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Both African American and LGBT voters can prove pivotal in electoral outcomes, but we know little about civic participation among Black LGBT people. Although decades of research on political participation has made it almost an article of faith that members of dominant groups (such as White people and individuals of higher socioeconomic status) vote at higher rates than their less privileged counterparts, recent work has suggested that there are circumstances under which members of marginalized groups might participate at higher rates. Some of this research suggests that political participation might also increase when groups perceive elections as particularly threatening. We argue that when such threats are faced by marginalized groups, the concern to protect hard-earned rights can activate a sense of what we call “political hypervigilance,” and that such effects may be particularly pronounced among members of intersectionally-marginalized groups such as LGBT African Americans. To test this theory, we use original data from the 2016 National Survey on HIV in the Black Community, a nationally-representative survey of Black Americans, to explore the relationship among same-sex sexual behavior, attitudes toward LGBT people, and respondent voting intentions in the 2016 presidential election. We find that respondents who reported having engaged in same-sex sexual behavior were strongly and significantly more likely to say they “definitely will vote” compared to respondents who reported no same-sex sexual behavior. More favorable views of LGBT individuals and issues (marriage equality) were also associated with greater intention to vote. We argue that these high rates provide preliminary evidence that political hypervigilance can, in fact, lead to increased political engagement among members of marginalized groups.
Introduction: Previous systematic reviews suggest early mobilization in the intensive care unit (ICU) population is feasible, safe, and may improve outcomes. Only one review investigated mobilization specifically in trauma ICU patients and failed to identify any relevant articles. The objective of the present systematic review was to conduct an up-to-date search of the literature to assess the effect of early mobilization in adult trauma ICU patients on mortality, length of stay (LOS) and duration of mechanical ventilation. Methods: We performed a systematic search of four electronic databases (Ovid MEDLINE, Embase, CINAHL, Cochrane Library) and the grey literature. To be included, studies must have compared early mobilization to delayed or no mobilization among trauma patients admitted to the ICU. Meta-analysis was performed to determine the effect of early mobilization on mortality, hospital LOS, ICU LOS, and duration of mechanical ventilation. Results: The search yielded 2,975 records from the 4 databases and 7 records from grey literature and bibliographic searches; of these, 9 articles met all eligibility criteria and were included in the analysis. There were 7 studies performed in the United States, 1 study from China and 1 study from Norway. Study populations included neurotrauma (3 studies), blunt abdominal trauma (2 studies), mixed injury types (2 studies) and burns (1 study). Cohorts ranged in size from 15 to 1,132 patients (median, 63) and varied in inclusion criteria. Most studies used some form of stepwise progressive mobility protocol. Two studies used simple ambulation as the mobilization measure, and 1 study employed upright sitting as their only intervention. Time to commencement of the intervention was variable across studies, and only 2 studies specified the timing of mobilization initiation. We did not detect a difference in mortality with early mobilization, although the pooled risk ratio (RR) was reduced (RR 0.90, 95% CI 0.74 to 1.09). Hospital LOS and ICU LOS were decreased with early mobilization, though this difference did not reach significance. Duration of mechanical ventilation was significantly shorter in the early mobilization group (mean difference −1.18. 95% CI −2.17 to −0.19). Conclusion: Our review identified few studies that examined mobilization of critically ill trauma patients in the ICU. On meta-analysis, early mobilization was found to reduce duration of mechanical ventilation, but the effects on mortality and LOS were not significant.
Introduction: Long-term immobility has detrimental effects for critically ill patients admitted to the intensive care unit (ICU) including ICU-acquired weakness. Early mobilization of patients admitted to ICU has been demonstrated to be a safe, feasible and effective strategy to improve patient outcomes. The optimal mobilization of trauma ICU patients has not been extensively studied. Our objective was to determine the impact of an early mobilization protocol on outcomes among trauma patients admitted to the ICU. Methods: We analyzed all adult trauma patients ( > 18 years old) admitted to ICU over a 2-year period prior to and following implementation of an early mobilization protocol, allowing for a 1-year transition period. Data were collected from the Nova Scotia Trauma Registry. We compared patient characteristics and outcomes (mortality, length of stay [LOS], ventilator days) between the pre- and post-implementation groups. Associations between early mobilization and clinical outcomes were estimated using binary and linear regression models. Results: Overall, there were 526 patients included in the analysis (292 pre-implementation, 234 post-implementation). The study population ranged in age from 18 to 92 years (mean age 49.0 ± 20.4 years) and 74.3% of all patients were male. The pre- and post-implementation groups were similar in age, sex, and injury severity. In-hospital mortality was reduced in the post-implementation group (25.3% vs. 17.5%; p = 0.031). In addition, there was a reduction in ICU mortality in the post-implementation group (21.6% vs. 12.8%; p = 0.009). We did not observe any difference in overall hospital LOS, ICU LOS, or ventilator days between the two groups. Compared to the pre-implementation period, trauma patients admitted to the ICU following protocol implementation were less likely to die in-hospital (OR = 0.52, 95% CI 0.30-0.91; p = 0.021) or in the ICU (OR = 0.40, 95% CI 0.21- 0.76, p = 0.005). Results were similar following a sensitivity analysis limited to patients with blunt or penetrating injuries. There was no difference between the pre- and post-implementation groups with respect to in-hospital LOS, ICU LOS, or the number of ventilator days. Conclusion: We found that trauma patients admitted to ICU during the post-implementation period had decreased odds of in-hospital mortality and ICU mortality. Ours is the first study to demonstrate a significant reduction in trauma mortality following implementation of an ICU mobility protocol.
