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Metacognition and perfectionism are factors found to be associated with both anxiety and depression. A common component that underlies these factors is the influence of perseverance, or the tendency to continue a behaviour or thought even if it is no longer productive.
This study aimed to investigate the relationships between metacognitive beliefs with maladaptive aspects of perfectionism (i.e. perseverance behaviours), and their relation to anxiety and depression.
Participants (n = 1033) completed six self-report questionnaires measuring metacognitive beliefs about rumination and worry, perseverance, anxiety and depression. Data were analysed using correlational testing, and structural equation modelling.
Results of structural equation modelling revealed that positive metacognitive beliefs about repetitive negative thinking increased the likelihood to perceive the thinking as uncontrollable, and that perseverance behaviours were predicted by all metacognitive beliefs. Furthermore, examination of partial correlations revealed that both negative metacognitive beliefs about repetitive negative thinking and perseverance behaviours predicted anxiety and depression; however, negative metacognitive beliefs were the strongest predictor, in both cases.
The results provided support for current metacognitive models, in that the interpretation of cognitive perseveration sequentially influences psychopathology, but also provided insight into the inclusion of perseveration behaviours. Furthermore, the findings may also have value in a clinical setting, as targeting metacognitive beliefs in the presence of perseverance type behaviours may prove beneficial for treatment.
In the midst of a ‘care crisis’, attention has turned again to families who are viewed both as untapped care resources and as disappearing ones. Within this apparent policy/demographic impasse, we test empirically theorised trajectories of family care, creating evidence of diverse patterns of care across the lifecourse. The study sample, drawn from a Statistics Canada national survey of family care, comprised all Canadians aged 65 and older who had ever provided care (N = 3,299). Latent Profile Analysis yielded five distinct care trajectories: compressed generational, broad generational, intensive parent care, career care and serial care. They differed in age of first care experience, number of care episodes, total years of care and amount of overlap among episodes. Trajectories generally corresponded to previously hypothesised patterns but with additional characteristics that added to our understanding of diversity in lifecourse patterns of care. The five trajectories identified provide the basis for further understanding how time and events unfold in various ways across lifecourses of care. A gap remains in understanding how relationships with family and social network members evolve in the context of care. A challenge is presented to policy makers to temper a ‘families by stealth’ policy approach with one that supports family carers who are integral to health and social care systems.
We report on a quality improvement initiative for hand hygiene adherence using the patient-as-observer method in the ambulatory setting. There were 604,661 observations recorded with improvement of adherence from 88% to 95% or greater; alcohol-based hand sanitizer purchasing correlated with this increase. This sustainable method effectively ensures hand hygiene adherence.
As part of the Z-PAndAS Keck II DEIMOS survey of resolved stars in our neighboring galaxy, Andromeda (M31), we have built up a unique data set of measured velocities and chemistries for thousands of stars in the Andromeda stellar halo, particularly probing its rich and complex substructure. In this contribution, we will discuss the structural, dynamical and chemical properties of Andromeda's dwarf spheroidal galaxies, and how there is no observational evidence for a difference in the evolutionary histories of those found on and off M31's vast plane of satellites. We will also discuss a possible extension to the most significant merger event in M31 - the Giant Southern Stream - and how we can use this feature to refine our understanding of M31's mass profile, and its complex evolution.
Andromeda XXVII is a dwarf spheroidal galaxy in the outskirts of the Andromeda galaxy (M31). It appears to be dissolving in to the Northern arc of M31, and could be the remnant of a strong tidal disruption. In the upcoming months, our spectroscopic program, which has measured velocities for multiple stars within both the dwarf galaxy progenitor and its stream (using the Keck II DEIMOS telescope, as part of the PAndAS survey), will determine velocity dispersions, scale radii and metallicities of both the dwarf and the stream. This in turn may enable us to ascertain the progenitor mass profile and determine whether it is cusped or cored.
Emergency medicine is an evolving discipline in Canadian medical schools. Little has been published regarding student preferences for emergency medicine training during the clerkship phase of MD programs. We assessed medical students' perceptions of a newly developed emergency medicine clerkship rotation involving multiple learning modalities. The evaluation process included assessment of the rotation's instructional elements and overall educational value.
The first cohort of medical students to complete this new emergency medicine clerkship was invited to answer a questionnaire just before graduation. Students rated their preferences for components of the rotation using paired comparisons. Open-ended questions explored students' satisfaction with the emergency medicine clerkship as well as perceptions of the rotation's impact on career development.
