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Proximal environments could facilitate smoking cessation among low-income smokers by making cessation appealing to strive for and tenable.
We sought to examine how home smoking rules and proximal environmental factors such as other household members' and peers' smoking behaviors and attitudes related to low-income smokers' past quit attempts, readiness, and self-efficacy to quit.
This analysis used data from Offering Proactive Treatment Intervention (OPT-IN) (randomized control trial of proactive tobacco cessation outreach) baseline survey, which was completed by 2,406 participants in 2011/12. We tested the associations between predictors (home smoking rules and proximal environmental factors) and outcomes (past-year quit attempts, readiness to quit, and quitting self-efficacy).
Smokers who lived in homes with more restrictive household smoking rules, and/or reported having ‘important others’ who would be supportive of their quitting, were more likely to report having made a quit attempt in the past year, had greater readiness to quit, and greater self-efficacy related to quitting.
Adjustments to proximal environments, including strengthening household smoking rules, might encourage cessation even if other household members are smokers.
Introduction: BACKGOUND In the modern era of terrorism and senseless violence, it is essential that hospital staff have expertise in implementation of a mass casualty incident (MCI) plan. OBJECTIVES 1. To assess current gaps in implementation of an academic urban hospital code orange plan using live simulation and tabletop exercise. 2. To identify and educate front-line staff to champion a hospital-wide MCI plan. INNOVATION Historically, in order to limit resource utilization and impact on patient care, disaster response training of front-line staff involved tabletop exercises only. The tenets of experiential learning suggest that learner engagement through realistic active practice of skills achieves deeper uptake of new knowledge. We enhanced the traditional tabletop approach through novel use of live actor patients presenting to an academic, urban emergency department (ED) during a hospital-wide MCI simulation. Methods: To assess the current code orange plan, an interprofessional, committee comprising expert leaders in trauma, emergency preparedness, emergency medicine and simulation integrated tabletop and live simulation to stage a MCI based on a mock incident at a new subway station. ED staff, the trauma team and champions from medicine, surgery and critical care participated along with support departments such as Patient Flow, Patient Transport, Environmental Services and the Hospital Emergency Operations Centre. Ten live actor patients and eight virtual patients presented to the ED. The exercise occurred in situ in the ED. Other participating departments conducted tabletop exercises and received live actor patients. Results: CURRICULUM Staff decanted the ED and other participating units using their current knowledge of hospital code orange policy. Live and virtual patients were triaged and managed according to severity of injuries. Live actor patients were assessed, intervened and transported to their designated unit. Virtual patients were managed through verbal discussion with the simulation controllers. An ED debrief took place using a plus/delta approach followed by a hospital-wide debrief. Conclusion: CONCLUSION An interprofessional hospital-wide MCI simulation revealed important challenges such as communication, command and control and patient-tracking . The exercise ignited enthusiasm and commitment to longitudinal practice and improvement for identified gaps.
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.
The Universe is permeated by hot, turbulent, magnetized plasmas. Turbulent plasma is a major constituent of active galactic nuclei, supernova remnants, the intergalactic and interstellar medium, the solar corona, the solar wind and the Earth’s magnetosphere, just to mention a few examples. Energy dissipation of turbulent fluctuations plays a key role in plasma heating and energization, yet we still do not understand the underlying physical mechanisms involved. THOR is a mission designed to answer the questions of how turbulent plasma is heated and particles accelerated, how the dissipated energy is partitioned and how dissipation operates in different regimes of turbulence. THOR is a single-spacecraft mission with an orbit tuned to maximize data return from regions in near-Earth space – magnetosheath, shock, foreshock and pristine solar wind – featuring different kinds of turbulence. Here we summarize the THOR proposal submitted on 15 January 2015 to the ‘Call for a Medium-size mission opportunity in ESAs Science Programme for a launch in 2025 (M4)’. THOR has been selected by European Space Agency (ESA) for the study phase.
During 1990 we surveyed the southern sky using a multi-beam receiver at frequencies of 4850 and 843 MHz. The half-power beamwidths were 4 and 25 arcmin respectively. The finished surveys cover the declination range between +10 and −90 degrees declination, essentially complete in right ascension, an area of 7.30 steradians. Preliminary analysis of the 4850 MHz data indicates that we will achieve a five sigma flux density limit of about 30 mJy. We estimate that we will find between 80 000 and 90 000 new sources above this limit. This is a revised version of the paper presented at the Regional Meeting by the first four authors; the surveys now have been completed.