Most patients admitted to the hospital via the emergency department (ED) do so with a peripheral intravenous catheter/cannula (PIVC). Many PIVCs develop postinsertion failure (PIF).
To determine the independent factors predicting PIF after PIVC insertion in the ED.
We analyzed data from a prospective clinical cohort study of ED-inserted PIVCs admitted to the hospital wards. Independent predictors of PIF were identified using Cox proportional hazards regression modeling.
In 391 patients admitted from 2 EDs, the rate of PIF was 31% (n=118). The types of PIF identified were infiltration, occlusion, pain and/or peripheral intravenous assessment score >2 (ie, the hospital’s assessment of PIVC phlebitis), and dislodgement (ie, accidental securement device failure or purposeful removal). Of the PIVCs that failed, infiltration and occlusion combined were the most common causes of PIF (n=55, 47%). The median PIVC dwell time was 28.5 hours (interquartile range [IQR], 17.4–50.8 hours). The following variables were associated with increased risk of PIF: being an older patient (for a 1-year increase, hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.01–1.03; P=.0001); having an Australian Triage Scale score of 1 or 2 compared to a score of 3, 4, or 5 (HR, 2.04; 95% CI, 1.39–3.01; P=.0003); having an ultrasound-guided PIVC (HR, 6.52; 95% CI, 2.11–20.1; P=.0011); having the PIVC inserted by a medical student (P=.0095); infection prevention breaches at insertion (P=.0326); and PIVC inserted in the ante cubital fossa or the back of hand compared to the upper arm (P=.0337).
PIF remains at an unacceptable level in both traditionally inserted and ultrasound-inserted PIVCs.
Clinical trial registration
Australian and New Zealand Trials Registry (ANZCTRN12615000588594).
Field studies of grazing management have frequently concluded that the magnitude and direction of vegetation response is dependent on initial vegetation condition. On upland heath, this dependence reflects the importance of small-scale ecological processes (e.g. plant competition), and local neighbourhood effects (e.g. spatial distribution of plant species), in driving the vegetation dynamics. These small-scale effects, together with variation in grazing patterns, increase the difficulty of deriving general rules about the effect of grazing on vegetation change from field studies. However, we need to determine the impacts of such grazing-related vegetation change upon biodiversity, (e.g. birds). For many bird species it is impractical to use experimental approaches due to low breeding densities, and the influence of other site and management effects (e.g. predator control). To predict the effect of management changes on them requires an accurate assessment of the large-scale effects of grazing management on the ecological landscape using data from small-scale field studies. This paper sets out an approach that integrates field studies with theoretical models to investigate the large-scale effects of grazing management on plant and bird communities on upland heath.
The breeding areas of the Critically Endangered Slender-billed Curlew Numenius tenuirostris are all but unknown, with the only well-substantiated breeding records being from the Omsk province, western Siberia. The identification of any remaining breeding population is of the highest priority for the conservation of any remnant population. If it is extinct, the reliable identification of former breeding sites may help determine the causes of the species’ decline, in order to learn wider conservation lessons. We used stable isotope values in feather samples from juvenile Slender-billed Curlews to identify potential breeding areas. Modelled precipitation δ2H data were compared to feather samples of surrogate species from within the potential breeding range, to produce a calibration equation. Application of this calibration to samples from 35 Slender-billed Curlew museum skins suggested they could have originated from the steppes of northern Kazakhstan and part of southern Russia between 48°N and 56°N. The core of this area was around 50°N, some way to the south of the confirmed nesting sites in the forest steppes. Surveys for the species might be better targeted at the Kazakh steppes, rather than around the historically recognised nest sites of southern Russia which might have been atypical for the species. We consider whether agricultural expansion in this area may have contributed to declines of the Slender-billed Curlew population.
The Numeniini is a tribe of 13 wader species (Scolopacidae, Charadriiformes) of which seven are Near Threatened or globally threatened, including two Critically Endangered. To help inform conservation management and policy responses, we present the results of an expert assessment of the threats that members of this taxonomic group face across migratory flyways. Most threats are increasing in intensity, particularly in non-breeding areas, where habitat loss resulting from residential and commercial development, aquaculture, mining, transport, disturbance, problematic invasive species, pollution and climate change were regarded as having the greatest detrimental impact. Fewer threats (mining, disturbance, problematic native species and climate change) were identified as widely affecting breeding areas. Numeniini populations face the greatest number of non-breeding threats in the East Asian-Australasian Flyway, especially those associated with coastal reclamation; related threats were also identified across the Central and Atlantic Americas, and East Atlantic flyways. Threats on the breeding grounds were greatest in Central and Atlantic Americas, East Atlantic and West Asian flyways. Three priority actions were associated with monitoring and research: to monitor breeding population trends (which for species breeding in remote areas may best be achieved through surveys at key non-breeding sites), to deploy tracking technologies to identify migratory connectivity, and to monitor land-cover change across breeding and non-breeding areas. Two priority actions were focused on conservation and policy responses: to identify and effectively protect key non-breeding sites across all flyways (particularly in the East Asian- Australasian Flyway), and to implement successful conservation interventions at a sufficient scale across human-dominated landscapes for species’ recovery to be achieved. If implemented urgently, these measures in combination have the potential to alter the current population declines of many Numeniini species and provide a template for the conservation of other groups of threatened species.
