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Grounded in self-determination theory's (SDT; Ryan & Deci, 2017) organismic perspective, we present a process view of integrative emotion regulation. SDT describes three general types of emotion regulation: integrative emotion regulation, which focuses on emotions as carrying information that is brought to awareness; controlled emotion regulation, which is focused on diminishing emotions through avoidance, suppression, or enforced expression or reappraisal; and amotivated emotion regulation, in which emotions are uncontrolled or dysregulated. We review survey and experimental research contrasting these emotion regulation styles, providing evidence for the benefits of integrative emotion regulation for volitional functioning, personal well-being, and high-quality relationships, and for the costs of controlled emotion regulation and dysregulation. The development of emotion regulation styles is discussed, especially the role of autonomy-supportive parenting in fostering more integrative emotion regulation, and the role of controlling parenting in contributing to controlled or dysregulated emotion processing. Overall, integrative emotion regulation represents a beneficial style of processing emotions, which develops most effectively in a nonjudgmental and autonomy-supportive environment, an issue relevant to both development and psychotherapy.
Few studies have used genomic epidemiology to understand tuberculosis (TB) transmission in rural and remote settings – regions often unique in history, geography and demographics. To improve our understanding of TB transmission dynamics in Yukon Territory (YT), a circumpolar Canadian territory, we conducted a retrospective analysis in which we combined epidemiological data collected through routine contact investigations with clinical and laboratory results. Mycobacterium tuberculosis isolates from all culture-confirmed TB cases in YT (2005–2014) were genotyped using 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) and compared to each other and to those from the neighbouring province of British Columbia (BC). Whole genome sequencing (WGS) of genotypically clustered isolates revealed three sustained transmission networks within YT, two of which also involved BC isolates. While each network had distinct characteristics, all had at least one individual acting as the probable source of three or more culture-positive cases. Overall, WGS revealed that TB transmission dynamics in YT are distinct from patterns of spread in other, more remote Northern Canadian regions, and that the combination of WGS and epidemiological data can provide actionable information to local public health teams.
Mercuric iodide HgI2 room temperature solid state radiation spectrometers having 4% energy resolution at 100 KeV detected the x-ray fluorescence (XRF) of the K shell of intermediate and high Z elements. The excitation of the K shells which emit XRF more energetic than 60 KeV was achieved with 7mCi collimated 57Co and for XRF less energetic than 60 KeV the excitation was done with a 10mCi 241Am source. The K shell XRF spectra of a 1:1 mixture of U and Th, and also of the single elements of Au, Tb, Ba, Ag, Mo, and Rb are shown. The results prove the feasibility of developing mercuric iodide portable XRF spectrometers which operate at room temperature and which have a wide range of geochemical and industrial applications.
Two Category 5 storms, Hurricane Irma and Hurricane Maria, hit the U.S. Virgin Islands (USVI) within 13 days of each other in September 2017. These storms caused catastrophic damage across the territory, including widespread loss of power, destruction of homes, and devastation of critical infrastructure. During large scale disasters such as Hurricanes Irma and Maria, public health surveillance is an important tool to track emerging illnesses and injuries, identify at-risk populations, and assess the effectiveness of response efforts. The USVI Department of Health (DoH) partnered with shelter staff volunteers to monitor the health of the sheltered population and help guide response efforts.
Shelter volunteers collect data on the American Red Cross Aggregate Morbidity Report form that tallies the number of client visits at a shelter’s health services every 24 hours. Morbidity data were collected at all 5 shelters on St. Thomas and St. Croix between September and October 2017. This article describes the health surveillance data collected in response to Hurricanes Irma and Maria.
Following Hurricanes Irma and Maria, 1130 health-related client visits were reported, accounting for 1655 reasons for the visits (each client may have more than 1 reason for a single visit). Only 1 shelter reported data daily. Over half of visits (51.2%) were for health care management; 17.7% for acute illnesses, which include respiratory conditions, gastrointestinal symptoms, and pain; 14.6% for exacerbation of chronic disease; 9.8% for mental health; and 6.7% for injury. Shelter volunteers treated many clients within the shelters; however, reporting of the disposition (eg, referred to physician, pharmacist) was often missed (78.1%).