We present an analysis of changes of state, pressures and conservation responses over 20 years in the Tanzanian portion of the Coastal Forests of Eastern Africa biodiversity hotspot. Baseline data collected during 1989–1995 are compared with data from a synthesis of recently published papers and reports and new field work carried out across the region during 2010–2014. We show that biodiversity endemism values are largely unchanged, although two new species (amphibian and mammal) have been named and two extremely rare tree species have been relocated. However, forest habitat continues to be lost and degraded, largely as a result of agricultural expansion, charcoal production to supply cities with cooking fuel, logging for timber and cutting of wood for firewood and building poles. Habitat loss is linked to an increase in the number of species threatened over time. The government-managed forest reserve network has expanded slightly but has low effectiveness. Three forest reserves have been upgraded to National Parks and Nature Reserves, which have stricter protection and more effective enforcement. There has also been rapid development of village-owned forest reserves, with more than 140 now existing; although usually small, they are an important addition to the areas being managed for sustainable resource use, and also provide tangible benefits to local people. Human-use pressures remain intense in many areas, and combined with emerging pressures from mining, gas and oil exploration, many endemic species remain threatened with extinction.
We present a detailed, complete glacier inventory for Alaska and neighboring Canada using multi-sensor satellite data from 2000 to 2011. For each glacier, we derive outlines and 51 variables, including center-line lengths, outline types and debris cover. We find 86 723 km2 of glacier area (27 109 glaciers >0.025 km2), ∼12% of the global glacierized area outside ice sheets. Of this area 12.0% is drained by 39 marine-terminating glaciers (74 km of tidewater margin), and 19.3% by 148 lake- and river-terminating glaciers (420 km of lake-/river margin). The overall debris cover is 11%, with considerable differences among regions, ranging from 1.4% in the Kenai Mountains to 28% in the Central Alaska Range. Comparison of outlines from different sources on >2500 km2 of glacierized area yields a total area difference of ∼10%, emphasizing the difficulties in accurately delineating debris-covered glaciers. Assuming fully correlated (systematic) errors, uncertainties in area reach 6% for all Alaska glaciers, but further analysis is needed to explore adequate error correlation scales. Preliminary analysis of the glacier database yields a new set of well-constrained area/length scaling parameters and shows good agreement between our area–altitude distributions and previously established synthetic hypsometries. The new glacier database will be valuable to further explore relations between glacier variables and glacier behavior.
To establish the diagnostic adequacy of ultrasound-guided fine needle aspiration cytology samples at the East Berkshire neck lump clinic, and to perform a cost-benefit analysis related to the hypothetical addition of an on-site cytology technician (required to review fine needle aspiration specimen adequacy).
The adequacy of all ultrasound-guided fine needle aspiration procedures was reviewed from 1 January to 30 June 2011. These results were used in the cost-benefit analysis related to on-site cytology assessment.
Of the 307 ultrasound-guided fine needle aspiration cytology procedures performed over 6 months, 67 (22 per cent) were reported to be non-diagnostic. Operator experience was found to correlate significantly with diagnostic adequacy (p < 0.001). Only 5 per cent of all fine needle aspirations were initially non-diagnostic but diagnostic on repeat sampling. This suggests that the financial and time costs of on-site fine needle aspirate adequacy assessment would outweigh any benefit.
In this series, the experience of individuals performing fine needle aspirations was the most important factor related to adequacy.
Carbon-based forest conservation requires the establishment of ‘reference emission levels’ against which to measure a country or region's progress in reducing their carbon emissions. In East Africa, landscape-scale estimates of carbon fluxes are uncertain and factors such as deforestation poorly resolved due to a lack of data. In this study, trends in vegetation cover and carbon for East Africa were quantified using moderate-resolution imaging spectroradiometer (MODIS) land cover grids from 2002 to 2008 (500-m spatial resolution), in combination with a regional carbon look-up table. The inclusion of data on rainfall and the distribution of protected areas helped to gauge impacts on vegetation burning (assessed using 1-km spatial resolution MODIS active fire data) and biome trends. Between 2002 and 2008, the spatial extents of forests, woodlands and scrublands decreased considerably and East Africa experienced a net carbon loss of 494 megatonnes (Mt). Most countries in the area were sources of carbon emissions, except for Tanzania and Malawi, where the areal increase of savannah and woodlands counterbalanced carbon emissions from deforestation. Both Malawi and Tanzania contain large areas of planted forest. Vegetation burning was correlated with rainfall (forest only) and differed depending on land management. Freely available global earth observation products have provided ways to achieve rapid assessment and monitoring of carbon change hotspots at the landscape scale.
Previous evidence shows that the n10 component of the ocular vestibular evoked myogenic potential indicates utricular function, while the p13 component of the cervical vestibular evoked myogenic potential indicates saccular function. This study aimed to assess the possibility of differential utricular and saccular function testing in the clinic, and whether loss of saccular function affects utricular response.
Following vibration conduction from the mid-forehead at the hairline, the ocular n10 component was recorded by surface electromyograph electrodes beneath both eyes, while the cervical p13–n23 component was recorded by surface electrodes over the tensed sternocleidomastoid muscles.
Fifty-nine patients were diagnosed with probable inferior vestibular neuritis, as their cervical p13–n23 component was asymmetrical (i.e. reduced or absent on the ipsilesional side), while their ocular n10 component was symmetrical (i.e. normal beneath the contralesional eye).
The sense organ responsible for the cervical and the ocular vestibular evoked myogenic potentials cannot be the same, as one response was normal while the other was not. Reduced or absent saccular function has no detectable effect on the ocular n10 component. On vibration stimulation, the ocular n10 component indicates utricular function and the cervical p13–n23 component indicates saccular function.
