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Background: Prevention of central-line–associated bloodstream infections (CLABSIs) and methicillin-resistant Staphylococcus aureus (MRSA) infections requires a multifaceted approach including strategies to decrease cutaneous bacterial colonization. Prior studies have shown benefit from chlorhexidine-gluconate (CHG) skin application on CLABSI and MRSA infection rates in intensive care units (ICUs); however, the use of CHG in the non-ICU population has not been well studied. Methods: We performed a quasi-experimental before-and-after study to evaluate the use of daily 2% CHG wipes in non-ICU patients at a 1,000 bed acute-care teaching hospital beginning in November 2017. The study population included adult and pediatric patients with central venous catheters on non-ICU units, excluding patients on the following units: stem cell transplant and hematologic malignancy (these units had already established use of CHG skin application as a standard prior to the intervention), labor and delivery, and psychiatry. CHG was applied according to the manufacturer’s instruction by nurses or nurse aides and random monthly auditing of compliance was performed. NHSN CLABSI, hospital-onset MRSA bacteremia, and hospital-onset MRSA LabID rates were compared for the period 24 months before the intervention (November 1, 2015, through October 31, 2017) to the 24-month period after the intervention (November 1, 2017, through October 31, 2019) using a paired t test. Notably, the health system also discontinued the use of contact precautions for patients with MRSA (excluding MRSA from open, draining wounds) 11 months prior to onset of this intervention. Results: The CLABSI rate decreased by 26% from 0.594 events per 1,000 central-line days (n = 50) before the intervention to 0.438 events per 1,000 central-line days (n = 38) after the intervention (P = 0.19). The number of CLABSIs with gram-positive organisms also decreased by 29%. MRSA LabID rates decreased by 37% from 0.301 events per 1,000 patient days (n = 119) to 0.189 events per 1,000 patient days (n = 75) (P = 0.01). MRSA bacteremia rates decreased by 79% from 0.058 events per 1,000 patient days (n = 23) to 0.012 events per 1,000 patient days (n = 5) (P < 0.01). Compliance with the intervention was 83% (n = 225). Conclusions: Daily CHG skin application in non-ICU patients with central venous catheters is an effective strategy to prevent CLABSIs and MRSA infections. We observed a decrease in MRSA LabID and bacteremia rates despite discontinuation of contact precautions. These findings suggest that a horizontal prevention approach of daily CHG skin application may be an effective alternative to contact isolation to interrupt transmission of MRSA in hospitalized patients outside the ICU setting.
This chapter includes an overview of achievement assessments that are designed to measure performance across multiple academic domains or a single domain. First, commonly used comprehensive achievement tests, such as the Woodcock-Johnson Tests of Achievement – Fourth Edition, the Wechsler Individual Achievement Test – Third Edition, and the Kaufman Tests of Educational Achievement – Third Edition, are reviewed. Next, several single subject area tests in reading, writing, or mathematics are presented. Next curriculum-based measurements (CBMs), designed to provide ongoing evaluation of a student’s progress toward curriculum-based achievement goals, are described. We also discuss advances in technology, issues related to achievement testing, considerations of culture and diversity, and misuses and misinterpretations of achievement testing. Finally, we include several interpretive and practical recommendations for achievement testing.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
The current study explored the experiences and aspirations of a cohort of Aboriginal and Torres Strait Islander adults with neurocognitive disability residing in a homeless shelter in regional Queensland, Australia. Neurocognitive disability (NCD) refers to any acquired disorder or injury to the brain where the primary clinical deficit is in cognitive function.
The data reported on in this paper emerged from a broader study that aimed to understand the extent and nature of neurocognitive disability amongst homeless Aboriginal and Torres Strait Islander people. The broader study found high levels of NCD which impacted on people’s ability to participate in society. As part of the study, qualitative information was sought regarding participant life experiences. A culturally safe and acceptable structure of “past, present and future” was applied to open-ended questions.
Thematic analysis of the data identified four broad themes of i) normalisation of illness and disability; ii) trauma and loss; iii) socioeconomic disadvantage; and iv) hope and disempowerment. This paper reports on these themes and experiences, which occurred across the life span, intersected with NCD, and contributed to what we have termed ‘complex disablement’ amongst this cohort.
While causal links between life experience, disability and disablement are not always clear, our findings suggest that attempts to address homelessness must engage with this complexity. The application of holistic, intersectoral supports, which encompass culturally informed, community driven approaches are needed. Understanding the impacts of individual and intergenerational trauma is crucial to safe and effective service provision for this cohort.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
Graduate students are often plagued by stress and anxiety in their journeys of becoming researchers. Concerned by the prevalence of poor graduate student wellbeing in Australia, we share our experiences of kin-making and collaboration within #aaeeer (Australasian Association for Environmental Education Emerging Researchers), a collective of graduate students and early career researchers formed in response to the Australian Association for Environmental Education (AAEE) conference in Hobart, Tasmania, in 2014. In this article, we begin to address the shortage of research into graduate student wellbeing, led by graduate students. Inspired by Donna Haraway's work on making kin in the Chthulucene, we present an exploration that draws together stories from the authors about the positive experiences our kin-making collective enables, and how it has supported our wellbeing and allowed us to work collaboratively. Specifically, we find that #aaeeer offers us a form of refuge from academic stressors, creating spaces for ‘composting together’ through processes of ‘decomposing’ and ‘recomposing’. Our rejection of neoliberal norms has gifted us experiences of joyful collective pleasures. We share our experiences here in the hope of supporting and inspiring other emerging and established researchers to ‘make kin’ and challenge the potentially isolating processes of becoming researchers.