Shelter surveillance is an efficient means of quickly identifying and characterizing health issues and concerns in sheltered populations following disasters, allowing for the development of evidence-based strategies to address identified needs. When incorporated into broader surveillance strategies using multiple data sources, shelter data can enable disaster epidemiologists to paint a more comprehensive picture of community health, thereby planning and responding to health issues both within and outside of shelters. The findings from this report illustrated that managing chronic conditions presented a more notable resource demand than acute injuries and illnesses. Although there remains room for improvement because reporting was inconsistent throughout the response, the capacity of shelter staff to address the health needs of shelter residents and the ability to monitor the health needs in the sheltered population were critical resources for the USVI DoH overwhelmed by the disaster. (Disaster Med Public Health Preparedness. 2019;13:38-43)
Two category 5 storms hit the US Virgin Islands (USVI) within 13 days of each other in September 2017. This caused an almost complete loss of power and devastated critical infrastructure such as the hospitals and airports
The USVI Department of Health conducted 2 response Community Assessments for Public Health Emergency Response (CASPERs) in November 2017 and a recovery CASPER in February 2018. CASPER is a 2-stage cluster sampling method designed to provide household-based information about a community’s needs in a timely, inexpensive, and representative manner.
Almost 70% of homes were damaged or destroyed, 81.2% of homes still needed repair, and 10.4% of respondents felt their home was unsafe to live in approximately 5 months after the storms. Eighteen percent of individual respondents indicated that their mental health was “not good” for 14 or more days in the past month, a significant increase from 2016.
The CASPERs helped characterize the status and needs of residents after the devastating hurricanes and illustrate the evolving needs of the community and the progression of the recovery process. CASPER findings were shared with response and recovery partners to promote data-driven recovery efforts, improve the efficiency of the current response and recovery efforts, and strengthen emergency preparedness in USVI. (Disaster Med Public Health Preparedness. 2019;13:53-62)
The spatial-intensity profile of light reflected during the interaction of an intense laser pulse with a microstructured target is investigated experimentally and the potential to apply this as a diagnostic of the interaction physics is explored numerically. Diffraction and speckle patterns are measured in the specularly reflected light in the cases of targets with regular groove and needle-like structures, respectively, highlighting the potential to use this as a diagnostic of the evolving plasma surface. It is shown, via ray-tracing and numerical modelling, that for a laser focal spot diameter smaller than the periodicity of the target structure, the reflected light patterns can potentially be used to diagnose the degree of plasma expansion, and by extension the local plasma temperature, at the focus of the intense laser light. The reflected patterns could also be used to diagnose the size of the laser focal spot during a high-intensity interaction when using a regular structure with known spacing.
We reviewed all patients who were supported with extracorporeal membrane oxygenation and/or ventricular assist device at our institution in order to describe diagnostic characteristics and assess mortality.
A retrospective cohort study was performed including all patients supported with extracorporeal membrane oxygenation and/or ventricular assist device from our first case (8 October, 1998) through 25 July, 2016. The primary outcome of interest was mortality, which was modelled by the Kaplan–Meier method.
