To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Emergency Medical Services (EMS) systems have developed protocols for prehospital activation of the cardiac catheterization laboratory for patients with suspected ST-elevation myocardial infarction (STEMI) to decrease first-medical-contact-to-balloon time (FMC2B). The rate of “false positive” prehospital activations is high. In order to decrease this rate and expedite care for patients with true STEMI, the American Heart Association (AHA; Dallas, Texas USA) developed the Mission Lifeline PreAct STEMI algorithm, which was implemented in Los Angeles County (LAC; California USA) in 2015. The hypothesis of this study was that implementation of the PreAct algorithm would increase the positive predictive value (PPV) of prehospital activation.
This is an observational pre-/post-study of the effect of the implementation of the PreAct algorithm for patients with suspected STEMI transported to one of five STEMI Receiving Centers (SRCs) within the LAC Regional System. The primary outcome was the PPV of cardiac catheterization laboratory activation for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The secondary outcome was FMC2B.
A total of 1,877 patients were analyzed for the primary outcome in the pre-intervention period and 405 patients in the post-intervention period. There was an overall decrease in cardiac catheterization laboratory activations, from 67% in the pre-intervention period to 49% in the post-intervention period (95% CI for the difference, -14% to -22%). The overall rate of cardiac catheterization declined in post-intervention period as compared the pre-intervention period, from 34% to 30% (95% CI, for the difference -7.6% to 0.4%), but actually increased for subjects who had activation (48% versus 58%; 95% CI, 4.6%-15.0%). Implementation of the PreAct algorithm was associated with an increase in the PPV of activation for PCI or CABG from 37.9% to 48.6%. The overall odds ratio (OR) associated with the intervention was 1.4 (95% CI, 1.1-1.8). The effect of the intervention was to decrease variability between medical centers. There was no associated change in average FMC2B.
The implementation of the PreAct algorithm in the LAC EMS system was associated with an overall increase in the PPV of cardiac catheterization laboratory activation.
Background: Adults are at risk of being exposed to influenza from many sources. Healthcare personnel (HCP) have the additional risk of being exposed to ill patients.
To determine whether HCP were at higher risk than adults working in nonhealthcare roles (non-HCP).
Prospective cohort study.
Acute-care hospitals and other businesses in Toronto, Ontario, Canada.
Adults aged 18–69 years were enrolled for 1 or more of the 2010/2011, 2011/2012, and 2012/2013 influenza seasons. Swabs collected during acute respiratory illnesses were tested for influenza and pre- and postseason blood samples were tested for influenza-specific immune response.
The adjusted odds of influenza were similar for HCP and non-HCP (odds ratio [OR], 1.29; 95% confidence interval [CI], 0.63–2.63). Older adults and those vaccinated against influenza had lower odds, and those who shared their workspace and who used corrective eyewear had higher odds of influenza.
HCP and other working adults are at similar risk of influenza infection.
Healthcare workers (HCWs) are at risk of acquiring and transmitting respiratory viruses while working in healthcare settings.
To investigate the incidence of and factors associated with HCWs working during an acute respiratory illness (ARI).
HCWs from 9 Canadian hospitals were prospectively enrolled in active surveillance for ARI during the 2010–2011 to 2013–2014 influenza seasons. Daily illness diaries during ARI episodes collected information on symptoms and work attendance.
At least 1 ARI episode was reported by 50.4% of participants each study season. Overall, 94.6% of ill individuals reported working at least 1 day while symptomatic, resulting in an estimated 1.9 days of working while symptomatic and 0.5 days of absence during an ARI per participant season. In multivariable analysis, the adjusted relative risk of working while symptomatic was higher for physicians and lower for nurses relative to other HCWs. Participants were more likely to work if symptoms were less severe and on the illness onset date compared to subsequent days. The most cited reason for working while symptomatic was that symptoms were mild and the HCW felt well enough to work (67%). Participants were more likely to state that they could not afford to stay home if they did not have paid sick leave and were younger.
HCWs worked during most episodes of ARI, most often because their symptoms were mild. Further data are needed to understand how best to balance the costs and risks of absenteeism versus those associated with working while ill.
