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A survey of hospital antimicrobial stewardship programs was performed to validate core element achievement data from the National Healthcare Safety Network’s (NHSN) Patient Safety Component Annual Survey. In total, 89% of hospitals met all 7 core elements, compared to only 68% according to the NHSN survey.
Fomesafen is a protoporphyrinogen oxidase–inhibitor herbicide with an alternative mode of action that provides PRE weed control in strawberry [Fragaria×ananassa (Weston) Duchesne ex Rozier (pro sp.) [chiloensis×virginiana]] produced in a plasticulture setting in Florida. Plasticulture mulch could decrease fomesafen dissipation and increase crop injury in rotational crops. Field experiments were conducted in Balm, FL, to investigate fomesafen persistence and movement in soil in Florida strawberry systems for the 2014/2015 and 2015/2016 production cycles. Treatments included fomesafen preplant at 0, 0.42, and 0.84 kg ai ha−1. Soil samples were taken under the plastic from plots treated with fomesafen at 0.42 kg ha−1 throughout the production cycle. Fomesafen did not injure strawberry or decrease yield. Fomesafen concentration data for the 0.0- to 0.1-m soil depth were described using a three-parameter logistic function. The fomesafen 50% dissipation times were 37 and 47 d for the 2014/2015 and 2015/2016 production cycles, respectively. At the end of the study, fomesafen was last detected in the 0.0- to 0.1-m depth soil at 167 and 194 d after treatment in the 2014/2015 and 2015/2016 production cycles, respectively. Fomesafen concentration was less than 25 ppb on any sampling date for 0.1- to 0.2-m and 0.2- to 0.3-m depths. Fomesafen concentration decreased significantly after strawberry was transplanted and likely leached during overhead and drip irrigation used during the crop establishment.
A study conducted as part of the development of the Eleventh International Classification of Mental Disorders for Primary Health Care (ICD-11 PHC) provided an opportunity to test the relationships among depressive, anxious and somatic symptoms in PHC.
Primary care physicians participating in the ICD-11 PHC field studies in five countries selected patients who presented with somatic symptoms not explained by known physical pathology by applying a 29-item screening on somatic complaints that were under study for bodily stress disorder. Patients were interviewed using the Clinical Interview Schedule-Revised and assessed using two five-item scales that measure depressive and anxious symptoms. Structural models of anxious-depressive symptoms and somatic complaints were tested using a bi-factor approach.
A total of 797 patients completed the study procedures. Two bi-factor models fit the data well: Model 1 had all symptoms loaded on a general factor, along with one of three specific depression, anxiety and somatic factors [x2 (627) = 741.016, p < 0.0011, RMSEA = 0.015, CFI = 0.911, TLI = 0.9]. Model 2 had a general factor and two specific anxious depression and somatic factors [x2 (627) = 663.065, p = 0.1543, RMSEA = 0.008, CFI = 0.954, TLI = 0.948].
These data along with those of previous studies suggest that depressive, anxious and somatic symptoms are largely different presentations of a common latent phenomenon. This study provides support for the ICD-11 PHC conceptualization of mood disturbance, especially anxious depression, as central among patients who present multiple somatic symptoms.
The study aimed to examine variations in the use of International Classification of Diseases, Tenth Edition (ICD-10) diagnostic categories for mental and behavioural disorders across countries, regions and income levels using data from the online World Psychiatric Association (WPA)-World Health Organization (WHO) Global Survey that examined the attitudes of psychiatrists towards the classification of mental disorders.
A survey was sent to 46 psychiatric societies which are members of WPA. A total of 4887 psychiatrists participated in the survey, which asked about their use of classification, their preferred system and the categories that were used most frequently.
The majority (70.1%) of participating psychiatrists (out of 4887 psychiatrists) reported using the ICD-10 the most and using at least one diagnostic category once a week. Nine out of 44 diagnostic categories were considerably variable in terms of frequency of use across countries. These were: emotionally unstable personality disorder, borderline type; dissociative (conversion) disorder; somatoform disorders; obsessive–compulsive disorder (OCD); mental and behavioural disorders due to the use of alcohol; adjustment disorder; mental and behavioural disorders due to the use of cannabinoids; dementia in Alzheimer's disease; and acute and transient psychotic disorder. The frequency of use for these nine categories was examined across WHO regions and income levels. The most striking differences across WHO regions were found for five out of these nine categories. For dissociative (conversion) disorder, use was highest for the WHO Eastern Mediterranean Region (EMRO) and non-existent for the WHO African Region. For mental and behavioural disorders due to the use of alcohol, use was lowest for EMRO. For mental and behavioural disorders due to the use of cannabinoids, use was lowest for the WHO European Region and the WHO Western Pacific Region. For OCD and somatoform disorders, use was lowest for EMRO and the WHO Southeast Asian Region. Differences in the frequency of use across income levels were statistically significant for all categories except for mental and behavioural disorders due to the use of alcohol. The most striking variations were found for acute and transient psychotic disorder, which was reported to be more commonly used among psychiatrists from countries with lower income levels.
