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People with cerebral palsy (CP) are less physically active than the general population and, consequently, are at increased risk of preventable disease. Evidence indicates that low-moderate doses of physical activity can reduce disease risk and improve fitness and function in people with CP. Para athletes with CP typically engage in ‘performance-focused’ sports training, which is undertaken for the sole purpose of enhancing sports performance. Anecdotally, many Para athletes report that participation in performance-focused sports training confers meaningful clinical benefits which exceed those reported in the literature; however, supporting scientific evidence is lacking. The aim of this paper is to describe the protocol for an 18-month study evaluating the clinical effects of a performance-focused swimming training programme for people with CP who have high support needs.
This study will use a concurrent multiple-baseline, single-case experimental design across three participants with CP who have high support needs. Each participant will complete a five-phase trial comprising: baseline (A1); training phase 1 (B1); maintenance phase 1 (A2); training phase 2 (B2); and maintenance phase 2 (A3). For each participant, measurement of swim velocity, health-related quality of life and gross motor functioning will be carried out a minimum of five times in each of the five phases.
The study described will produce Level II evidence regarding the effects of performance-focused swimming training on clinical outcomes in people with CP who have high support needs. Findings are expected to provide an indication of the potential for sport to augment outcomes in neurological rehabilitation.
Starting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs). Antibiotic days of therapy decreased significantly (P < .05) in the acute and long-term care units at both intervention sites, suggesting that tele-stewardship can effectively support antibiotic stewardship practices in rural VAMCs.
Content analysis is the process of turning text into data, with either automated or manual techniques, and it provides a feasible and attractive option for undergraduate students to develop and utilize original data. This article presents a cohesive framework for teaching computerized content analysis in undergraduate political science courses. The article discusses examples of how we have taught the techniques in our own classrooms and provides a framework for a content-analysis research assignment. We describe coding, sources of text data available to students, software recommendations appropriate for students, and write-up issues. In the process, we also discuss various learning opportunities that arise from both the strengths and weaknesses of computerized content analysis as a methodological strategy.
The majority of paediatric Clostridioides difficile infections (CDI) are community-associated (CA), but few data exist regarding associated risk factors. We conducted a case–control study to evaluate CA-CDI risk factors in young children. Participants were enrolled from eight US sites during October 2014–February 2016. Case-patients were defined as children aged 1–5 years with a positive C. difficile specimen collected as an outpatient or ⩽3 days of hospital admission, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one control. Caregivers were interviewed regarding relevant exposures. Multivariable conditional logistic regression was performed. Of 68 pairs, 44.1% were female. More case-patients than controls had a comorbidity (33.3% vs. 12.1%; P = 0.01); recent higher-risk outpatient exposures (34.9% vs. 17.7%; P = 0.03); recent antibiotic use (54.4% vs. 19.4%; P < 0.0001); or recent exposure to a household member with diarrhoea (41.3% vs. 21.5%; P = 0.04). In multivariable analysis, antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% CI 2.18–17.96). Improved antibiotic prescribing might reduce CA-CDI in this population. Further evaluation of the potential role of outpatient healthcare and household exposures in C. difficile transmission is needed.
Medical procedures and patient care activities may facilitate environmental dissemination of healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus (MRSA).
Observational cohort study of MRSA-colonized patients to determine the frequency of and risk factors for environmental shedding of MRSA during procedures and care activities in carriers with positive nares and/or wound cultures. Bivariate analyses were performed to identify factors associated with environmental shedding.
A Veterans Affairs hospital.
This study included 75 patients in contact precautions for MRSA colonization or infection.
Of 75 patients in contact precautions for MRSA, 55 (73%) had MRSA in nares and/or wounds and 25 (33%) had positive skin cultures. For the 52 patients with MRSA in nares and/or wounds and at least 1 observed procedure, environmental shedding of MRSA occurred more frequently during procedures and care activities than in the absence of a procedure (59 of 138, 43% vs 8 of 83, 10%; P < .001). During procedures, increased shedding occurred ≤0.9 m versus >0.9 m from the patient (52 of 138, 38% vs 25 of 138, 18%; P = .0004). Contamination occurred frequently on surfaces touched by personnel (12 of 38, 32%) and on portable equipment used for procedures (25 of 101, 25%). By bivariate analysis, the presence of a wound with MRSA was associated with shedding (17 of 29, 59% versus 6 of 23, 26%; P = .04).
Environmental shedding of MRSA occurs frequently during medical procedures and patient care activities. There is a need for effective strategies to disinfect surfaces and equipment after procedures.
To evaluate the efficacy of multiple ultraviolet (UV) light decontamination devices in a radiology procedure room.
