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As access to cancer care has improved throughout sub-Saharan Africa, treatment-associated infections have increased. Assessing healthcare worker knowledge of antimicrobial stewardship and identifying the barriers to infection management will inform the development of contextually appropriate antimicrobial stewardship programs, improving cancer outcomes in sub-Saharan Africa.
The Uganda Cancer Institute (UCI), a national cancer referral center in Kampala, Uganda.
We surveyed 61 UCI staff: 29 nurses, 7 pharmacists, and 25 physicians.
The survey contained 25 questions and 1 ranking exercise. We examined differences in responses by staff role.
All 60 respondents who answered the question had heard the term “antimicrobial resistance.” Only 44 (73%) had heard the term “antimicrobial stewardship.” Nurses were less likely than pharmacists or physicians to be familiar with either term. Also, 41 respondents (68%) felt that loss of antibiotic susceptibility is a major issue at UCI. Regarding barriers to diagnosing infections, 54 (93%) of 58 thought that it was difficult to obtain blood cultures and 48 (86%) of 56 thought that it was difficult to regularly measure temperatures.
Although most recognized the term “antimicrobial resistance,” fewer were familiar with the term “antimicrobial stewardship.” Inappropriate antibiotic use was recognized as a contributor to antimicrobial resistance, but hand hygiene was underrecognized as a contributing factor. We identified numerous barriers to diagnosing infections, including the ability to obtain blood cultures and consistently monitor temperatures. Educating staff regarding antimicrobial selection, allocating resources for blood cultures, and implementing strategies to enhance fever detection will improve infection management.
We examine the socioeconomic consequences of discrimination against people of Southern origins during the US Great Migration of the first half of the twentieth century. We ask whether people living in the American North and Midwest in 1940 fared worse with respect to education, occupation, and income if they were perceived to be of Southern origins. We also assess variation in these effects across racial groups and across actual region of origin groups. Using linked data from the 1920 and 1940 US censuses, we compare the life outcomes of about half a million pairs of brothers who differed with respect to the regional origin implied by their first names. For both Whites and Blacks, we find statistically significant associations between outcomes and the regional origin implied by names; regardless of where they were born, men living in the North or Midwest in 1940 did worse if their names implied Southern origins. However, these associations are entirely confounded by family-specific cultural, socioeconomic, and other factors that shaped both family naming practices and life outcomes. This finding—that regional discrimination in the early-twentieth-century United States did not happen based on names—contrasts sharply with findings from research in more recent years that uses names as proxies for people’s risk of exposure to various forms of discrimination. Whereas names are a basis for discrimination in modern times, they were not a basis for regional discrimination in an era in which people had more immediate and direct evidence about regional origins.
In Turner v. Rogers,1 Justice Clarence Thomas distinguished himself as arguably the most progressive Justice on the U.S. Supreme Court – at least with respect to children’s rights. The case was brought by a noncustodial father who had accrued $13,814.72 in unpaid child support and was imprisoned for a year after being held in civil contempt for his failure to pay. It was just one of six times Mr. Turner had been held in contempt for failing to pay $51.73 per week to support his child between 2003 and 2010.2
Many modern paleobiological analyses are conducted at the generic level, a practice predicated on the validity of genera as meaningful proxies for species. Uncritical application of genera in such analyses, however, has led—perhaps inadvertently—to the unjustified reification of genera in an evolutionary context. While the utility of genera as proxies for species in evolutionary studies should be evaluated as an empirical issue, in practice it is increasingly assumed (rather than demonstrated) that genera are suitable proxies for species. This is problematic on both ontological and epistemological grounds. Genera are arbitrarily circumscribed, non-equivalent, often paraphyletic, and sometimes polyphyletic collections of species. They are useful tools for communication but have no theoretical or biological reality of their own and, whether monophyletic or not, cannot themselves operate in the evolutionary process. Attributes considered important for understanding macroevolution—e.g., geographic ranges, niche breadths, and taxon durations—are frequently variable among species within genera and will be inflated at the generic level, especially in species-rich genera. Consequently, the meaning(s) of results attained at the generic level may not “trickle down” in any obvious way that elucidates our understanding of evolution at the species level. Ideally, then, evolutionary studies that are actually about species should be pursued using species-level data rather than proxy data tabulated using genera. Where genera are used, greater critical attention should be focused on the degree to which attributes tabulated at the generic level reflect biological properties and processes at the species level.
