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This article synthesises the results of a large international study on primary care (PC), the QUALICOPC study.
Since the Alma Ata Declaration, strengthening PC has been high on the policy agenda. PC is associated with positive health outcomes, but it is unclear how care processes and structures relate to patient experiences.
Survey data were collected during 2011–2013 from approximately 7000 PC physicians and 70 000 patients in 34, mainly European, countries. The data on the patients are linked to data on the PC physicians within each country and analysed using multilevel modelling.
Patients had more positive experiences when their PC physician provided a broader range of services. However, a broader range of services is also associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries where patients had a continuous relationship with PC physicians. Additionally, patients with a long-term relationship with their PC physician were less likely to attend the emergency department. Capitation payment was associated with more positive patient experiences. Mono- and multidisciplinary co-location was related to improved processes in PC, but the experiences of patients visiting multidisciplinary practices were less positive. A stronger national PC structure and higher overall health care expenditures are related to more favourable patient experiences for continuity and comprehensiveness. The study also revealed inequities: patients with a migration background reported less positive experiences. People with lower incomes more often postponed PC visits for financial reasons. Comprehensive and accessible care processes are related to less postponement of care.
The study revealed room for improvement related to patient-reported experiences and highlighted the importance of core PC characteristics including a continuous doctor–patient relationship as well as a broad range of services offered by PC physicians.
Mothers’ return to work and childcare providers’ support for feeding expressed human milk are associated with breast-feeding duration rates in the USA, where most infants are regularly under non-parental care. The objective of the present study was to explore Florida-based childcare centre administrators’ awareness and perceptions of the Florida Breastfeeding Friendly Childcare Initiative.
Semi-structured interviews were based on the Consolidated Framework for Implementation Research and analysed using applied thematic analysis.
Childcare centre administrators in Tampa Bay, FL, USA, interviewed in 2015.
Twenty-eight childcare centre administrators: female (100 %) and Non-Hispanic White (61 %) with mean age of 50 years and 13 years of experience.
Most administrators perceived potential implementation of the Florida Breastfeeding Friendly Childcare Initiative as simple and beneficial. Tension for change and a related construct (perceived consumer need for the initiative) were low, seemingly due to formula-feeding being normative. Perceived financial costs and relative priority varied. Some centres had facilitating structural characteristics, but none had formal breast-feeding policies.
A cultural shift, facilitated by state and national breast-feeding-friendly childcare policies and regulations, may be important for increasing tension for change and thereby increasing access to breast-feeding-friendly childcare. Similar to efforts surrounding the rapid growth of the Baby Friendly Hospital Initiative, national comprehensive evidence-based policies, regulations, metrics and technical assistance are needed to strengthen state-level breast-feeding-friendly childcare initiatives.
Ultrafast measurement technology provides essential contributions to our understanding of the properties and functions of solids and nanostructures. Atomic-scale vistas with ever-growing spatial and temporal resolution are offered by methods based on short pulses of x-rays and electrons. Time-resolved electron diffraction and microscopy are among the most powerful approaches to investigate nonequilibrium structural dynamics. In this article, we discuss recent advances in ultrafast electron imaging enabled by significant improvements in the coherence of pulsed electron beams. Specifically, we review the development and first application of ultrafast low-energy electron diffraction for the study of structural dynamics at surfaces, and discuss novel opportunities for ultrafast transmission electron microscopy facilitated by laser-triggered field-emission sources. These and further developments will render coherent electron beams an essential component in future ultrafast nanoscale imaging.
Active participation in social activities is important for the wellbeing of older adults. This study explored benefits of active social engagement by evaluating whether relationships that comprise active involvement (e.g. co-engagement in activities) bring more social benefits (i.e. social support, companionship, positive social influence) than other relationships that do not involve co-engagement. A total of 133 adults ages 60 years and older living in a rural Midwestern city in the United States of America were interviewed once and provided information on 1,740 social network members. Among 1,506 social relationships in which interactions occurred at least once a month, 52 per cent involved engagement in social activities together and 35 per cent involved eating together regularly. Results of the generalised linear mixed model showed that relationships involving co-engagement were significantly more likely to also convey social support (i.e. emotional, instrumental, informational), companionship and social influence (encouragement for healthy behaviours) than relationships that do not involve co-engagement. Having more network members who provide companionship was associated with higher sense of environmental mastery, positive relations with others and satisfaction with social network. Interventions may focus on maintaining and developing such social relationships and ensuring the presence of social settings in which co-engagement can occur. Future research may explore whether increasing co-engagement leads to an enhanced sense of companionship and psychological wellbeing.