We compared the efficacy of 8 UV decontamination devices with a 4-minute UV exposure time in reducing recovery of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridium difficile spores on steel disk carriers placed at 5 sites on a computed tomography patient table. Analysis of variance was used to compare reductions for the different devices. A spectrometer was used to obtain irradiance measurements for the devices.
Four standard vertical tower low-pressure mercury devices achieved 2 log10CFU or greater reductions in VRE and MRSA and ~1 log10CFU reductions in C. difficile spores, whereas a pulsed-xenon device resulted in less reduction in the pathogens (P<.001). In comparison to the vertical tower low-pressure mercury devices, equal or greater reductions in the pathogens were achieved by 3 nonstandard low-pressure mercury devices that included either adjustable bulbs that could be oriented directly over the exam table, a robotic base allowing movement along the side of the table during operation, or 3 vertical towers operated simultaneously. The low-pressure mercury devices produced primarily UV-C light, whereas the pulsed-xenon device produced primarily UV-A and UV-B light. The time required to move the devices from the corner of the room and set up for operation varied from 18 to 59 seconds.
Many currently available UV devices could provide an effective and efficient adjunct to manual cleaning and disinfection in radiology procedure rooms.
Soldier operational performance is determined by their fitness, nutritional status, quality of rest/recovery, and remaining injury/illness free. Understanding large fluctuations in nutritional status during operations is critical to safeguarding health and well-being. There are limited data world-wide describing the effect of extreme climate change on nutrient profiles. This study investigated the effect of hot-dry deployments on vitamin D status (assessed from 25-hydroxyvitamin D (25(OH)D) concentration) of young, male, military volunteers. Two data sets are presented (pilot study, n 37; main study, n 98), examining serum 25(OH)D concentrations before and during 6-month summer operational deployments to Afghanistan (March to October/November). Body mass, percentage of body fat, dietary intake and serum 25(OH)D concentrations were measured. In addition, parathyroid hormone (PTH), adjusted Ca and albumin concentrations were measured in the main study to better understand 25(OH)D fluctuations. Body mass and fat mass (FM) losses were greater for early (pre- to mid-) deployment compared with late (mid- to post-) deployment (P<0·05). Dietary intake was well-maintained despite high rates of energy expenditure. A pronounced increase in 25(OH)D was observed between pre- (March) and mid-deployment (June) (pilot study: 51 (sd 20) v. 212 (sd 85) nmol/l, P<0·05; main study: 55 (sd 22) v. 167 (sd 71) nmol/l, P<0·05) and remained elevated post-deployment (October/November). In contrast, PTH was highest pre-deployment, decreasing thereafter (main study: 4·45 (sd 2·20) v. 3·79 (sd 1·50) pmol/l, P<0·05). The typical seasonal cycling of vitamin D appeared exaggerated in this active male population undertaking an arduous summer deployment. Further research is warranted, where such large seasonal vitamin D fluctuations may be detrimental to bone health in the longer-term.
In 4 hospitals, we demonstrated frequent dispersal of fluorescent tracer and fluoroquinolone-resistant gram-negative bacilli from sink drains to sink bowls and to surfaces outside the bowl. Fluorescent tracer dispersal correlated inversely with the depth of the sink bowl. Modifications in sink design could substantially reduce the risk for pathogen dissemination.
To test the feasibility of using telehealth to support antimicrobial stewardship at Veterans Affairs medical centers (VAMCs) that have limited access to infectious disease-trained specialists.
A prospective quasi-experimental pilot study.
Two rural VAMCs with acute-care and long-term care units.
At each intervention site, medical providers, pharmacists, infection preventionists, staff nurses, and off-site infectious disease physicians formed a videoconference antimicrobial stewardship team (VAST) that met weekly to discuss cases and antimicrobial stewardship-related education.
Descriptive measures included fidelity of implementation, number of cases discussed, infectious syndromes, types of recommendations, and acceptance rate of recommendations made by the VAST. Qualitative results stemmed from semi-structured interviews with VAST participants at the intervention sites.
Each site adapted the VAST to suit their local needs. On average, sites A and B discussed 3.5 and 3.1 cases per session, respectively. At site A, 98 of 140 cases (70%) were from the acute-care units; at site B, 59 of 119 cases (50%) were from the acute-care units. The most common clinical syndrome discussed was pneumonia or respiratory syndrome (41% and 35% for sites A and B, respectively). Providers implemented most VAST recommendations, with an acceptance rate of 73% (186 of 256 recommendations) and 65% (99 of 153 recommendations) at sites A and B, respectively. Qualitative results based on 24 interviews revealed that participants valued the multidisciplinary aspects of the VAST sessions and felt that it improved their antimicrobial stewardship efforts and patient care.
This pilot study has successfully demonstrated the feasibility of using telehealth to support antimicrobial stewardship at rural VAMCs with limited access to local infectious disease expertise.