Of the 94 students in the first clerkship cohort, 81 (86%) responded to the survey. Students found the emergency medicine clerkship highly valuable, citing the broad range of cases seen, close supervision, and opportunities to develop clinical assessment, decision-making and procedural skills. Students' curricular preferences were for advanced cardiac life support (ACLS) (26.4%), clinical shifts (20.6%), supervised clinical shifts (17.8%), procedural skills laboratories (14.8%), tutorials (10.8%) and preceptor-assisted learning sessions (9.8%).
This new emergency medicine clerkship program incorporated multiple learning methods within a 4-week rotation and was highly rated by students. Although clinical shifts and ACLS were generally preferred activities, students had varying individual preferences for specific learning activities. Multiple learning methods allowed all students to benefit from the rotation. This study makes a compelling case for including an emergency medicine rotation with multiple learning modalities as a core element of clerkship at every medical school.
To assess the impact of an institution-wide infection control education program on the rate of transmission of methicillin-resistant Staphylococcus aureus (MRSA).
A 472-bed, urban, university-affiliated hospital.
During the period March-May 2004, all hospital staff completed a mandatory infection control education program, including the receipt of hospital-specific MRSA data and case-based practice with additional precautions.
The rate of nosocomial MRSA acquisition was calculated as the number of cases of nosocomial MRSA acquisition per 100 days that a person with MRSA colonization or infection detected at admission is present in the hospital (“admission MRSA” exposure-days) for 3 time periods: June 2002-February 2003 (before the Toronto outbreak of severe acute respiratory syndrome [SARS]), June 2003-February 2004 (after the outbreak of SARS), and June 2004-February 2005 (after education). A case of nosocomial acquisition of MRSA colonization or infection represented a patient first identified as colonized or infected more than 72 hours after admission or at admission after a previous hospitalization.
The rate of nosocomial acquisition of MRSA colonization or infection was 8.8 cases per 100 admission MRSA exposure-days for the period before SARS, 3.8 cases per 100 admission MRSA exposure-days for the period after SARS (P < .001 for before SARS vs after SARS), and 1.9 cases per 100 admission MRSA exposure-days for the period after education (P = .02 for after education vs before education). The volume of alcohol-based handrub purchased was apparently stable, with 4,010 L during fiscal year 2003-2004 (April 2003-March 2004) compared with 3,780 L during fiscal year 2004—2005. The observed rate of compliance with hand washing did not change significantly (40.9% during education vs 44.2% after education; P = .23). The total number of patients screened for MRSA colonization was not different in the 3 periods.
The rate of nosocomial acquisition of MRSA colonization or infection decreased after SARS and was further reduced in association with a hospital-wide education program.
There are limited data from prospective studies to indicate whether improvement in hand hygiene associated with the use of alcohol-based hand hygiene products results in improved patient outcomes.
A 2-year, prospective, controlled, cross-over trial of alcohol-based hand gel.
The study was conducted in 2 medical-surgical ICUs for adults, each with 12 beds, from August 2001 to September 2003 at a university-associated, tertiary care teaching hospital.
An alcohol-based hand gel was provided in one critical care unit and not provided in the other. After 1 year, the assignment was reversed. The hand hygiene adherence rate and the incidence of nosocomial infection were monitored. Samples for culture were obtained from nurses' hands every 2 months.
During 17,994 minutes of observation, which included 3,678 opportunities for hand hygiene, adherence rates improved dramatically after the introduction of hand gel, increasing from 37% to 68% in one unit and from 38% to 69% in the other unit (P < .001). Improvement was observed among all groups of healthcare workers. Hand hygiene rates were better at higher workloads when hand gel was available in the unit (P = .02). No substantial change in the rates of device-associated infection, infection due to multidrug-resistant pathogens, or infection due to Clostridium difficile was observed. Culture of samples from the hands of nursing staff revealed that an increased number of microbes and an increased number of microbe species was associated with longer fingernails (ie, more than 2 mm long), the wearing of rings, and/or lack of access to hand gel.
The introduction of alcohol-based gel resulted in a significant and sustained improvement in the rate of hand hygiene adherence. Fingernail length greater than 2 mm, wearing rings, and lack of access to hand gel were associated with increased microbial carriage on the hands. This improvement in the hand hygiene adherence rate was not associated with detectable changes in the incidence of healthcare-associated infection.