A relationship between epilepsy and damage to mesial temporal structures has long been recognized. Recent advances have clarified somewhat the issue of whether the pathological changes seen in mesial temporal sclerosis represent the cause or the effect of seizures. This paper reviews mesial temporal sclerosis from an historical perspective and summarizes recent developments in the fields of excitotoxicity, selective vulnerability, and synaptic reorganization as they pertain to the pathogenesis of mesial temporal sclerosis.
Objectives: The objective of this study was to compare evidence requirements for health technology assessment of pharmaceuticals by national agencies across Europe responsible for reimbursement decisions focusing specifically on relative effectiveness assessment.
Methods: Evidence requirements from thirty-three European countries were requested and twenty-nine national agencies provided documents to review. Data were extracted from national documents (manufacturer's submission templates and associated guidance) into a purpose-made framework with categories covering information about the health condition, the technology, clinical effectiveness and safety.
Results: The level of detail in the required evidence varies considerably across countries. Some countries include specific questions while others request information under general headings. Some countries include all information in a single document, which may or may not include guidance on how to complete the template. Others have specific guidance documents or methods and process manuals that help with the completion of the submission templates. Despite differences in quantity and detail, the content of the evidence requirements is broadly similar. All countries ask for information on the health technology, target disease, and clinical effectiveness and safety. However, one country only requests clinical effectiveness information as part of cost-effectiveness analyses. We found twenty-six evidence requirements for which generic answers may apply across borders and nineteen in which countries requested nationally specific information.
Conclusions: This work suggests that it would be possible to put together a minimum set of evidence requirements for HTA to support reimbursement decisions across Europe which could facilitate collaboration between jurisdictions.
Many patients approaching death experience hopelessness, helplessness, and a depressed mood, and these factors can contribute to a difficult end-of-life (EoL) period. Biography services may assist patients in finding meaning and purpose at this time. The aim of our study was to investigate the lived experience of volunteers involved in a biography service in Melbourne, Australia, using a qualitative methodology.
The participants were 10 volunteers who had participated in a biography service within a private palliative care service. Each volunteer was interviewed separately using a study-specific semistructured interview guide. The transcripts of these interviews were then subjected to thematic analysis.
Analysis yielded the following themes: motivations for volunteering; dealing with death, dying, and existential issues; psychosocial benefits of volunteering; and benefits and challenges of working with patients and their families. Our results indicated that volunteering gave the volunteers a deeper appreciation of existential issues, and helped them to be more appreciative of their own lives and gain a deeper awareness of the struggles other people experience. They also suggested that volunteers felt that their involvement contributed to their own personal development, and was personally rewarding. Furthermore, the results highlighted that volunteers found that encounters with family members were sometimes challenging. While some were appreciative, others imposed time limits, became overly reliant on the volunteers, and were sometimes offended, hurt, and angered by what was included in the final biography.
Significance of Results:
It is hoped that the findings of the current study will provide direction for improvements in the biography services that will benefit patients, family members, and volunteers. In particular, our findings highlight the need to provide ongoing support for volunteers to assist them in handling the challenges of volunteering in a palliative care setting.
Background: Initial therapy appointments have high nonattendance rates yet the reasons remain poorly understood. Aims: This study aimed to identify positive and negative attitudes towards therapy that predicted initial attendance, informed by a perceptual control theory account of approach-avoidance conflicts in help-seeking. Method: A prospective study was conducted within a low intensity CBT service using first appointment attendance (n = 96) as an outcome. Measures included attitudes towards therapy, depression and anxiety scales, and demographic variables. Results: Endorsement of a negative attitude item representing concern about self-disclosure was independently predictive of nonattendance. Positive attitudes predicted increased attendance, especially endorsement of motives for self-reflection, but only among less depressed individuals. Conclusions: Self-disclosure concerns contribute to therapy avoidance and having goals for self-reflection may represent approach motivation for therapy; however, the latter has less impact among more highly depressed people.
