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Evidence from the literature shows that clinicians’ knowledge of rules and legislation surrounding driving can often be poor. A closed-loop audit was conducted to gauge the level of driving advice given to patients with dizziness.
The clinical notes of 100 patients referred to the vertigo clinic at a tertiary referral centre were retrospectively searched for evidence of driving advice. Education sessions were undertaken and a patient information leaflet was developed before a second cycle of the audit.
Results and conclusion
The proportion of patients having documented evidence of receiving driving advice increased from 6.3 per cent to 10.4 per cent. It is therefore clear that, despite this improvement, a significant proportion of patients’ notes did not contain documentation about driving. This is likely because of many reasons, including individual interpretation by clinicians. This paper provides a reminder of the rules, and discusses their interpretation and implementation in an increasingly medicolegal environment.
This chapter argues that in reading the social teaching of Pope Francis what is needed is the deployment of a “hermeneutic of continuity,” one that forthrightly reads Francis’s continuities and discontinuities within the context of the tradition of Catholic thought that preceded him. This chapter closely examines the central themes of the pope’s teaching in the following texts: Caring for Our Common Home, The Joy of the Gospel, The Church and Europe, The Church and America, In the Name of Mercy, and The Family in the Modern World. It then considers “The Other Francis,” the Francis who is prone to troubling off-the-cuff remarks that lack any authoritative status as Catholic teaching or doctrine. The essay concludes with a brief discussion of the “Crisis in the Church” which has arisen from Francis’s tendency to question the teachings of his predecessors and to ignore reasonable requests for the clarification of Catholic teaching.
The efficient and effective movement of research into practice is acknowledged as crucial to improving population health and assuring return on investment in healthcare research. The National Center for Advancing Translational Science which sponsors Clinical and Translational Science Awards (CTSA) recognizes that dissemination and implementation (D&I) sciences have matured over the last 15 years and are central to its goals to shift academic health institutions to better align with this reality. In 2016, the CTSA Collaboration and Engagement Domain Task Force chartered a D&I Science Workgroup to explore the role of D&I sciences across the translational research spectrum. This special communication discusses the conceptual distinctions and purposes of dissemination, implementation, and translational sciences. We propose an integrated framework and provide real-world examples for articulating the role of D&I sciences within and across all of the translational research spectrum. The framework’s major proposition is that it situates D&I sciences as targeted “sub-sciences” of translational science to be used by CTSAs, and others, to identify and investigate coherent strategies for more routinely and proactively accelerating research translation. The framework highlights the importance of D&I thought leaders in extending D&I principles to all research stages.
Objectives: Individuals with moderate–severe traumatic brain injury (TBI) experience a transitory state of impaired consciousness and confusion often called posttraumatic confusional state (PTCS). This study examined the neuropsychological profile of PTCS. Methods: Neuropsychometric profiles of 349 individuals in the TBI Model Systems National Database were examined 4 weeks post-TBI (±2 weeks). The PTCS group was subdivided into Low (n=46) and High Performing PTCS (n=45) via median split on an orientation/amnesia measure, and compared to participants who had emerged from PTCS (n=258). Neuropsychological patterns were examined using multivariate analyses of variance and mixed model analyses of covariance. Results: All groups were globally impaired, but severity differed across groups (F(40,506)=3.44; p<.001; ŋp2 =.206). Rate of forgetting (memory consolidation) was impaired in all groups, but failed to differentiate them (F(4,684)=0.46; p=.762). In contrast, executive memory control was significantly more impaired in PTCS groups than the emerged group: Intrusion errors: F(2,343)=8.78; p<.001; ŋp2=.049; False positive recognition errors: F(2,343)=3.70; p<.05; ŋp2=.021. However, non-memory executive control and other executive memory processes did not differentiate those in versus emerged from PTCS. Conclusions: Executive memory control deficits in the context of globally impaired cognition characterize PTCS. This pattern differentiates individuals in and emerged from PTCS during the acute recovery period following TBI. (JINS, 2019, 25, 302–313)
Women have organized around their gendered identity to accomplish political goals both inside and outside legislatures. Formal and informal institutional norms shape the form this collective action takes and whether it is successful. What, then, are the favorable conditions for organizing women's caucuses inside legislatures? Using an original dataset and employing an event history analysis, we identify the institutional conditions under which women's caucuses emerged in the 50 US states from 1972 to 2009. Within a feminist institutional framework, we argue that women's ability to alter existing organizational structures and potentially affect gender norms within legislatures is contextual. Although we find that women's presence in conjunction with Democratic Party control partially explains women's ability to act collectively and in a bipartisan way within legislatures, our analysis suggests that institutional-level variables are not enough to untangle this complicated phenomenon. Our work explains how gender and party interact to shape legislative behavior and clarifies the intractability of institutional norms while compelling further qualitative evidence to uncover the best conditions for women's collective action within legislatures.