A total of 223 patients underwent 241 extracorporeal membrane oxygenation runs. Median support time was 4.0 days, ranging from 0.04 to 55.8 days, with a mean of 6.4±7.0 days. Mean (±SD) age at initiation was 727.4 days (±146.9 days). Indications for extracorporeal membrane oxygenation were stratified by primary indication: cardiac extracorporeal membrane oxygenation (n=175; 72.6%) or respiratory extracorporeal membrane oxygenation (n=66; 27.4%). The most frequent diagnosis for cardiac extracorporeal membrane oxygenation patients was hypoplastic left heart syndrome or hypoplastic left heart syndrome-related malformation (n=55 patients with HLHS who underwent 64 extracorporeal membrane oxygenation runs). For respiratory extracorporeal membrane oxygenation, the most frequent diagnosis was congenital diaphragmatic hernia (n=22). A total of 24 patients underwent 26 ventricular assist device runs. Median support time was 7 days, ranging from 0 to 75 days, with a mean of 15.3±18.8 days. Mean age at initiation of ventricular assist device was 2530.8±660.2 days (6.93±1.81 years). Cardiomyopathy/myocarditis was the most frequent indication for ventricular assist device placement (n=14; 53.8%). Survival to discharge was 42.2% for extracorporeal membrane oxygenation patients and 54.2% for ventricular assist device patients. Kaplan–Meier 1-year survival was as follows: all patients, 41.0%; extracorporeal membrane oxygenation patients, 41.0%; and ventricular assist device patients, 43.2%. Kaplan–Meier 5-year survival was as follows: all patients, 39.7%; extracorporeal membrane oxygenation patients, 39.7%; and ventricular assist device patients, 43.2%.
This single-institutional 18-year review documents the differential probability of survival for various sub-groups of patients who require support with extracorporeal membrane oxygenation or ventricular assist device. The indication for mechanical circulatory support, underlying diagnosis, age, and setting in which cannulation occurs may affect survival after extracorporeal membrane oxygenation and ventricular assist device. The Kaplan–Meier analyses in this study demonstrate that patients who survive to hospital discharge have an excellent chance of longer-term survival.
Based on a surgical site infection (SSI) cohort at an academic center, we showed a median potentially preventable loss per non-SSI case of $17,916 in colon surgery and of $34,741 in coronary artery bypass grafting.
OBJECTIVES/SPECIFIC AIMS: To evaluate the NIH-sponsored Best Practices for Social and Behavioral Research e-learning course. METHODS/STUDY POPULATION: Four universities partnered in a pilot study to evaluate this new course. Outcomes from 294 participants completing the course included efficient progress through the training, perceived relevance of the course to current work, level of engagement with the course material, intent to work differently as a result of the course, and downloading digital resources. RESULTS/ANTICIPATED RESULTS: Participants rated the course as relevant and engaging (6.4 and 5.8 on a 7-point Likert scale) and 96% of respondents said they would recommend the course to colleagues. Qualitative analysis of participant testimonials suggested that most respondents had a readiness to change in the way they worked as a result of the course. Overall, results suggest participants completed the course efficiently, perceived outcomes positively and worked differently after the training. DISCUSSION/SIGNIFICANCE OF IMPACT: These results will inform new guidelines for future participants (e.g., average time to complete, expectations for knowledge checks in the training). Future studies should include larger samples and closer coordination and communication between study sites.
The Best Practices in Social and Behavioral Research Course was developed to provide instruction on good clinical practice for social and behavioral trials. This study evaluated the new course.
Participants across 4 universities took the course (n=294) and were sent surveys following course completion and 2 months later. Outcomes included relevance, how engaging the course was, and working differently because of the course. Open-ended questions were posed to understand how work was impacted.
Participants rated the course as relevant and engaging (6.4 and 5.8/7 points) and reported working differently (4.7/7 points). Participants with less experience in social and behavioral trials were most likely to report working differently 2 months later.
The course was perceived as relevant and engaging. Participants described actions taken to improve rigor in implementing trials. Future studies with a larger sample and additional participating sites are recommended.
Diagnostic errors cause significant patient harm and increase costs. Data characterising such errors in the paediatric cardiac intensive care population are limited. We sought to understand the perceived frequency and types of diagnostic errors in the paediatric cardiac ICU.
Paediatric cardiac ICU practitioners including attending and trainee physicians, nurse practitioners, physician assistants, and registered nurses at three North American tertiary cardiac centres were surveyed between October 2014 and January 2015.
