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To investigate (i) changes in stakeholder commitment and (ii) perceptions of the purpose, challenges and benefits of healthy food and beverage provision in community sports settings during the stepwise implementation of a healthy beverage policy.
Convergent, parallel, mixed-methods design complemented (i) repeat semi-structured interviews with council stakeholders (n 17 interviews, n 6 interviewees), with (ii) repeat quantitative stakeholder surveys measuring Commitment to Organisational Change; (iii) weekly sales data examining health behaviour and revenue effects (15 months pre-intervention; 14 months post-intervention); (iv) customer exit surveys (n 458); and (v) periodic photographic audits of beverage availability. Interviews were analysed inductively. Stakeholder surveys, sales data, customer surveys and audits were analysed descriptively.
Four local government-owned sports and recreation centres in Melbourne, Australia, completed a 3-month trial to increase the availability of healthy beverages and decrease the availability of unhealthy beverages in food outlets.
Interviews were conducted with council managers and those involved in implementation (September 2016–October 2017). Customers were surveyed (September–October 2017).
Interviews and surveys indicated that stakeholders’ commitment to policies varied such that, over time, optimism that changing beverage availability could increase the healthiness of customers’ purchases became more widespread among interviewees. Stakeholder focus generally progressed from anticipatory concern to solutions-focused discussions. Sales, audit and customer survey data supported interview findings.
We found a general increase in optimism regarding policy outcomes over time during the implementation of a healthy beverage policy. Stepwise trials should be further explored as an engagement tool within community retail settings.
Cover crops play an important role in agricultural sustainability. Unlike commodity cash crops, however, there has been relatively little cover crop breeding research and development. We conducted an online survey to evaluate: (a) the perspectives of organic and conventional farmers in the USA who use cover crops and (b) the specific cover crop traits that are important to farmers. We recruited participants from both organic and conventional agriculture networks and 69% of respondents reported that they farmed organic land. In addition to demographic data and information on management practices, we quantified farmer perspectives on four winter annual cover crops: (1) Austrian winter pea, (2) crimson clover, (3) hairy vetch and (4) cereal rye. Overall, respondents represented a wide range of states, farm sizes, plant hardiness zones and cash crops produced. Of the 417 full responses received, 87% of respondents reported that they used cover crops. The maximum amount farmers were willing to spend on cover crop seed varied by farmer type: 1% of conventional farmers versus 19% of organic farmers were willing to spend over US$185 ha−1 (US$75 acre−1). Organic and conventional farmers differed in terms of the reasons why they grew cover crops, with organic farmers placing greater value on the ecosystem services from cover crops. More organic (63%) than conventional (51%) farmers agreed that participatory breeding was important for cover crop variety development (P = 0.047). Both groups shared strong support for cover crop research and considered many of the same traits to be important for breeding. For the legume cover crops, nitrogen fixation was considered the most important trait, whereas winter hardiness, early vigor, biomass production and weed suppression were the most important traits for cereal rye. Our results illustrate common interests as well as differences in the perspectives between organic and conventional farmers on cover crops and can be used to inform nascent cover crop breeding efforts.
In 2008–2009, the Canadian Institute for Health Information reported over 30,000 cases of sepsis hospitalizations in Canada, an increase of almost 4,000 from 2005. Mortality rates from severe sepsis and septic shock continue to remain greater than 30% in Canada and are significantly higher than other critical conditions treated in the emergency department (ED). Our group formed a multidisciplinary sepsis committee, conducted an ED process of care analysis, and developed a quality improvement protocol. The objective of this study was to evaluate the effects of this sepsis management bundle on patient mortality.
This before and after study was conducted in two large Canadian tertiary care EDs and included adult patients with suspected severe infection that met at least two systemic inflammatory response syndrome (SIRS) criteria. We studied the implementation of a sepsis bundle including triage flagging, RN medical directive, education campaign, and a modified sepsis protocol. The primary outcomes were 30-day all-cause mortality and sepsis protocol use.
We included a total of 167 and 185 patients in the pre- and post-intervention analysis, respectively. Compared to the pre-intervention group, mortality was significantly lower in the post-intervention group (30.7% versus 17.3%; absolute difference, 13.4%; 95% CI 9.8–17.0; p=0.006). There was also a higher rate of sepsis protocol use in the post-intervention group (20.3% versus 80.5%, absolute difference 60.2%; 95% CI 55.1–65.3; p<0.001). Additionally, we found shorter time-intervals from triage to MD assessment, fluid resuscitation, and antibiotic administration as well as lower rates of vasopressor requirements and ICU admission.
The implementation of our multidisciplinary ED sepsis bundle, including improved early identification and protocolized medical care, was associated with improved time to achieve key therapeutic interventions and a reduction in 30-day mortality. Similar low-cost initiatives could be implemented in other EDs to potentially improve outcomes for this high-risk group of patients.