We evaluate the variability in basal friction for Kronebreen, Svalbard, a fast-flowing tidewater glacier. We invert 3 years (2013–15) of surface velocities at high temporal resolution (generally 11 days), to estimate the changing basal properties of the glacier. Our results suggest that sliding behaviour of Kronebreen within a year is primarily influenced by changes in water input patterns during the meltwater season and basal friction is highly variable from a year to another. At present, models usually employ parameterisations to encompass the complex physics of glacier sliding by mathematically simulate their net effect. For such ice masses with strong seasonal variations of surface melt, the spatio-temporal patterns of basal friction imply that it is neither possible nor appropriate to use a parameterisation for bed friction that is fixed in space and/or time, at least in a timescale of a few years. Basal sliding may not only be governed by local processes such as basal topography or summer melt, but also be mediated by factors that vary over a larger distance and over a longer time period such as subglacial hydrology organisation, ice-thickness changes or calving front geometry.
Breast-feeding initiation rates have increased in the USA; however, maintenance of breast-feeding for recommended durations is low. The objective of the present study was to identify factors that may facilitate breast-feeding for longer durations among first-time mothers, including physiological and social experiences and changes in maternal perceptions.
Survival analysis and linear regression methods were used to explore the relationship between experiences and breast-feeding duration, and the possible mediating effect of changes in maternal perceptions.
Secondary data from the Infant Feeding Practices Study II, conducted in the USA between 2005 and 2007.
Data from 762 first-time mothers who ever breast-fed were analysed.
Experiencing trouble with baby’s latch, problems with milk flow/supply and painful breast-feeding were significantly associated with breast-feeding duration (64, 26 and 36 % shorter duration, respectively). Meanwhile, positive changes in perception with respect to breast-feeding self-efficacy, opinion about infant feeding and belief about breast milk were associated with 16–27 % longer duration. Furthermore, changes in perception were observed to partially mediate the impact of physiological experiences on breast-feeding duration.
Perceptions of breast-feeding self-efficacy, beliefs and opinions can change over time and are influenced by breast-feeding experiences. The combined effect of experience and perception plays a key role in influencing breast-feeding duration. Future research should explore interventions to maintain or improve these perceptions while accounting for physiological experiences to support breast-feeding for recommended durations among first-time mothers.
We describe a versatile infrared camera/spectrograph, IRIS, designed and constructed at the Anglo-Australian Observatory for use on the Anglo-Australian Telescope. A variety of optical configurations can be selected under remote control to provide several direct image scales and a few low-resolution spectroscopic formats. Two cross-dispersed transmission echelles are of novel design, as is the use of a modified Bowen-Burch system to provide a fast f/ratio in the widest-field option. The drive electronics includes a choice of readout schemes for versatility, and continuous display when the array is not taking data, to facilitate field acquisition and focusing.
The linearity of the detector has been studied in detail. Although outwardly good, slight nonlinearities prevent removal of fixed-pattern noise from the data without application of a cubic linearising function.
Specific control and data-reduction software has been written. We describe also a scanning mode developed for spectroscopic imaging.
Astronomical observations of Centaurs and trans-Neptunian objects (TNOs) yield two characteristic features – near-infrared (NIR) reflectance and low geometric albedo. The first feature apparently originates due to complex organic material on their surfaces, but the origin of the material contributing to low albedo is not well understood. Titan tholins synthesized to simulate aerosols in the atmosphere of Saturn's moon Titan have also been used for simulating the NIR reflectances of several Centaurs and TNOs. Here, we report novel detections of large polycyclic aromatic hydrocarbons, nanoscopic soot aggregates and cauliflower-like graphite within Titan tholins. We put forth a proof of concept stating the surfaces of Centaurs and TNOs may perhaps comprise of highly ‘carbonized’ complex organic material, analogous to the tholins we investigated. Such material would apparently be capable of contributing to the NIR reflectances and to the low geometric albedos simultaneously.