The response rate was 46% (N=200). Most respondents (81%) perceived that diagnostic errors harm patients more than five times per year. More than half (65%) reported that errors permanently harm patients, and up to 18% perceived that diagnostic errors contributed to death or severe permanent harm more than five times per year. Medication side effects and psychiatric conditions were thought to be most commonly misdiagnosed. Physician groups also ranked pulmonary overcirculation and viral illness to be commonly misdiagnosed as bacterial illness. Inadequate care coordination, data assessment, and high clinician workload were cited as contributory factors. Delayed diagnostic studies and interventions related to the severity of the patient’s condition were thought to be the most commonly reported process breakdowns. All surveyed groups ranked improving teamwork and feedback pathways as strategies to explore for preventing future diagnostic errors.
Paediatric cardiac intensive care practitioners perceive that diagnostic errors causing permanent harm are common and associated more with systematic and process breakdowns than with cognitive limitations.
Fg 1 (He 2–66) is a southern planetary nebula that presents an elliptical shape. Deep CCD imaging and long-slit spectroscopy have been obtained at Las Campanas Observatory of this object. The images were obtained in the light of Hα+[NII], [SII] λλ6716,6731, HeII λ4686 and in the broad-band Rgunn filter. The spectra were obtained oriented N-S, P.A. 90°, and P.A. 85°. The instrumental combination yields a spectral resolution of ∼ 2 Å FWHM, covering a spectral range ≃ λλ 6290–6805 Å.
During the past decade the achievements in the theory of stellar atmospheres of hot stars combined with improved spectrograph and detector technology at large telescopes have led to a significantly improved knowledge of PN nuclei properties (see Méndez et al. 1988, Kudritzki and Méndez 1989).
He 2-119 is a bright, elliptical, planetary nebula of relatively large size (117 arcsec along the major axis and 74 arcsec along the minor one). Digital, unsharp masking CCD imaging of this object is presented, revealing a filamentary, nearly bipolar inner structure. In addition, the discovery of an extended, faint halo in this object is reported. The halo has a diameter of 208 arcsec and has a nearly circular form. He 2-119 thus becomes a new member of the group of planetary nebulae with halos. Its general characteristics are discussed.
The enormous potential of direct imaging CCDs with respect to stellar photometry was soon discovered after these detectors became available for standard instrumentation at modern telescopes. Among favourable properties like high quantum efficiency, linearity, and large dynamic range the multiplexing advantage of the 2-dimensional detector has permitted to perform quantitative work that otherwise would have been impossible with classical photoelectric photometry. Striking examples for this are the progress in constructing colour magnitude diagrams for globular clusters (see e.g. Hesser et al. 1987, their Fig.9) or the high precision (down to the mmag level) achieved in differential photometry on ensembles of stars (Gilliland and Brown 1988). Several groups have also used CCDs for time series measurements employing specialized instruments and/or proper observing strategies (Dunham et al. 1985, Howell and Jacoby 1986, Stover and Allen 1987). If high time resolution (on the order of seconds or less) is required, however, the photoelectric method is still superior to CCDs mainly because of problems like data rates and readout time overhead (Barwig 1987).
NGC 3603, one of the most massive H II regions in our galaxy, shows recent star forming activity (Frogel et al. 1977; Tapia 1981; Persi et al., 1985). In this paper we report new near-infrared maps and photometric observations in the complex region surrounding Irs 9, Irs 2 and Irs 8. Most data were gathered at the 1.5-m telescope of CTIO, using an InSb photometer. Tables 1 and 2 synthesize the observations and the results of the photometry. While the low resolution K map (Figure 1) shows basically the previously reported features, the high resolution K and L maps (shown superimposed in Figure 2), show that Irs 9 is the brightest source in the field, clearly resolved from Irs 2 and Irs 8. The presence of a previously unreported source some 22″N and 5″W of Irs 2, should be further investigated. The spectral distributions derived from our measurements and from previous ones by Persi et al. (1985) strongly suggest that the 10 and 20 μm fluxes reported by Frogel et al. (1977) at the position of Irs 2, probably correspond to Irs 9. Under this assumption, Irs 9 is probably a highly reddened massive star (1 μm to 20 μm luminosity, L∗ = 2.2 × 104 L⊙) while the luminosity of Irs 2 is less than 102 L⊙. We therefore conclude that Irs 9 is a young massive star surrounded by a warm (Tdust ∼ 250 K) dust envelope; Irs 2 seems to be the less obscured part of an associated H II region, as further corroborated by the Brγ emission and the free-free like spectrum and spectral distribution, as reported by Persi et al. (1985) and in this paper.