Language disorders have been reported after severe falciparum malaria but the deficits have not been described in detail. We assessed language outcome in three groups of children aged 6 to 9 years (n=487): those previously admitted to Kilifi District Hospital, Kenya, with cerebral malaria (CM; n=152; mean age 7y 4 mo [SD 1y 1mo]; 77 males, 75 females); or those with malaria and complicated seizures (M/S; n=156; mean age 7y 4mo [SD 1y 2mo]; 72 males, 84 females); and those unexposed to either condition (n=179; mean age 7y 6mo [SD 1y 1mo]; 93 males, 86 females). Median age at hospital admission was 28 months (interquartile range [IQR] 19 to 44 mo) among children with a history of CM and 23 months (IQR 12 to 35mo) among children with a history of M/S. A battery of eight assessments covering the major facets of speech and language was used to measure language performance. Cognitive performance, neurological/motor skills, behaviour, hearing, and vision were also measured. Eighteen (11.8%) of the CM group, 14 (9%) of the M/S group, and four (2.2%) of the unexposed group were found to have a language impairment. CM (odds ratio 3.68, 95% confidence interval 1.09 to 12.4, p=0.04) was associated with significantly increased odds of an impairment-level score relative to the unexposed group. The results suggest that falciparum malaria is one of the most common causes of acquired language disorders in the tropics.
We have considered multiple subpial transection (MST) as a treatment option for Landau–Kleffner syndrome (LKS) for the past 6 years. The effect of this technique on language and cognitive ability, behaviour, seizures, and EEG abnormalities is analysed here. Five children (4 males, 1 female; aged 5.5 to 10 years) underwent MST with sufficiently detailed pre- and postoperative data for analysis. Behaviour and seizure frequency improved dramatically after surgery in all children. Improvement in language also occurred in all children, although none improved to an age-appropriate level. All five had electrical status epilepticus in sleep (ESES) before surgery, which was eliminated by the procedure. One child has had an extension of his MST due to the recurrence of ESES and accompanying clinical deterioration with good effect. An attempt is made to set the effect of MST against the natural history of the condition. MST is an important treatment modality in LKS, although the timing of this intervention and its effect on final language outcome remains to be defined.
We report the 13C NMR spectra of amorphous hydrogenated carbon and boron carbide. The amorphous hydrogenated carbon spectra consist primarily of a sp2 carbon peak at 40 ppm and a sp3 carbon peak at 140 ppm and are in reasonable agreement with recent theoretical calculations of Mauri, Pfrommer, and Louie, but there are some noteable discrepancies. The amorphous hydrogenated boron carbide spectra are very different from that of amorphous hydrogenated carbon, showing two sharp lines at 135 and 170 ppm at low boron concentrations and an intense, broader line at 15 ppm at high boron concentrations. We suggest the two sharp lines at 135 and 170 ppm could be due to carbon atoms in boron-containing aromatic rings, and the broader line at 15 ppm as due to carbon atoms in boron carbide icosahedra. These lines provide evidence of nanocrystalline structure imbedded in an amorphous hydrogenated boron carbide matrix.
Levels of I were determined in selected foods and dietary supplements, and in samples of the British ‘Total Diet’. The average concentration of I in British milk collected in thirteen areas on four occasions during 1990 and 1991 was 150 μg/kg (range 40–310 μg/kg), compared with 230 μg/kg in 1977–79. No difference was found between skimmed and whole milk. Winter milk contained 210 μg/kg while summer milk contained 90 μg/kg. Regional differences were less pronounced than seasonal differences. Levels in fish and fish products were between 110 and 3280 μg/kg. Edible seaweed contained I levels of between 4300 and 2660000 μg/kg. Kelp-based dietary supplements contained I at levels that would result in a median intake of 1000 μg if the manufacturers' recommended maximum daily dose of the supplement was taken, while other I-containing supplements contained a median level of 104 μg in the manufacturers' maximum recommended daily dose. Intake of I, as estimated from the Total Diet Study, was 173 μg/d in 1985 (277 μg if samples with very high I contents were included) and 166 μg/d in 1991. These levels are above the UK reference nutrient intake of 140 μg/d for adults but well below the Joint Expert Committee on Food Additives provisional maximum tolerable intake of 1000 μg/d.