We conducted a program of research to derive and test the reliability of a clinical prediction rule to identify high-risk older adults using paramedics’ observations.
We developed the Paramedics assessing Elders at Risk of Independence Loss (PERIL) checklist of 43 yes or no questions, including the Identifying Seniors at Risk (ISAR) tool items. We trained 1,185 paramedics from three Ontario services to use this checklist, and assessed inter-observer reliability in a convenience sample. The primary outcome, return to the ED, hospitalization, or death within one month was assessed using provincial databases. We derived a prediction rule using multivariable logistic regression.
We enrolled 1,065 subjects, of which 764 (71.7%) had complete data. Inter-observer reliability was good or excellent for 40/43 questions. We derived a four-item rule: 1) “Problems in the home contributing to adverse outcomes?” (OR 1.43); 2) “Called 911 in the last 30 days?” (OR 1.72); 3) male (OR 1.38) and 4) lacks social support (OR 1.4). The PERIL rule performed better than a proxy measure of clinical judgment (AUC 0.62 vs. 0.56, p=0.02) and adherence was better for PERIL than for ISAR.
The four-item PERIL rule has good inter-observer reliability and adherence, and had advantages compared to a proxy measure of clinical judgment. The ISAR is an acceptable alternative, but adherence may be lower. If future research validates the PERIL rule, it could be used by emergency physicians and paramedic services to target preventative interventions for seniors identified as high-risk.
To determine whether use of contact precautions on hospital ward patients is associated with patient adverse events
Individually matched prospective cohort study
The University of Maryland Medical Center, a tertiary care hospital in Baltimore, Maryland
A total of 296 medical or surgical inpatients admitted to non–intensive care unit hospital wards were enrolled at admission from January to November 2010. Patients on contact precautions were individually matched by hospital unit after an initial 3-day length of stay to patients not on contact precautions. Adverse events were detected by physician chart review and categorized as noninfectious, preventable and severe noninfectious, and infectious adverse events during the patient’s stay using the standardized Institute for Healthcare Improvement’s Global Trigger Tool.
The cohort of 148 patients on contact precautions at admission was matched with a cohort of 148 patients not on contact precautions. Of the total 296 subjects, 104 (35.1%) experienced at least 1 adverse event during their hospital stay. Contact precautions were associated with fewer noninfectious adverse events (rate ratio [RtR], 0.70; 95% confidence interval [CI], 0.51–0.95; P=.02) and although not statistically significant, with fewer severe adverse events (RtR, 0.69; 95% CI, 0.46–1.03; P=.07). Preventable adverse events did not significantly differ between patients on contact precautions and patients not on contact precautions (RtR, 0.85; 95% CI, 0.59–1.24; P=.41).
Hospital ward patients on contact precautions were less likely to experience noninfectious adverse events during their hospital stay than patients not on contact precautions.
Infect. Control Hosp. Epidemiol. 2015;36(11):1268–1274
Pre-service teacher education institutions are large and complex organisations that are notoriously difficult to change. One factor is that many change efforts focus largely on individual pre-service teacher educators altering their practice. We report here on our experience using a model for effecting change, which views pre-service teacher education institutions and educators as a part of a much broader system. We identified numerous possibilities for, and constraints on, embedding change, but focus only on two in this article: participants’ knowledge of change strategies and their leadership capacities. As a result of our study findings and researcher reflections, we argue that being a leader in an academic area within pre-service teacher education does not equate to leadership knowledge or skills to initiate and enact systems-wide change. Furthermore, such leadership capacities must be explicitly developed if education for sustainability is to become embedded in pre-service teacher education.
Computed tomography (CT) is an important tool in clinical diagnostic imaging enabling three-dimensional anatomic imaging at high spatial resolution with short scan times. However, X-ray attenuation differences in physiological fluids and soft tissues are relatively small, requiring the use of contrast agents to achieve sufficient imaging contrast. Recent advances in energy-sensitive X-ray detectors have made spectral (color) CT commercially feasible by unmixing the energy-dependent attenuation profile of different materials and will potentially enable molecular imaging in CT. In order to leverage these capabilities for diagnostic imaging, we are developing a spectral library of nanoparticle contrast agents with K-shell absorption edges spaced at least 10 keV apart. The objective of this study was to demonstrate the ability of spectral CT to simultaneously detect up to three different contrast agents and unmixed their signals to create color images. Gadolinium oxide (Gd), hafnium oxide (Hf) and gold (Au) were chosen due to exhibiting K-edges spaced 10-20 keV apart. Core-shell nanoparticles of each composition were synthesized by various methods to have a core diameter of 15-20 nm and were coated with a silica shell at least 2-4 nm in thickness to create a common platform for surface functionalization. The contrast agents were imaged in a soft tissue equivalent phantom using source-side method for spectral CT imaging. The source-side approach utilized monochromatic synchrotron radiation at the Argonne National Laboratory which, while not clinically applicable, served as a gold standard due to providing the highest spectral resolution. The nanoparticles designed for this study have broad applications in biomedical imaging due to their modular assembly, potential for enabling multi-modal detection, and surface functionalization with biomolecules (e.g., antibodies, peptides or enzymes) for active targeting.