Cognitive theories of generalised anxiety disorder (GAD) posit that cognitive and behavioural factors maintain the disorder. This study examined whether avoidance and safety behaviours mediated the relationship between cognitive factors and GAD symptoms. We also examined the reverse mediation model; that is, whether cognitive factors mediated the relationship between maladaptive behaviours and GAD symptoms. Undergraduate psychology students (N = 125 and N = 292) completed the Worry Behaviours Inventory (a recently developed measure of maladaptive behaviours associated with GAD), in addition to measures of intolerance of uncertainty, cognitive avoidance, metacognitive beliefs, and symptoms of GAD and depression. Analyses supported the reliability and validity of the WBI. We consistently found that engagement in maladaptive behaviours significantly mediated the relationship between cognitive factors and symptoms of GAD. The reverse mediation model was also supported. Our results are consistent with the contention that cognitive and behavioural factors contribute to GAD symptom severity.
Background: Cognitive models of generalized anxiety disorder (GAD) suggest that maladaptive behaviours may contribute to the maintenance of the disorder; however, little research has concentrated on identifying and measuring these behaviours. To address this gap, the Worry Behaviors Inventory (WBI) was developed and has been evaluated within a classical test theory (CTT) approach. Aims: As CTT is limited in several important respects, this study examined the psychometric properties of the WBI using an Item Response Theory approach. Method: A large sample of adults commencing treatment for their symptoms of GAD (n = 537) completed the WBI in addition to measures of GAD and depression symptom severity. Results: Patients with a probable diagnosis of GAD typically engaged in four or five maladaptive behaviours most or all of the time in an attempt to prevent, control or avoid worrying about everyday concerns. The two-factor structure of the WBI was confirmed, and the WBI scales demonstrated good reliability across a broad range of the respective scales. Together with previous findings, our results suggested that hypervigilance and checking behaviours, as well as avoidance of saying or doing things that are worrisome, were the most relevant maladaptive behaviours associated with GAD, and discriminated well between adults with low, moderate and high degrees of the respective WBI scales. Conclusions: Our results support the importance of maladaptive behaviours to GAD and the utility of the WBI to index these behaviours. Ramifications for the classification, theoretical conceptualization and treatment of GAD are discussed.
Near ice shelves around Antarctica the ocean becomes supercooled and has been observed to carry small suspended ice crystals. Our measurements demonstrate that these small crystals are persistently present in the water column beneath the winter fast ice, and when incorporated in sea ice they reduce the mean grain size of the sea-ice cover. By midwinter, larger ice crystals below the ice/water interface are observed to form a porous sub-ice platelet layer with an ice volume fraction of 0.25 ± 0.06. The magnitude and direction of the oceanic heat flux varied between (5 ± 6) Wm-2 (upwards) and (-15 ± 10) Wm-2 (downwards) in May, but by September it settled between (-6 ± 2) and (-11 ± 2) W m-2. The negative values imply that the ocean acts as a heat sink which is responsible for the growth of 12% of the ice thickness between June and September. This oceanic contribution should not be ignored in models of Antarctic sea-ice thickness close to an ice shelf.
The Two Micron Galactic Survey (TMGS) is described by Calbet et al. (this symposium) and Mahoney et al. (1990). It has been cross-correlated with the IRAS point source catalogue (IRPS) using a 15-arcsec search radius, and preliminary results are presented here.