Children reared in impoverished environments are at risk for enduring psychological and physical health problems. Mechanisms by which poverty affects development, however, remain unclear. To explore one potential mechanism of poverty's impact on social–emotional and cognitive development, an experimental examination of a rodent model of scarcity-adversity was conducted and compared to results from a longitudinal study of human infants and families followed from birth (N = 1,292) who faced high levels of poverty-related scarcity-adversity. Cross-species results supported the hypothesis that altered caregiving is one pathway by which poverty adversely impacts development. Rodent mothers assigned to the scarcity-adversity condition exhibited decreased sensitive parenting and increased negative parenting relative to mothers assigned to the control condition. Furthermore, scarcity-adversity reared pups exhibited decreased developmental competence as indicated by disrupted nipple attachment, distress vocalization when in physical contact with an anesthetized mother, and reduced preference for maternal odor with corresponding changes in brain activation. Human results indicated that scarcity-adversity was inversely correlated with sensitive parenting and positively correlated with negative parenting, and that parenting fully mediated the association of poverty-related risk with infant indicators of developmental competence. Findings are discussed from the perspective of the usefulness of bidirectional–translational research to inform interventions for at-risk families.
The Zika virus was largely unknown to many health care systems before the outbreak of 2015. The unique public health threat posed by the Zika virus and the evolving understanding of its pathology required continuous communication between a health care delivery system and a local public health department. By leveraging an existing relationship, NYC Health+Hospitals worked closely with New York City Department of Health and Mental Hygiene to ensure that Zika-related processes and procedures within NYC Health+Hospitals facilities aligned with the most current Zika virus guidance. Support given by the public health department included prenatal clinical and laboratory support and the sharing of data on NYC Health+Hospitals Zika virus screening and testing rates, thus enabling this health care delivery system to make informed decisions and practices. The close coordination, collaboration, and communication between the health care delivery system and the local public health department examined in this article demonstrate the importance of working together to combat a complex public health emergency and how this relationship can serve as a guide for other jurisdictions to optimize collaboration between external partners during major outbreaks, emerging threats, and disasters that affect public health. (Disaster Med Public Health Preparedness. 2018;12:689-691)
The objective of the paper was to survey patients’ preference in relation to a continuity, or split, model of inpatient consultant care in the Louth Mental Health Service.
A written survey was administered to all patients attending the Louth Mental Health Service over a 2-week period. Participants were asked for their preferred model of care and clinical information was obtained from their clinical notes.
In total, 149 patients completed the survey questionnaire and 103 respondents (69%) indicated a preference for a continuity model of inpatient consultant psychiatric care. There was a trend for those who reported a past experience of inpatient hospitalisation to indicate a preference for the continuity model (76% v. 61%, respectively, χ2 3.67, p=0.056).
Patients indicate a preference for a continuity model of inpatient psychiatric care and this is important to consider in service planning. More research is needed to evaluate if any model of consultant care is associated with better patient outcomes.
Layered ice has been used to investigate the initiation of fabrics in shear zones where there is preservation of a refolded layering The fabrics were measured using an apparatus that acquires pixel-based images that illustrate the variation of c-axis orientation within and between grains. In the centre of the shear zones there is dynamic recrystallization with the production of an asymmetric two-maxima fabric. The way dynamic recrystallization modifies the inherited folds and microstructure suggests that there is little effect of inheritance from a precursor grain microstructure or fabric No obvious evidence has been found for the occurrence of sub-grains, which implies that the role of sub-grain rotation is minimal or is obliterated by the recrystallization process. The final c-axis pattern is asymmetric with respect to the direction of shortening, with a strong maximum at ~5° to the pole of the shear zone, and a sense of asymmetry in the direction of the shear, and a secondary maximum inclined at ~45° to the plane of shearing. Distinct sets of nearest-neighbour c-axis distributions, namely, intermediate-angle (10–25°), high-angle (50–65°) and very high-angle (120–150°), suggest there may be special grain-boundary relationships.
Using a series of combined compression–simple-shear experiments, it has been possible to investigate strain distributions and crystal-orientation fabrics related to varying layer orientation in ice. A variety of flattening strains accompanied by layer buckling, simple shear and the development of a lenticular layering are produced in anisotropic ice masses. In samples where the creep curve has only just reached a minimum strain rate, the c-axis preferred orientation is similar to that in the starting material, with specific c-axis concentrations affected by the extent of preserved host grains. At shear strains where γ ≤ 1, it was found that the c-axis preferred orientations were highly variable depending on the magnitude of strain, strain distribution and upon the modification and degree of rotation of initial c-axis preferred orientation. However, once recrystallization dominates in high-strain zones (γ ≥ 1), there is a rapid development of an asymmetric two-maxima fabric with little evidence of any contributions from inherited fabric elements. The final c-axis pattern is asymmetric with respect to the direction of shortening, with a strong maximum at ∼80° to the shear zone, with a sense of asymmetry in the direction of the shear, and a secondary maximum lying at ∼50° to the plane of shearing.