The differences in frequency of use reported in the current study show that cross-cultural variations in psychiatric practice exist. However, whether these differences are due to the variations in prevalence, treatment-seeking behaviour and other factors, such as psychiatrist and patient characteristics as a result of culture, cannot be determined based on the findings of the study. Further research is needed to examine whether these variations are culturally determined and how that would affect the cross-cultural applicability of ICD-10 diagnostic categories.
Aberrant emotional biases have been reported in bipolar disorder (BD), but results are inconsistent. Despite the clinical relevance of chronic mood variability in BD, there is no previous research investigating how the extent of symptom fluctuations in bipolar disorder might relate to emotional biases. This exploratory study investigated, in a large cohort of bipolar patients, whether instability in weekly mood episode symptoms and other clinical and demographic factors were related to emotional bias as measured in a simple laboratory task.
Participants (N = 271, BDI = 206, BDII = 121) completed an ‘emotional categorization and memory’ task. Weekly self-reported symptoms of depression and mania were collected prospectively. In linear regression analyses, associations between cognitive bias and mood variability were explored together with the influence of demographic and clinical factors, including current medication.
Greater accuracy in the classification of negative words relative to positive words was associated with greater instability in depressive symptoms. Furthermore, greater negative bias in free recall was associated with higher instability in manic symptoms. Participants diagnosed with BDII, compared with BDI, showed overall better word recognition and recall. Current antipsychotic use was associated with reduced instability in manic symptoms but this did not impact on emotional processing performance.
Emotional processing biases in bipolar disorder are related to instability in mood. These findings prompt further investigation into the underpinnings as well as clinical significance of mood instability.
Habitat suitability models can guide species conservation by identifying correlates of occurrence and predicting where species are likely to occur. We created habitat suitability models for the White-breasted Thrasher Ramphocinclus brachyurus, a narrowly distributed endangered songbird that occupies dry forest in Saint Lucia and Martinique. Eighty-five percent of the global population inhabits two ranges in Saint Lucia, both of which are largely unprotected and threatened by development. We developed three habitat suitability models using Maxent techniques and published occupancy datasets collected from the species’ two Saint Lucian ranges, and used abiotic, land cover, and predator distribution predictors. We built one model with occupancy data from both ranges, and two others with occupancy data specific to each range. The best full-range model included 11 predictors; high suitability was associated with close proximity to Saint Lucia fer-de-lance Bothrops caribbeaus range, moderately low precipitation, and areas near streams. Our assessment of suitable sites island-wide was more restricted than results from a recent model that considered older land cover data and omitted predator distributions. All sites identified in our full-range model as highly suitable were in or adjacent to the species’ current designated range. The model trained on southern range occurrences predicted zero suitable habitat in the northern range, where the population is much smaller. In contrast, the model trained on northern range occurrences identified areas of moderate suitability within the southern range and patches of moderately suitable habitat in the western part of the island, where no White-breasted Thrashers currently occur. We interpret these results as suggesting that White-breasted Thrashers currently occupy virtually all suitable habitat on the island, that birds in the northern range occupy marginal habitat, or that an important correlate of suitability is missing from the model. Our results suggest that habitat management should focus on currently occupied areas.
Introduction: Recent years have brought an epidemic of opioid abuse to Canada. At present, in Ontario, Naloxone may not be administered by any paramedic without the direct online medical approval of a Base Hospital Physician (BHP). The objective of this study was to review the use of Naloxone by Emergency Medical Service (EMS) personnel, under the existing Advanced Life Support Patient Care Standards (ALS-PCS) medical directive for opioid toxicity, for safety and potential complications that may occur with removal of the mandatory patch point. Methods: This study was a retrospective ambulance call report review of consecutive Naloxone requests placed to a BHP of the Regional Paramedic Program of Eastern Ontario (RPPEO) between Oct 1st, 2013 and Oct 31st, 2015. The RPPEO consists of 10 prehospital services, both urban and rural jurisdictions, and has a mix of advance care and primary care paramedics. All ambulance call reports are electronically stored at the secured RPPEO data warehouse. Data was extracted using a standardized data collection tool. All ambulance call reports were reviewed by 2 independent authors (VC, NC). Compliance with the existing medical directive for opioid toxicity was determined. We calculated the frequency of denied Naloxone requests and the rationale for each patch refusal was recorded. We also categorized all adverse events associated with Naloxone administration. Results: From 244 patches, 215 patients were administered Naloxone. Only 7.8% (19/215) of requests for Naloxone were refused; 78.9% (15/19) did not meet existing inclusion criteria for Naloxone administration in the ALS-PCS medical directive for opioid toxicity because the patient’s respiration rate was above 12/min. Of the 215 patients who were administered Naloxone, adverse events were extremely uncommon: 5 (2.3%) became violent or verbally abusive, 1 (0.5%) was transiently hypertensive and 4 (1.9%) vomited. Conclusion: Requests for Naloxone to a BHP are common and yet are seldom declined. The use of prehospital Naloxone is associated with few adverse events. These results demonstrate that it would be safe to remove online medical direction for Naloxone from the ALS-PCS medical directive for opioid toxicity if combined with updated paramedic education.
