medieval slavery has received little attention relative to slavery in ancient Greece and Rome and in the early modern Atlantic world. This imbalance in the scholarship has led many to assume that slavery was of minor importance in the Middle Ages. In fact, the practice of slavery continued unabated across the globe throughout the medieval millennium. This volume – the final volume in The Cambridge World History of Slavery – covers the period between the fall of Rome and the rise of the transatlantic plantation complexes by assembling twenty-three original essays, written by scholars acknowledged as leaders in their respective fields. The volume demonstrates the continual and central presence of slavery in societies worldwide between 500 CE and 1420 CE. The essays analyze key concepts in the history of slavery, including gender, trade, empire, state formation and diplomacy, labor, childhood, social status and mobility, cultural attitudes, spectrums of dependency and coercion, and life histories of enslaved people.
General readers still lack awareness of the prevalence of slavery between the classical period and the post-1420 wider Atlantic World. This phenomenon is not just temporal but geographic, in that Asia, the Indian Ocean World, Amerindian societies and Oceania still receive far less scholarly attention than their populations warrant. This situation exists despite the rapid growth of interest in the general subject of slavery in recent decades. The Islamic conquests and the Mongol expansions generated large numbers of captives, but in fact no society in the Medieval millennium was without enslaved people. While no consensus on the definition of slavery is possible – in this era it assumed a wide spectrum of dependencies - the existence of slave markets across the known world indicates that buyers and sellers shared enough of a common understanding of the practice to sustain a vibrant slave trade. Despite this traffic and major military disruptions, many enslaved people derived their status via birth even though the sources suggest that probably most slaves were female. They also exercised some agency. Prejudice against black people is apparent but the ebb and flow of empires ensured that any group could be a slave, just as any could be a slave owner.
The COVID-19 pandemic and mitigation measures are likely to have a marked effect on mental health. It is important to use longitudinal data to improve inferences.
To quantify the prevalence of depression, anxiety and mental well-being before and during the COVID-19 pandemic. Also, to identify groups at risk of depression and/or anxiety during the pandemic.
Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC) index generation (n = 2850, mean age 28 years) and parent generation (n = 3720, mean age 59 years), and Generation Scotland (n = 4233, mean age 59 years). Depression was measured with the Short Mood and Feelings Questionnaire in ALSPAC and the Patient Health Questionnaire-9 in Generation Scotland. Anxiety and mental well-being were measured with the Generalised Anxiety Disorder Assessment-7 and the Short Warwick Edinburgh Mental Wellbeing Scale.
Depression during the pandemic was similar to pre-pandemic levels in the ALSPAC index generation, but those experiencing anxiety had almost doubled, at 24% (95% CI 23–26%) compared with a pre-pandemic level of 13% (95% CI 12–14%). In both studies, anxiety and depression during the pandemic was greater in younger members, women, those with pre-existing mental/physical health conditions and individuals in socioeconomic adversity, even when controlling for pre-pandemic anxiety and depression.
These results provide evidence for increased anxiety in young people that is coincident with the pandemic. Specific groups are at elevated risk of depression and anxiety during the COVID-19 pandemic. This is important for planning current mental health provisions and for long-term impact beyond this pandemic.
It is not clear to what extent associations between schizophrenia, cannabis use and cigarette use are due to a shared genetic etiology. We, therefore, examined whether schizophrenia genetic risk associates with longitudinal patterns of cigarette and cannabis use in adolescence and mediating pathways for any association to inform potential reduction strategies.
Associations between schizophrenia polygenic scores and longitudinal latent classes of cigarette and cannabis use from ages 14 to 19 years were investigated in up to 3925 individuals in the Avon Longitudinal Study of Parents and Children. Mediation models were estimated to assess the potential mediating effects of a range of cognitive, emotional, and behavioral phenotypes.
The schizophrenia polygenic score, based on single nucleotide polymorphisms meeting a training-set p threshold of 0.05, was associated with late-onset cannabis use (OR = 1.23; 95% CI = 1.08,1.41), but not with cigarette or early-onset cannabis use classes. This association was not mediated through lower IQ, victimization, emotional difficulties, antisocial behavior, impulsivity, or poorer social relationships during childhood. Sensitivity analyses adjusting for genetic liability to cannabis or cigarette use, using polygenic scores excluding the CHRNA5-A3-B4 gene cluster, or basing scores on a 0.5 training-set p threshold, provided results consistent with our main analyses.
Our study provides evidence that genetic risk for schizophrenia is associated with patterns of cannabis use during adolescence. Investigation of pathways other than the cognitive, emotional, and behavioral phenotypes examined here is required to identify modifiable targets to reduce the public health burden of cannabis use in the population.
Active galactic nuclei (AGN) are believed to regulate star formation inside their host galaxies through “AGN feedback”. We summarise our on-going study of luminous AGN (z ∼ 0.2−3; LAGN,bol 1043 erg s−1), which is designed to search for observational signatures of feedback by combining observed star-formation rate (SFR) measurements from statistical samples with cosmological model predictions. Using the EAGLE hydrodynamical cosmological simulations, in combination with our Herschel + ALMA surveys, we show that – even in the presence of AGN feedback – we do not necessarily expect to see any relationships between average galaxy-wide SFRs and instantaneous AGN luminosities. We caution that the correlation with stellar mass for both SFR and AGN luminosity can contribute to apparent observed positive trends between these two quantities. On the other hand, the EAGLE simulations, which reproduce our observations, predict that a signature of AGN feedback can be seen in the wide specific SFR distributions of all massive galaxies (not just AGN hosts). Overall, whilst we can not rule out that AGN have an immediate small-scale impact on in-situ star-formation, all of our results are consistent with a feedback model where galaxy-wide in-situ star formation is not rapidly suppressed by AGN, but where the feedback likely acts over a longer timescale than a single AGN episode.