The binary galaxies NGC 4038/39 have extended filamentary arms generated by tidal interactions (Toomre and Toomre, Ap. J. 178; 623, (1972)(TT)). The velocity field was determined by HI observations taken with the VLA (a facility operated by the NRAO under contract with the NSF), and the combined velocity and morphological information was used to constrain the allowed orbital parameters, halo characteristics, and dynamical friction. TT-type calculations were carried out with central masses and rings of test particles, and the calculated results compared with the data. Using disk orientations derived from optical data (Rubin et al., (1970) Ap. J. 160 81), and solving for the six remaining orbital parameters, central potential softening constant (representing the halo), and frictional relaxation time, a good fit between the model and the radio data was found. The best model is shown in Figure 1, and is superimposed on an HI column density map in Figure 2. The orbit is well-determined, and must be nearly parabolic; the pair are interacting for the first time, and if the galaxies have extensive massive halos much larger than their discs, then their tidal arms would be shorter and stubbier than observed. More limited halos are allowed; each galaxy could have up to 80% of its total mass in a halo, but the halos cannot be much larger than the discs. A halo several times larger than the disc, with 10 to 20 times the disc mass, is not permitted by the data.
Gravitational interactions allow one to investigate the nature of matter in the universe independent of the properties that make it luminous. Much as studies of the dynamics of galaxies and clusters of galaxies have indicated the presence of dark matter, gravitational lensing provides an independent probe of the large scale distribution of dark matter in the universe.
Background: The use of maladaptive behaviors by individuals with generalized anxiety disorder (GAD) is theoretically important and clinically meaningful. However, little is known about the specificity of avoidant behaviors to GAD and how these behaviors can be reliably assessed. Aims: This study replicated and extended the psychometric evaluation of the Worry Behaviors Inventory (WBI), a brief self-report measure of avoidant behaviors associated with GAD. Method: The WBI was administered to a hospital-based sample of adults seeking treatment for symptoms of anxiety and/or depression (n = 639) and to a community sample (n = 55). Participants completed measures of symptom severity (GAD, depression, panic disorder, health anxiety, and personality disorder), and measures of checking, reassurance-seeking and behavioral inhibition. Analyses evaluated the factor structure, convergent, divergent, incremental, and discriminant validity, as well the temporal stability and treatment sensitivity of the WBI. Results: The two-factor structure found in the preliminary psychometric evaluation of the WBI was replicated. The WBI was sensitive to changes across treatment and correlated well with measures of GAD symptom severity and maladaptive behaviors. The WBI was more strongly related to GAD symptom severity than other disorders. The WBI discriminated between clinical and community samples. Conclusions: The WBI provides clinicians and researchers with a brief, clinically meaningful index of problematic behaviors that may guide treatment decisions and contribute to our understanding of maintaining factors in GAD.
The dependence of oxygen isotope fractionation on ice growth rate during the freezing of sea water is investigated based on laboratory experiments and field observations in McMurdo Sound, Antarctica. The laboratory experiments were performed in a tank filled with sea water, with sea ice grown under calm conditions at various room temperatures ranging from −5°C to −20°C. In McMurdo Sound, the ice growth rate was monitored using thermistor probes for first-year landfast ice that grew to ∼2 m in thickness. Combining these datasets allows, for the first time, examination of fractionation at a wide range of growth rates from 0.8 × 10−7 to 9.3 × 10−7 m s−1. In the analysis a stagnant boundary-layer model is parameterized using these two independent datasets. As a result, the optimum values of equilibrium pure-ice fractionation factor and boundary-layer thickness are estimated. It is suggested that a regime shift may occur at a growth rate of ∼2.0 × 10−7 m s−1. A case study on sea ice in the Sea of Okhotsk, where the growth rate is modeled by coupling the thermodynamic properties of the sea ice with meteorological data, demonstrates the utility of the fitted models.
The analysis of multilayer networks is among the most active areas of network science, and there are several methods to detect dense “communities” of nodes in multilayer networks. One way to define a community is as a set of nodes that trap a diffusion-like dynamical process (usually a random walk) for a long time. In this view, communities are sets of nodes that create bottlenecks to the spreading of a dynamical process on a network. We analyze the local behavior of different random walks on multiplex networks (which are multilayer networks in which different layers correspond to different types of edges) and show that they have very different bottlenecks, which correspond to rather different notions of what it means for a set of nodes to be a good community. This has direct implications for the behavior of community-detection methods that are based on these random walks.