Sustainability is a Cross-Curriculum Priority (SCCP) in the Australian Curriculum and is intended to be integrated into teaching and learning where deemed appropriate by teachers. This article explores teachers’ knowledge, understanding, and beliefs about curriculum priorities and the situational context of teaching and learning in Queensland schools. In this article we discuss the ways in which teachers describe their relationship with sustainability education and the SCCP. Data were collected from interviews with 26 Queensland teachers, teaching across all year levels from early childhood to Year 12, as part of two different PhD research projects. Queensland teachers participating in both studies indicated strong support for the inclusion of sustainability within formal curriculum; however, this strong support did not translate into practice in most cases. As a result of curriculum and policy pressures, teachers indicated that despite their belief that Education for Sustainability (EfS) is important, few believe they have the time or support for teaching EfS. The current educational context teachers have described offers limited opportunity for teachers to integrate sustainability in ways that are meaningful and relevant to their students. The SCCP did not influence planning or teaching decisions, and many teachers were unaware of its existence. Data from both studies question the adequacy of current educational policy and curriculum documents for supporting teachers to engage with sustainability education.
An original cohort study found that over half of the individuals detained under Section 136 (S136) of the Mental Health Act 1983 were discharged home after assessment, and nearly half were intoxicated.
To investigate whether the cohort was followed up by psychiatric services, characterise those repeatedly detained and assess whether substance use was related to these outcomes.
Data were retrospectively collected from the notes of 242 individuals, who presented after S136 detention to a place of safety over a 6-month period, and were followed up for 1 year.
After 1 year, 48% were in secondary care. Those with psychosis were the most likely to be admitted. Diagnoses of personality disorder or substance use were associated with multiple detentions; however, few were in contact with secondary services.
Crisis and long-term care pathways for these groups need to be developed to reduce repeated and unnecessary police detention.
For decades, scholars have attributed Black Americans' unified political and policy views, despite growing internal class and status differences, to a strong perception of linked fate. In recent years, the concept has been measured in other racial and ethnic groups and with regard to gender, but not applied to social statuses such as class or religion. Without broad comparisons across groups and different statuses, however, one cannot determine the appropriate empirical test or most distinctive correlates of this canonical construct. Using a new national survey, we examine Americans' views of linked fate by race or ethnicity, and also by gender, class, or religion. We find expressions of linked fate to be similar across racial or ethnic groups, robust to experimental manipulation, and as strong for class as for racial or ethnic identity. Intra-individual correlations on linked fate items are very high, while a sense of linked fate is rarely associated with political views or political participation. Expressions of linked fate are not always closely related to feelings of closeness to one's group or perceptions of discrimination against that group. We speculate on the broader meaning of responses to this standard item, and conclude that the enormously fruitful theory of racial linked fate is due for further conceptual development and empirical experimentation.
Vegetation affects feedbacks in Earth's hydrologic system, but is constrained by physiological adaptations. In extant ecosystems, the mechanisms controlling plant water used can be measured experimentally; for extinct plants in the recent geological past, water use can be inferred from nearest living relatives, assuming minimal evolutionary change. In deep time, where no close living relatives exist, fossil material provides the only information for inferring plant water use. However, mechanistic models for extinct plant water use must be built on first principles and tested on extant plants. Plants serve as a conduit for water movement from the soil to the atmosphere, constrained by tissue-level construction and gross architecture. No single feature, such as stomata or veins, encompasses enough of the complexity underpinning water-use physiology to serve as the basis of a model of functional water use in all (or perhaps any) extinct plants. Rather, a “functional whole plant” model must be used. To understand the interplay between plant and atmosphere, water use in relation to environmental conditions is investigated in an extinct plant, the seed fern Medullosa ((Division Pteridospermatophyta), by reviewing methods for reconstructing physiological variables such as leaf and stem hydraulic capacity, photosynthetic rate, transpiration rate, stomatal conductance, and albedo. Medullosans had the potential for extremely high photosynthetic and assimilation rates, water transport, stomatal conductance, and transpiration—rates comparable to later angiosperms. When these high growth and gas exchange rates of medullosans are combined with the unique atmospheric gas composition of the late Paleozoic atmosphere, complex vegetation-environmental feedbacks are expected despite their basal phylogenetic position relative to post-Paleozoic seed plants.
To solve the problem of induction we had first better know what it is. Some ways of formulating the worry about induction are underwhelming as they depend on assumptions that don't survive much scrutiny. Perhaps the most disturbing argument for inductive skepticism appeals to the claim that we could not possibly be justified in taking our inductive methods to be reliable independently of our use of those methods. And the use of inductive methods cannot give us justification to suppose that they are reliable. I argue for a new way to escape the first horn of this dilemma.
My title refers to three accounts of interpersonal love: the rationalist (and ultimately rational egoist) account that Terence Irwin ascribes to Plato; the anti-rationalist but strikingly similar account that Harry Frankfurt endorses in his own voice; and the ‘ekstatic’ account that I – following the lead of Martha Nussbaum – find in Plato's Phaedrus. My claim is that the ekstatic account points to important features of interpersonal love to which the other accounts fail to do justice, especially reciprocity and a regulative ideal of equality.