We present preliminary results of models of terrestrial planet formation using on the one hand classical numerical integration of hundreds of small bodies on CPUs and on the other hand—for comparison—the results of our GPU code with thousands of small bodies which then merge to larger ones. To be able to determine the outcome of collision events we use our smooth particle hydrodynamics (SPH) code which tracks how water is lost during such events.
Cryptosporidium, a parasite known to cause large drinking and recreational water outbreaks, is tolerant of chlorine concentrations used for drinking water treatment. Human laboratory-based surveillance for enteric pathogens detected a cryptosporidiosis outbreak in Baker City, Oregon during July 2013 associated with municipal drinking water. Objectives of the investigation were to confirm the outbreak source and assess outbreak extent. The watershed was inspected and city water was tested for contamination. To determine the community attack rate, a standardized questionnaire was administered to randomly sampled households. Weighted attack rates and confidence intervals (CIs) were calculated. Water samples tested positive for Cryptosporidium species; a Cryptosporidium parvum subtype common in cattle was detected in human stool specimens. Cattle were observed grazing along watershed borders; cattle faeces were observed within watershed barriers. The city water treatment facility chlorinated, but did not filter, water. The community attack rate was 28·3% (95% CI 22·1–33·6), sickening an estimated 2780 persons. Watershed contamination by cattle probably caused this outbreak; water treatments effective against Cryptosporidium were not in place. This outbreak highlights vulnerability of drinking water systems to pathogen contamination and underscores the need for communities to invest in system improvements to maintain multiple barriers to drinking water contamination.
To identify the social contextual factors, specifically the presence of information that supports v. undermines clinical recommendations, associated with infant feeding behaviours among mothers in low-income areas.
Cross-sectional survey evaluating social support networks and social relationships involved in providing care to the infant along with feeding beliefs and practices.
Out-patient paediatric and government-funded (Women, Infants, and Children) clinics in an urban, low-income area of the south-eastern USA.
Eighty-one low-income mothers of infants between 0 and 12 months old.
Most mothers reported receiving both supportive and undermining advice. The presence of breast-feeding advice that supports clinical recommendations was associated with two infant feeding practices that are considered beneficial to infant health: ever breast-feeding (OR=6·7; 95 % CI 1·2, 38·1) and not adding cereal in the infant’s bottle (OR=15·9; 95 % CI 1·1, 227·4). Advice that undermines clinical recommendations to breast-feed and advice about solid foods were not associated with these behaviours.
Efforts to facilitate optimal infant feeding practices may focus on increasing information supportive of clinical recommendations while concentrating less on reducing the presence of undermining information within mothers’ networks. Cultural norms around breast-feeding may be stronger than the cultural norms around the introduction of solid foods in mothers’ social environments; thus, additional efforts to increase information regarding introduction of solid foods earlier in mothers’ infant care career may be beneficial.
The aim of this study was to estimate the association between birth order and number of siblings with body composition in adolescents. Data are from a birth cohort study conducted in Pelotas, Brazil. At the age of 18 years, 4563 adolescents were located, of whom 4106 were interviewed (follow-up rate 81·3 %). Of these, 3974 had complete data and were thus included in our analysis. The variables used in the analysis were measured during the perinatal period, or at 11, 15 and/or 18 years of age. Body composition at 18 years was collected by air displacement plethysmography (BOD POD®). Crude and adjusted analyses of the association between birth order and number of siblings with body composition were performed using linear regression. All analyses were stratified by the adolescent sex. The means of BMI, fat mass index and fat-free mass index among adolescents were 23·4 (sd 4·5) kg/m2, 6·1 (sd 3·9) kg/m2 and 17·3 (sd 2·5) kg/m2, respectively. In adjusted models, the total siblings remained inversely associated with fat mass index (β = − 0·37 z-scores, 95 % CI − 0·52, − 0·23) and BMI in boys (β = − 0·39 z-scores, 95 % CI − 0·55, − 0·22). Fat-free mass index was related to the total siblings in girls (β = 0·06 z-scores, 95 % CI − 0·04, 0·17). This research has found that number of total siblings, and not birth order, is related to the fat mass index, fat-free mass index and BMI in adolescents. It suggests the need for early prevention of obesity or fat mass accumulation in only children.