Due to the high turnover of teaching staff in remote schools, the long-term sustainability of educational initiatives that enhance Indigenous student's learning is a major concern. This article presents a study of a remote Indigenous school (Ischool) situated in Queensland. Ischool has changed its approach to leadership, particularly the distribution of power and authority within the school context, to address this concern. The focus is on building the capacity of Indigenous staff. It is a holistic and communal approach that is culturally inclusive of Indigenous ways of being and operating. The approach actively ensures that power and authority, and roles and responsibilities, are shared between Indigenous and non-Indigenous staff. Data were collected in one-on-one interviews with Indigenous and non-Indigenous participants involved in the change process. A grounded methodological approach was utilised using open coding to break down data into distinct units of meaning. The results reveal that the Indigenous community of Ischool were more committed to promoting and sustaining education initiatives that improve student learning when: (a) school leadership structures were inclusive of Indigenous voices and Indigenous ways of relating; (b) power and authority within the school context was shared, and (c) Indigenous staff were included in professional development opportunities that foster collaborative classroom partnerships and legitimise their own knowledge of their culture and community.
To examine the association between breakfast skipping and physical activity among US adolescents aged 12–19 years.
A cross-sectional study of nationally representative 2007–2008 National Health and Nutrition Examination Survey (NHANES) data.
Breakfast skipping was assessed by two 24 h dietary recalls. Physical activity was self-reported by participants and classified based on meeting national recommendations for physical activity for the appropriate age group. Multiple logistic regression analysis was used to model the association between breakfast skipping and physical activity while controlling for confounders.
A total of 936 adolescents aged 12–19 years in the USA.
After adjusting for family income, there was no association between breakfast skipping and meeting physical activity guidelines for age among adolescents aged 12–19 years (OR = 0·95, 95 % CI 0·56, 1·32).
Findings from the study differ from previous research findings on breakfast skipping and physical activity. Therefore, further research that uses large, nationally representative US samples and national recommended guidelines for physical activity is needed.
Background: Nonattendance rates remain high for first therapy appointments, despite initiatives to increase access to psychological therapy. The reasons for nonattendance are poorly understood and studies of demographic and clinical predictors have produced conflicting findings. Aims: We aimed to pilot a method for investigating psychological factors associated with first appointment attendance in a primary care mental health service. Method: Questionnaires were completed by individuals at the point of referral to CBT with a low-intensity service in one general practice (n = 67), including a measure of beliefs, goals and attitudes towards therapy, as well as anxiety and depression scales. Subsequent attendance at the first appointment was used as an outcome. Results: Preliminary results showed that attendance was not associated with age or gender, severity of distress, or overall ratings for positive or negative attitudes towards therapy; although distress itself was associated with increased endorsement of negative attitudes. However, one specific psychological item, “Talking to a therapist will help me understand better how my mind works” had a significant association with subsequent attendance. Conclusions: The psychological factor that was associated with increased attendance may reflect the concept of psychological mindedness; however, this requires replication in a larger study. A full-scale study was deemed to be warranted based on this prospective design.
In Juffureh, Gambia, in the summer of 2006, a Gambian man followed a group of European and American tourists back to the boat that had brought them to his village after a three-hour trip from the capital of Banjul. He held up two small, wooden, hand-carved statues, and when he caught up to the tourists, he called out a price of 300 dalasi (about twelve American dollars) for the pair. As he and the tourists drew closer to the dock where the boat waited, he lowered his asking price. By the time they reached the dock he reduced it again, and when he saw that the tourists where still not interested, he lowered the amount once more to a third of his original price. Seeing that the visitors were more concerned about eating their noontime meal on the boat than buying the statues that he had to sell, the man appealed to the disinterested group one last time. ‘It's Kunta Kinte!’ he yelled, hoping that the tourists would understand the value of his handiwork by naming the famous enslaved ancestor of Alex Haley, American author of a book that traced his roots back to Africa. Holding a statue high in each of his hands, the Gambian seller shouted to the unfazed crowd, ‘How much for Kunta Kinte?!’
There is no intrinsic reason for a foreign tourist to visit the village of Juffureh on the River Gambia other than its link to Haley's best-selling book, Roots: The Saga of an American Family. When Haley published Roots in 1976, he detailed how his family tree traced back over two centuries to a 17-year-old African ancestor named Kunta Kinte that slave traders had captured near that same village. The following year, the television mini-series captivated American audiences for eight nights in an unprecedented way.