We have detected the 8.7 GHz hyperfine line of 3He+ in the HII regions W43, W51, and W3 and obtained significant upper limits for M17, W49, and Orion A. Even though the abundances derived from measured line parameters can have large uncertainty due to the detailed structure of the sources, it seems almost certain that the 3He+ abundance in W3, 12 kpc from the galactic center is significantly higher than in sources closer to the galactic center. If this is the result of general chemical evolution of the galaxy, it is exactly the opposite of what is expected.
Objectives: Studies suggest that impairments in some of the same domains of cognition occur in different neuropsychiatric conditions, including those known to share genetic liability. Yet, direct, multi-disorder cognitive comparisons are limited, and it remains unclear whether overlapping deficits are due to comorbidity. We aimed to extend the literature by examining cognition across different neuropsychiatric conditions and addressing comorbidity. Methods: Subjects were 486 youth consecutively referred for neuropsychiatric evaluation and enrolled in the Longitudinal Study of Genetic Influences on Cognition. First, we assessed general ability, reaction time variability (RTV), and aspects of executive functions (EFs) in youth with non-comorbid forms of attention-deficit/hyperactivity disorder (ADHD), mood disorders and autism spectrum disorder (ASD), as well as in youth with psychosis. Second, we determined the impact of comorbid ADHD on cognition in youth with ASD and mood disorders. Results: For EFs (working memory, inhibition, and shifting/ flexibility), we observed weaknesses in all diagnostic groups when participants’ own ability was the referent. Decrements were subtle in relation to published normative data. For RTV, weaknesses emerged in youth with ADHD and mood disorders, but trend-level results could not rule out decrements in other conditions. Comorbidity with ADHD did not impact the pattern of weaknesses for youth with ASD or mood disorders but increased the magnitude of the decrement in those with mood disorders. Conclusions: Youth with ADHD, mood disorders, ASD, and psychosis show EF weaknesses that are not due to comorbidity. Whether such cognitive difficulties reflect genetic liability shared among these conditions requires further study. (JINS, 2018, 24, 91–103)
This is a brief report on a sensitive search for excited OH absorption and emission sources made with the Effelsberg 100 m telescope towards several compact HII regions. Our data are discussed elsewhere (Guilloteau et al., 1983) and we mainly present here our II3/2, J = 5/2 and 7/2 OH narrow emission results (masers). In the J = 5/2 state, 14 sources were observed with a typical 1 σ sensitivity of 0.2 Jy. Among 13 positive detections, 4 and may be 5 are new maser sources: G43.1, W48, K3-50, ON3 and G34.3 (?). With the exception of W3 (OH) the 6035 MHz line is always much stronger than the 6030 MHz line. Comparison with spectra published by others suggests time variability in M17, W51 and Orion A. In W3 (OH) a weak broad emission was also detected at 6049 MHz. In our j = 7/2 observations the peak to peak noise was the range 0.1 to 1 Jy. No masers were detected even in the strong 6035 MHz sources associated with M17 and W33 cont. Thus the F = 4−4 emission line in W3 (OH) seems to be really exceptional (Baudry et al., 1981).
A fully sampled map of size ∼1′×3′ (R.A. Dec), centered on BN-KL has been made in the J = 1-0 line of 12C18O with 21″ angular resolution. The 12C18O emission is concentrated in a ← 40″ wide continuous strip running S to NE. Several maxima are superposed on the ridge, but none exceeds the average emission level by more than 40%. There is no intense peak of 12C18O J = 1-0 line emission centered on BN-KL, in contrast to maps of the dust emission. The dust and 12C18O results can be reconciled with a constant (CO/H2) ratio if there are variations in the kinetic temperature and column density of ∼50%. Peaks in both temperature and column density are then located near BN-KL, and 90″ to the south. From the estimated CO column density, about 10% of the carbon is in the form of CO. Near the BN-KL region, the 12C18O line profiles tend to become wider. These wider lines appear to be superposed on a weak, 18 km s−1 (FWHP) wide pedestal. In regions 40″ NE and 30″ S of BN-KL, the 12C18O lines have widths of less than 2 km s−1. Presumably, these are the locations of high density, quiescent molecular gas. The radial velocity of the CO emission increases from 6.5 km s−1 (at 90″ S) to 10.5 km s−1 (at 60″ NE) of BN-KL. Close to BN-KL, however, there is evidence that this trend is reversed.