GM24 is a small visible nebulosity in the vicinity of a molecular cloud. In this contribution we present the results of continuum (6-cm) and CO line (J = 1 → 0) radio observations, infrared maps, broad-band photometry and low-resolution spectroscopy as well as long-slit Echelle Ha spectroscopy. We found evidence that the GM24 = PP85 nebula is part of a larger region where star formation occurred in the past 104 years; the region is embedded in a typical molecular cloud with a dimension of ∼ 10 pc and mass of ∼104 M⊙. A compact radio H II region seems to be associated with GM24 and with one of the mid-infrared peaks detected. The nebula is most probably the visible part of an embedded H II region that is starting to emerge from the cloud. The other infrared peaks found in its vicinity (∼ 1 pc) are probably associated with less evolved stellar objects. The complex also shows an extended near-infrared flux which we believe to arise in a reflection nebula. From energy arguments, we found that the luminosity required to power the H II region and keep the cloud at the observed large temperature (TK ≅33 K), is ∼105 L⊙ which is consistent with the infrared total flux from the present measurements and those from IRAS of 4x104 L⊙; this corresponds to the flux of ∼3 BO ZAMS stars. The details of the present work have appeared in the Revista Mexicana de Astronomía y Astrofísica, Volume 11, 83, 1985.
The photometric behaviour of AGK3-0°965, the central star of the bipolar planetary nebula NGC 2346, has been monitored photometrically for several months at the Observatorio Astronómico Nacional at Tonantzintla and San Pedro Mértir, Mexico. A model is proposed in which the eclipses were caused by the passage of an elongated cool dust cloudlet of size ~ 2–5 × 1012 cm and total mass ~ 10−12 M⊙. This model can explain most of the observations. The velocity of the cloud in the direction of the major axis of the projected central binary orbit is vp = 0.14 km s−1. Another warmer (T ≲ 1000 K) circumstellar cloud is responsible for the infrared excess at wavelengths from 3 to 12 μm. Its emission, as seen from the Earth, has not changed significantly at λ > 3 μm during the past twelve years, as shown by new infrared observations also reported. Its most relevant physical properties are still to be determined. The present results provide the first evidence of a dense circumstellar cloudlet of mass similar to that of a minor planet which is probably the result of the fragmentation of a disk or toroid around the central star of NGC 2346. Although the presence of many other similar cloudlets in its vicinity is expected, the probability of similar events occurring in the next few hundred years is very small.
The details of the present work will be published in the Revista Mexicana de Astronomía y Astrofísica.
Near-infrared observations of 82 stars in h and χ Persei (NGC 869 and 884) were obtained with the Mexican National Observatory infrared photometer/spectrometer on the 2.1 m telescope at San Pedro Mártir, Baja California. The JHK photometry covers most of the stars in the upper main sequence of the central parts of the clusters as well as the giants and supergiants in a more extended region, with additional L' and M measurements of the brightest members. In Figure 1 the (J-H) vs (H-K) and (H-K) vs (K-L) diagrams are presented. In order to complement the available good quality UBV photometry, we carried out photoelectric measurements of 23 stars in our sample for which only low quality photographic data has been published. These observations were made with the pulse-counting photometer attached to the newly refurbished 1.5 m telescope at San Pedro Mártir.
We have searched for the near-infrared emission from selected areas of the star forming region NGC 6357. Six fields of 90x90 arcsec2 centered on the far-IR peaks G353.19+0.91, G353.22+0.67, G353.13+0.64, G353.05+0.56, on the 6-cm radio continuum peak G353.035+0.78, and on the water maser source H20353.27+0.64, were scanned through the K(2.2 μm) filter at the 2.1-m telescope of the Observatorio Astronómico Nacional at S. Pedro Mártir, Baja California, México.