The name Bos caffer was attributed by Sparrman in 1779. Since then, 92 species names have been given to the African buffalo. Taxonomists initially thought that each buffalo form represented a distinct species. Brooke (1873, 1875), who established the first classification of the African buffalo, reduced the number to three. Later, Blancou (1935) described up to 12 subspecies of buffalo.
Haltenorth (1963), Ansell (1972) and Grubb (1972) summarized the first classifications of Christy (1929), Schouteden (1945) and Blancou (1935, 1954), concluding that all forms should be considered as monospecific. Although there are considerable morphological variations in body size, fur colour, horn shape and size throughout the range of distribution, the African buffalo is currently considered as a single species by various authorities (IUCN 2013; Prins & Sinclair 2013), with a subdivision into four subspecies: Cape buffalo (S. c. caffer), forest buffalo (S. c. nanus), West African savanna buffalo (S. c. brachyceros), and Central African savanna buffalo (S. c. aequinoctialis). Additionally to those four subspecies, a mountain form(S. c. mathewsi) was also described in East Africa and may be distinct (Kingdon 1982).
It is 7 years since we wrote this article, yet the reorientation of teacher education towards sustainability remains a challenge. However, there have been some pockets of progress internationally and in Australia (Belgeonne, Clough, Inman, Rogers, & Warwick, 2014; UNECE, 2012).
Produce rich in phytochemicals may alter postprandial glucose and insulin responses by interacting with the pathways that regulate glucose uptake and insulin secretion in humans. The aims of the present study were to assess the phytochemical constituents of red beetroot juice and to measure the postprandial glucose and insulin responses elicited by either 225 ml beetroot juice (BEET), a control beverage matched for macronutrient content (MCON) or a glucose beverage in healthy adults. Beetroot juice was a particularly rich source of betalain degradation compounds. The orange/yellow pigment neobetanin was measured in particularly high quantities (providing 1·3 g in the 225 ml). A total of sixteen healthy individuals were recruited, and consumed the test meals in a controlled single-blind cross-over design. Results revealed a significant lowering of the postprandial insulin response in the early phase (0–60 min) (P < 0·05) and a significantly lower glucose response in the 0–30 min phase (P < 0·05) in the BEET treatment compared with MCON. Betalains, polyphenols and dietary nitrate found in the beetroot juice may each contribute to the observed differences in the postprandial insulin concentration.
This volume of the Haskins Society Journal furthers the Society's commitment to historical and interdisciplinary research on the early and central Middle Ages, especially in the Anglo-Saxon, Anglo-Norman, and Angevin worlds but also on the continent. The topics of the essays it contains range from the curious place of Francia in the historiography of medieval Europe to strategies of royal land distribution in tenth-century Anglo-Saxon England to the representation of men and masculinity in the works of Anglo-Norman historians. Essays on the place of polemical literature in Frutolf of Michelsberg's Chronicle, exploration of the relationship between chivalry and crusading in Baudry of Bourgeuil's History, and Cosmas of Prague's manipulation of historical memory in the service of ecclesiastical privilege and priority each extend the volume's engagement with medieval historiography, employing rich continental examples to do so. Investigations of comital personnel in Anjou and Henry II's management of royal forests and his foresters shed new light on the evolving nature of secular governance in the twelfth centuries and challenge and refine important aspects of our view of medieval rule in this period. The volume ends with a wide-ranging reflection on the continuing importance of the art object itself in medieval history and visual studies. Contributors: H.F. Doherty, Kathryn Dutton, Kirsten Fenton, Paul Fouracre, Herbert Kessler, Ryan Lavelle, Thomas J.H. McCarthy, Lisa Wolverton, Simon Yarrow.
The site of Çatalhöyük occupies a key position within the development of larger settlements in south-west Asia, but the apparent absence of outdoor activity areas has challenged conceptions of social interaction within the site. Where did the inhabitants of this substantial settlement meet together if there were no public spaces? The identification of outdoor activity areas is difficult in such a densely patterned settlement, but micromorphology and phytolith analysis, when used together, can provide secure interpretations. The present study applies these methods to a stratigraphic sequence of deposits in the South Area, where a succession of open areas was located adjacent to a series of buildings. The analysis reveals that these open areas were gradually transformed from a place for the dumping or accumulation of midden material in the early phases, to an informal and then a formally laid surface in the later stages. This suggests that although streets or courtyards may have been rare or absent in the early centuries at Çatalhöyük, they were present in the later phases of the occupation.