To describe the frequency, characteristics, and exposure associated with influenza in hospitalized patients in a Toronto hospital
Prospective data collected for consenting patients with laboratory-confirmed influenza and a retrospective review of infection control charts for roommates of cases over 3 influenza seasons
Of the 661 patients with influenza (age range: 1 week–103 years), 557 were placed on additional precautions upon admission. Of 104 with symptoms detected after admission, 57 cases were community onset and 47 were nosocomial (10 nosocomial were part of outbreaks). A total of 78 cases were detected after admission exposing 143 roommates. Among roommates tested for influenza after exposure, no roommates of community-onset cases and 2 of 16 roommates of nosocomial cases were diagnosed with influenza. Of 637 influenza-infected patients, 25% and 57% met influenza-like illness definitions from the Public Health Agency of Canada (PHAC) and Centers for Disease Control and Prevention (CDC), respectively, and 70.3% met the Provincial Infectious Diseases Advisory Committee (PIDAC) febrile respiratory illness definition. Among the 56 patients with community-onset influenza detected after admission, only 13%, 23%, and 34%, met PHAC, CDC, and PIDAC classifications, respectively.
In a setting with extensive screening and testing for influenza, 1 in 6 patients with influenza was not diagnosed until patients and healthcare workers had been exposed for >24 hours. Only 30% of patients with community-onset influenza detected after admission met the Ontario definition intended to identify cases, hampering efforts to prevent patient and healthcare worker exposures and reinforcing the need for prevention through vaccination.
This article discusses developments in theory and research on happiness two decades after publication of Psychological Well-Being in Later Life (Butterworths, 1991) by Albert Kozma, Michael Stones, and Kevin McNeil. Major empirical advances include new knowledge about contributions to happiness resulting from genetically related effects and personality. Personality traits have stronger relationships with happiness than was apparent 20 years ago and contribute to covariance between happiness and some of its predictors. Evolving emphases in research include the ways in which genetically related effects influence how people shape, and react to, their environment.
In this work, the growth and characterization of GaAsSbN epilayers nearly lattice matched to GaAs, grown in an elemental solid source molecular beam epitaxy (MBE) system with a RF plasma nitrogen source, are discussed. The Sb and N compositions of the nearly lattice matched layers are 2.6% and 6.8%, respectively, as determined by high resolution x-ray diffraction (HRXRD) and secondary ion mass spectroscopy (SIMS) analysis. The layers are found to be fully strained as evidenced by the presence of Pendellosung fringes on the x-ray diffraction spectra.
Effects of in-situ and ex-situ annealing on the low temperature photoluminescence (PL) characteristics are discussed. The 10 K PL peak energy of 1 eV with a FWHM of 18 meV has been achieved on ex-situ annealed samples in N ambient. The temperature dependence of PL peak energy exhibits “S-shaped” behavior in the low temperature regime, indicative of the presence of localized excitons. Raman spectroscopy analysis has been carried out to determine the local structural changes on annealing.
In a sample of 1449 adults, divided by age into young, middle-age, and old, mood was found to consist of two age invariant components, vigour and affect. Factor structure differed by age for affect but not vigour. For old adults, two unipolar affect factors were obtained, whereas one bipolar affect factor was obtained for the two younger groups. From these factor analyses a mood scale (the Memorial University Mood Scale, the MUMS) was developed and its predictive validity and reliability established for all age groups. Using the MUMS, mean level differences by age were found in both vigour and affect, as well as a measure of globed mood, with the old adults higher on all three measures. Age invariant, diurnal patterns were found for both vigour and affect. Vigour followed an inverted U-shaped diurnal pattern and affect a primarily linear pattern, suggestive of appraisals of somatic state and environmental conditions, respectively.
Findings are presented on the psychometric properties of a short psychological hardiness measure using subjects predominantly aged over 60 years. The sample of 223 participants was administered the hardiness questionnaire and other instruments twice, with a one-year test-retest interval. First-order factor analysis yielded three factors termed challenge, control, and commitment. Second-order factor analysis revealed a single main factor of general hardiness on which all the first-order components loaded highly. Both internal consistency and test-retest forms of reliability were in the range 0.6 to 0.7. Concurrent validity was illustrated by significant correlations between hardiness and measures of happiness and adjustment.
Email your librarian or administrator to recommend adding this to your organisation's collection.