A research-led reform strategy is urgently required in the field of child protection in Australia. While international research can be a valuable resource, a strong research base which is relevant to this country’s needs, legislation and service systems is essential. Two recent audits of Australian research completed over the past decade – one on out-of-home care and the other on child protection more broadly – have highlighted significant gaps in existing research. There is a number of important topics that have not been addressed – as well as an over-reliance on small-scale, qualitative studies and a very low level of funding for research. This paper explores these gaps and identifies crucial areas for development, encompassing: the development of a national child protection and out-of-home care research agenda; adequate funding for research, especially for multi-site, cross-jurisdictional studies; and closer collaboration between researchers, policymakers and practitioners to close the gap between what we know and what we do.
To evaluate and compare the opinions of key stakeholders involved in the involuntary admission and treatment of patients under the Mental Health Act (MHA) 2001 regarding their views towards the operation of the legislation.
We employed a descriptive survey design. A questionnaire was distributed to stakeholders involved in the operation of the MHA 2001 (except service users, whose views were explored in a separate qualitative study) via paper or online versions evaluating their opinions regarding the operation of the MHA 2001 in relation to assessment, care, rights, transfer and information available.
Stakeholders agreed that in their opinion that patients generally benefit from the care they receive (79%) and that the MHA 2001 ensures an independent and fair review of the person’s detention (65%). However, only 23% of stakeholders were satisfied with the process of transferring patients to hospital and with the clinical assessment procedures therein (37%), with the greatest levels of dissatisfaction amongst Gardai (Police), general practitioners (GPs) and family members.
While the introduction of the MHA 2001 has assisted delivery of care to patients with improved adherence to international human rights frameworks applicable at the time of its enactment, substantial dissatisfaction with the implementation of the MHA 2001 in practice is experienced by stakeholders particularly at the distressing phase of clinical assessment and transfer to hospital.
Tuberous sclerosis complex (TSC) is associated with intellectual disability, but the risk pathways are poorly understood.
The Tuberous Sclerosis 2000 Study is a prospective longitudinal study of the natural history of TSC. One hundred and twenty-five UK children age 0–16 years with TSC and born between January 2001 and December 2006 were studied. Intelligence was assessed using standardized measures at ≥2 years of age. The age of onset of epilepsy, the type of seizure disorder, the frequency and duration of seizures, as well as the response to treatment was assessed at interview and by review of medical records. The severity of epilepsy in the early years was estimated using the E-Chess score. Genetic studies identified the mutations and the number of cortical tubers was determined from brain scans.
TSC2 mutations were associated with significantly higher cortical tuber count than TSC1 mutations. The extent of brain involvement, as indexed by cortical tuber count, was associated with an earlier age of onset and severity of epilepsy. In turn, the severity of epilepsy was strongly associated with the degree of intellectual impairment. Structural equation modelling supported a causal pathway from genetic abnormality to cortical tuber count to epilepsy severity to intellectual outcome. Infantile spasms and status epilepticus were important contributors to seizure severity.
The findings support the proposition that severe, early onset epilepsy may impair intellectual development in TSC and highlight the potential importance of early, prompt and effective treatment or prevention of epilepsy in tuberous sclerosis.
The effect of strain on the surface magnetism of the manganite La0.7Sr0.3MnO3 has been studied as a function of temperature, using magnetic force microscopy. The non- uniform strain distribution in the film leads to a two-phase coexistence between ferromagnetic and non-ferromagnetic phases. This leads to a reduction of the surface curie temperature and the formation of ferromagnetic islands. Methods of controlling this behavior in order to fabricate arrays of magnetic nanodots are discussed.
The synthesis of materials with void volumes in excess of 50% is an ongoing challenge in molecular sieve science. It has been shown that a correlation exists between the minimum framework density (FD) and the smallest ring in which all tetrahedral atoms reside (MINR). Based on this evidence it appears that materials containing 3-membered rings (3MR) will be necessary in order to obtain FDs lower than those currently attainable. Several framework beryllosilicate minerals including the natural zeolite, lovdarite, contain 3MRs. Unfortunately, beryllium can form highly toxic compounds that limit its suitability for many applications. Thus, in this study we have searched for a replacement for Be and have found that zinc is a suitable substitute with respect to the formation of three-membered rings.
We report here VPI-7, a novel zincosilicate molecular sieve which contains three-membered rings. The VPI-7 framework contains rings composed of 3–, 4– and 5 T-atoms which form unidimensional 8– and intersecting 9MR channels.