Conversion of forest to other land uses is a major contributor to climate change. The coastal forests of Tanzania have increasingly been recognized as being of global biodiversity importance, due to high rates of species endemism. Rates of forest loss are similar to those of other tropical regions, resulting in increasing levels of threat for the biological values within the remaining forest and potentially significant source of CO2 emissions. This study estimated the remaining cover and carbon stock of Tanzania's coastal forests and the CO2 emissions due to forest loss between c. 1990 and c. 2007. Coastal Tanzania contained over 273 700 ha of forest in 2007. Deforestation rates in the area have slowed from 1.0% yr−1, or > 3735 ha yr−1 during the 1990s, to 0.4% yr−1, or > 1233 ha yr−1 during 2000–2007. Despite lower deforestation rates in 2000–2007, the percentage forest lost from within reserved areas has remained steady at 0.2% yr−1 for both time periods. CO2 emissions from deforestation slowed from at least 0.63 Mt CO2 yr−1 in 1990–2000 to at least 0.20 Mt CO2 yr−1 in 2000–2007. Regional forest clearance in Tanzania is highly dynamic; while rates have slowed since 2000, forest habitat conversion has continued and there is no guarantee that future rates will remain low. A rigorous policy on reducing emissions from deforestation and degradation (REDD) should be implemented to avoid future increases in deforestation rates.
Emergency medical services (EMS) personnel care for patients in challenging and dynamic environments that may contribute to an increased risk for adverse events. However, little is known about the risks to patient safety in the EMS setting. To address this knowledge gap, we conducted a systematic review of the literature, including nonrandomized, noncontrolled studies, conducted qualitative interviews of key informants, and, with the assistance of a pan-Canadian advisory board, hosted a 1-day summit of 52 experts in the field of EMS patient safety. The intent of the summit was to review available research, discuss the issues affecting prehospital patient safety, and discuss interventions that might improve the safety of the EMS industry. The primary objective was to define the strategic goals for improving patient safety in EMS. Participants represented all geographic regions of Canada and included administrators, educators, physicians, researchers, and patient safety experts. Data were collected through electronic voting and qualitative analysis of the discussions. The group reached consensus on nine recommendations to increase awareness, reduce adverse events, and suggest research and educational directions in EMS patient safety: increasing awareness of patient safety principles, improving adverse event reporting through creating nonpunitive reporting systems, supporting paramedic clinical decision making through improved research and education, policy changes, using flexible algorithms, adopting patient safety strategies from other disciplines, increasing funding for research in patient safety, salary support for paramedic researchers, and access to graduate training in prehospital research.
The proposed mechanism for Reducing Emissions from Deforestation and Degradation (REDD+) offers significant potential for conserving forests to reduce negative impacts of climate change. Tanzania is one of nine pilot countries for the United Nations REDD Programme, receives significant funding from the Norwegian, Finnish and German governments and is a participant in the World Bank’s Forest Carbon Partnership Facility. In combination, these interventions aim to mitigate greenhouse gas emissions, provide an income to rural communities and conserve biodiversity. The establishment of the UN-REDD Programme in Tanzania illustrates real-world challenges in a developing country. These include currently inadequate baseline forestry data sets (needed to calculate reference emission levels), inadequate government capacity and insufficient experience of implementing REDD+-type measures at operational levels. Additionally, for REDD+ to succeed, current users of forest resources must adopt new practices, including the equitable sharing of benefits that accrue from REDD+ implementation. These challenges are being addressed by combined donor support to implement a national forest inventory, remote sensing of forest cover, enhanced capacity for measuring, reporting and verification, and pilot projects to test REDD+ implementation linked to the existing Participatory Forest Management Programme. Our conclusion is that even in a country with considerable donor support, progressive forest policies, laws and regulations, an extensive network of managed forests and increasingly developed locally-based forest management approaches, implementing REDD+ presents many challenges. These are being met by coordinated, genuine partnerships between government, non-government and community-based agencies.
Patients who have undergone tracheoesophageal puncture for surgical voice restoration often use unnaturally high oesophageal air pressures during speech. This study examined the effect of high oesophageal air pressure on oesophageal body motility, lower oesophageal sphincter function and dyspeptic symptoms.
Cross-sectional study using several investigative tests of oesophageal function.
Materials and methods:
Sixteen patients who used tracheoesophageal fistula speech underwent several investigations, including: oesophageal manometry, videofluoroscopy, barium swallow, and tracheal pressure measurements during speech. The patients were also asked to complete a dyspepsia questionnaire.
We demonstrated that more than 50 per cent of these patients had subjective or objective disordered oesophageal function. Videofluoroscopy and manometry identified oesophageal dysmotility in the same patients.
Oesophageal function appears to be altered by tracheoesophageal fistula speech. However, our study showed that there is no contraindication to proceeding with tracheoesophageal fistula voicing even in patients with a history of oesophageal dysfunction.