Self-help therapies, such as bibliotherapy, are becoming increasingly more available to the general population as a treatment for psychological disorders, such as depression and anxiety. However, relatively few of these self-help books are properly evaluated to test their treatment efficacy. Two studies aimed to test a new self-help book to treat fears, phobias and anxiety in order to see if symptoms of anxiety and associated symptoms, such as functioning and coping, were improved compared to baseline scores and a waiting-list control group. Study 1 adopted a minimal guided approach (experimental group: n = 25; waiting-list control group: n = 29) whereas Study 2 adopted a non-guided approach (experimental group: n = 17; waiting-list control group: n = 16). In both studies, functioning and coping were improved and the current state of phobic symptoms was reduced. The main phobia improved only when adopting a guided approach and general psychological distress only reduced when adopting a non-guided approach. These studies provide preliminary support for a modest effect in a subclinical population. The results could have good implications for the treatment of anxiety and the use of self-help methods as an additional treatment aid or as a preventative treatment.
This article examines the nature of oral language and representations used by teachers as they instruct young Indigenous Australian students at the beginning of formal schooling during play-based activities in mathematics. In particular, the use of Standard Australian English (SAE), the mathematical register used, and the interplay with mathematical representations during classroom instruction are analysed based upon the teachers' selfreported practices. The data are drawn from structured telephone interviews with 40 teachers in 15 schools from rural and remote or multicultural settings in Queensland at the initial stage of a large, longitudinal study. The specific aim of the study was the identification of effective pedagogical practices that may assist young Australian students from diverse ethnic and cultural backgrounds to negotiate western mathematical understanding. The findings indicate that despite experience in these settings and focused professional learning sessions, the majority of these teachers report practices which reflect a strong emphasis on literacy acquisition rather than mathematical understanding. It is the contention of the researchers that the use of oral language with a rich selection of mathematical representations strongly supports mathematical understanding.
Working across knowledge-based research programmes, rather than institutional structures, should be central to interdisciplinary research. In this paper, a novel framework is proposed to facilitate interdisciplinary research, with the goals of promoting communication, understanding and collaborative work. Three core elements need to be addressed to improve interdisciplinary research: the types (forms and functions) of theories, the underlying philosophies of knowledge and the combination of research styles; these three elements combine to form the research programme. Case studies from sustainability science and environmental security illustrate the application of this research programme-based framework. This framework may be helpful in overcoming often oversimplified distinctions, such as qualitative/quantitative, deductive/inductive, normative/descriptive, subjective/objective and theory/practice. Applying this conceptual framework to interdisciplinary research should foster theoretical advances, more effective communication and better problem-solving in increasingly interdisciplinary environmental fields.
This study examined expectancy judgement and current concerns in high and low depression and anxiety participants. Expectancy judgement was measured using the Personal Future Task. Depression and anxiety symptoms were measured using the Depression and Anxiety Stress Scale (DASS). A novel scale, the Current Concerns Checklist, was developed to measure ten current concerns that were thought to relate to the most salient concerns of common Axis I disorders. Using the DASS, 19 participants were allocated to the distressed group and 17 to the non-distressed group. As hypothesized, there was a main effect for the current concern concept; participants thought of more future events regarding their current concern than their non-concern. However, the hypothesis that the distressed group would generate more negative relative to positive responses than the non-distressed group within the domain of their most prominent current concern was not supported. Future research and implications for CBT are discussed.
The consumer credit market is broken. Businesses have learned to exploit customers' systematic cognitive errors, selling complex credit products that are loaded with tricks and traps. Because customers cannot see or understand complete credit terms until it is too late, the market no longer operates to achieve competitive efficiency. Instead, creditors engage in a race to the bottom, boosting profits by offering ever-riskier products that families are poorly equipped to handle. The consequences are serious: Americans are sinking deeper in debt each year, and defaults, foreclosures and bankruptcies are on the rise.
The regulatory framework that once controlled consumer credit is now in tatters. From colonial times until 1979, state-based usury laws were the central feature of consumer protection. In 1979, a Supreme Court interpretation of ambiguous language in a national banking law effectively ended state usury laws. Congress could easily have reversed the opinion by clarifying the language, but it turned away while this critical consumer protection vanished. By the 1990s, product innovation from payday lending to universal default to creative mortgage financing took root largely outside the purview of any regulatory body. Truth-in-Lending laws, which were designed to supplement usury protection, failed to keep pace with market changes. The Federal Reserve, the Office of the Controller of the Currency, the Office of Thrift Supervision, and other federal and state agencies regulate various financial institutions, but the mission of these regulators is aimed squarely at protecting the banks and the stability of the overall financial system, with scant attention to consumer protection.