Culture does not change because we desire to change it. Culture changes when the organization is transformed; the culture reflects the realities of people working together every day.
– Frances Hesselbein
Have you ever had a job you loved and felt empowered to fulfill your responsibilities? If so, what was it about your co-workers, your manager/supervisor, and your work environment that made your experience so positive? Perhaps you've never felt that way about a job and, instead, you've dreaded heading to work every morning. Your boss might have rarely recognized your efforts. It's possible you weren't sure how to perform your job, but felt uncomfortable asking for help. Your co-workers might have seemed like characters from the movie Mean Girls. In this perfect storm of the forces of disengagement, we suspect you didn't last too long at that job. Or you felt overwhelmed with too much to do, with too little support, as depicted in the illustration on the next page.
According to a 2013 survey, more than half of workers in the United States were dissatisfied with their jobs. This statistic is alarming; after all, we spend approximately one-third of our waking hours and energy at work, plus dissatisfied employees tend to find new employers. Because we spend so much of our time and energy at work, the organizational culture can have a profound impact on our lives and the lives of those around us. If work cultures support interdependent, prosocial behavior instead of individualism and competition, we believe the business world, indeed our everyday lives, will be more positive and productive for almost everyone.
Any organization's mission will benefit from employees who care about their work and their colleagues. It's a win-win scenario. What factors influence employee job satisfaction? Aside from the obvious – job security, pay, and benefits (e.g., health insurance) – employees report that feeling safe at work, having a positive relationship with their immediate supervisor, and communicating openly and cooperatively with other employees and senior management contribute significantly to their work satisfaction. The bad news: In many organizational cultures, managers/supervisors struggle with these very issues, resulting in unacceptably high rates of employee dissatisfaction and turnover and a climate of distrust.
Imagine these disgruntled employees as supervisors who are responsible for mentoring newly recruited employees.
Poor maternal nutrition inhibits muscle development and postnatal muscle growth. Satellite cells are myogenic precursor cells that contribute to postnatal muscle growth, and their activity can be evaluated by the expression of several transcription factors. Paired-box (Pax)7 is expressed in quiescent and active satellite cells. MyoD is expressed in activated and proliferating satellite cells and myogenin is expressed in terminally differentiating cells. Disruption in the expression pattern or timing of expression of myogenic regulatory factors negatively affects muscle development and growth. We hypothesized that poor maternal nutrition during gestation would alter the in vitro temporal expression of MyoD and myogenin in satellite cells from offspring at birth and 3 months of age. Ewes were fed 100% or 60% of NRC requirements from day 31±1.3 of gestation. Lambs from control-fed (CON) or restricted-fed (RES) ewes were euthanized within 24 h of birth (birth; n=5) or were fed a control diet until 3 months of age (n=5). Satellite cells isolated from the semitendinosus muscle were used for gene expression analysis or cultured for 24, 48 or 72 h and immunostained for Pax7, MyoD or myogenin. Fusion index was calculated from a subset of cells allowed to differentiate. Compared with CON, temporal expression of MyoD and myogenin was altered in cultured satellite cells isolated from RES lambs at birth. The percent of cells expressing MyoD was greater in RES than CON (P=0.03) after 24 h in culture. After 48 h of culture, there was a greater percent of cells expressing myogenin in RES compared with CON (P<0.001). After 72 h of culture the percent of satellite cells expressing myogenin in RES was less than CON (P<0.01). There were no differences in the gene expression of Pax7, Myf5 or MyoD in isolated satellite cells at birth (P>0.05). In satellite cells from RES lambs at 3 months of age, the percent of cells expressing MyoD and myogenin were greater than CON after 72 h in culture (P<0.05). Fusion index was reduced in RES lambs at 3 months of age compared with CON (P<0.001). Restricted nutrition during gestation alters the temporal expression of myogenic regulatory factors in satellite cells of the offspring, which may reduce the pool of myoblasts, decrease myoblast fusion and contribute to the poor postnatal muscle growth previously observed in these animals.
The physical mechanisms responsible for electrically-induced parametric degradation in GaN-based high electron mobility transistors are examined using a combination of experiments, device simulation, and first-principles defect analysis. A relatively simple formulation is developed under the assumption that the hot-electron scattering cross-section is independent of the electron energy. In this case, one can relate the change in defect concentration to the operational characteristics of a device, such as the spatial and energy distribution of electrons (electron temperature), electric field distribution, and electron energy loss to the lattice.
Mathematical and computational neuroscience have contributed to the brain sciences by the
study of the dynamics of individual neurons and more recently the study of the dynamics of
electrophysiological networks. Often these studies treat individual neurons as points or
the nodes in networks and the biochemistry of the brain appears, if at all, as some
intermediate variables by which the neurons communicate with each other. In fact, many
neurons change brain function not by communicating in one-to-one fashion with other
neurons, but instead by projecting changes in biochemistry over long distances. This
biochemical network is of crucial importance for brain function and it influences and is
influenced by the more traditional electrophysiological networks. Understanding how
biochemical networks interact with electrophysiological networks to produce brain function
both in health and disease poses new challenges for mathematical neuroscience.