We report on two experiments that ask when and under what linguistic conditions comprehenders construct detailed shape representations of mentioned objects, and whether these can change over the course of a sentence when new information contradicts earlier expectations. We used Japanese because the verb-final word order of Japanese presented a revealing test case where information about objects can radically change with a subsequent verb. The results show that language understanders consistently generate a distinct and detailed shape for an object by integrating the semantic contributions of different sentential elements. These results first confirm that the tendency to generate specific shape information about objects that are involved in described events is not limited to English, but is also present in Japanese, a typologically and genetically distinct language. But more importantly, they shed light on the processing mechanism of object representation, showing that mental representations are initiated sentence medially, and are rapidly revised if followed by a verb that implies a change to an object shape. This work contributes to ongoing research on incremental language processing – comprehenders appear to construct extremely detailed semantic representations early in a sentence, and modify them as needed.
The original design of this research was to determine whether the extract of suprarenal medulla (or its active principle) has the power of antagonising the effects of an overdose of chloroform upon the heart and arterial system. Incidentally the research became extended so as to cover the action of certain other antagonising agents. It further appeared necessary, as the investigation proceeded, to subject the action of chloroform upon the vascular system to renewed study. For although, as the result of numerous recent researches, physiologists are in agreement regarding the general effect of the drug upon the heart, there yet remain various points requiring elucidation both as regards its effect on the heart and on the arteries.
Cannabis varies considerably in levels of its two major constituent cannabinoids – (delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Recently, we found evidence that those who smoked cannabis containing detectable levels of CBD had fewer psychotic-like symptoms than those whose cannabis had no CBD. The present study aimed, first, to replicate those findings and, second, to determine whether protective effects of CBD may extend to other harms of cannabis, such as memory impairment and reduced psychological well-being.
A total of 120 current cannabis smokers, 66 daily users and 54 recreational users were classified into groups according to whether analysis of their hair revealed the presence or absence of CBD and high versus low levels of THC. All were assessed on measures of psychosis-like symptoms, memory (prose recall; source memory) and depression/anxiety.
Lower psychosis-like symptoms were found in those whose hair had CBD compared with those without. However, this was seen only in recreational users, who had higher levels of THC in their hair. Higher THC levels in hair were associated with increased depression and anxiety. Prose recall and source memory were poorer in daily users with high THC levels in hair while recognition memory was better in individuals with CBD present in hair.
CBD attenuates the psychotic-like effects of cannabis over time in recreational users. Higher THC negatively impacts on memory and psychological well-being. These findings raise concerns for the harms stemming from use of varieties such as ‘skunk’ (sensimillia), which lack any CBD but currently dominate the supply of cannabis in many countries.
Samples of Fe78B13Si9 and Fe81B13.5Si3.5C2 metallic glasses were irradiated with a pulsed alexandrite laser (λ=750 nm, τ=60 μs) using different laser fluences. Kinetics of laser-induced phase transformations and fluence dependence of magnetic properties were studied by scanning electron microscopy (SEM) and Mössbauer spectroscopy. Low laser fluences were found to induce changes in magnetic texture and onset of crystallization. High laser fluences, however, correlated with additional oxidation effects and the formation of stoichiometric Fe3O4 particles in the irradiated alloy system. An activation energy of 11.9 eV was estimated for the laser-driven synthesis of magnetite nanoparticles. Pulsed alexandrite laser processing is an intriguing alternative technique for the controlled synthesis of iron oxide phases from ferromagnetic glass precursors.
Monitoring the vadose zone below buried waste provides an early warning of contaminate Advanced Tensiometer transport toward the groundwater. To quantify the transport mechanisms, vadose zone hydraulic characteristics and the physical variables need to be obtained. We have designed and implemented a Vadose Zone Monitoring System (VZMS) to monitor or sample the 3 state variables of the vadose zone, water potential, water content and chemical concentration. The state variables are monitored using an Advanced Tensiometer (AT), a borehole water content sensor (BWCS) and a vacuum lysimeter, respectively. This system was installed at the Savannah River Site (SRS) E-Area disposal site, where low level wastes have been disposed of in shallow trenches. The system has operated for The system has operated for several months providing nearly continuous water content and water potential data. The vacuum lysimeters were activated on a quarterly schedule. Installation details and an example data set are presented to illustrate the effectiveness of the VZMS, and demonstrate the utility of the VZMS as an indicator of contaminant transport.