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The excitation of low frequency dust acoustic (or dust density) waves in a dusty plasma can be driven by the flow of ions relative to dust. We consider the nonlinear development of the ion–dust streaming instability in a highly collisional plasma, where the ion and dust collision frequencies are a significant fraction of their corresponding plasma frequencies. This collisional parameter regime may be relevant to dusty plasma experiments under microgravity or ground-based conditions with high gas pressure. One-dimensional particle-in-cell simulations are presented, which take into account collisions of ions and dust with neutrals, and a background electric field that drives the ion flow. Ion flow speeds of the order of a few times thermal are considered. Waveforms of the dust density are found to have broad troughs and sharp crests in the nonlinear phase. The results are compared with the nonlinear development of the ion–dust streaming instability in a plasma with low collisionality.
To evaluate the effect of 70% isopropyl alcohol–impregnated central venous catheter caps on ambulatory central-line–associated bloodstream infections (CLABSIs) in pediatric hematology-oncology patients.
This study was a 24-month, cluster-randomized, 2 period, crossover clinical trial.
The study was conducted in 15 pediatric healthcare institutions, including 16 pediatric hematology-oncology clinics.
All patients with an external central line followed at 1 of the 16 hematology-oncology clinics.
Usual ambulatory central-line care per each institution using 70% isopropyl alcohol–impregnated caps at home compared to usual ambulatory central-line care in each institution without using 70% isopropyl alcohol–impregnated caps.
Of the 16 participating clinics, 15 clinics completed both assignment periods. As assigned, there was no reduction in CLABSI incidence in clinics using 70% isopropyl alcohol–impregnated caps (1.23 per 1,000 days) compared with standard practices (1.38 per 1,000 days; adjusted incidence rate ratio [aIRR], 0.83; 95% CI, 0.63–1.11). In the per-protocol population, there was a reduction in positive blood culture incidence in clinics using 70% isopropyl alcohol-impregnated caps (1.51 per 1,000 days) compared with standard practices (1.88 per 1,000 days; aIRR, 0.72; 95% CI, 0.52–0.99). No adverse events were reported.
Isopropyl alcohol–impregnated central-line caps did not lead to a statistically significant reduction in CLABSI rates in ambulatory hematology-oncology patients. In the per-protocol analysis, there was a statistically significant decrease in positive blood cultures. Larger trials are needed to elucidate the impact of 70% isopropyl alcohol–impregnated caps in the ambulatory setting.
Successful management of an event where health-care needs exceed regional health-care capacity requires coordinated strategies for scarce resource allocation. Publications for rapid development, training, and coordination of regional hospital triage teams to manage the allocation of scarce resources during coronavirus disease 2019 (COVID-19) are lacking. Over a period of 3 weeks, over 100 clinicians, ethicists, leaders, and public health authorities convened virtually to achieve consensus on how best to save the most lives possible and share resources. This is referred to as population-based crisis management. The rapid regionalization of 22 acute care hospitals across 4500 square miles in the midst of a pandemic with a shifting regulatory landscape was challenging, but overcome by mutual trust, transparency, and confidence in the public health authority. Because many cities are facing COVID-19 surges, we share a process for successful rapid formation of health-care care coalitions, Crisis Standard of Care, and training of Triage Teams. Incorporation of continuous process improvement and methods for communication is essential for successful implementation. Use of our regional health-care coalition communications, incident command system, and the crisis care committee helped mitigate crisis care in the San Diego and Imperial County region as COVID-19 cases surged and scarce resource collaborative decisions were required.
We describe an approach to the evaluation and isolation of hospitalized persons under investigation (PUIs) for coronavirus disease 2019 (COVID-19) at a large US academic medical center. Only a small proportion (2.9%) of PUIs with 1 or more repeated severe acute respiratory coronavirus virus 2 (SARS-CoV-2) nucleic acid amplification tests (NAATs) after a negative NAAT were diagnosed with COVID-19.
Mesoscale features within the Gulf of Mexico (GOM) are known to influence zooplankton dynamics. Here we describe the composition of the zooplankton assemblage off shelf during summer in relation to environmental conditions, with emphasis on hyperiid amphipods and salps. Zooplankton samples were collected in summer of 2015 and 2016 in the central and southern GOM and in the Yucatan Channel in 2015. Two anticyclonic gyres were present in the north and less intense coupled cyclonic-anticyclonic gyres in the south. Zooplankton abundances differed temporally and spatially. Copepods were the dominant group (>55% of total abundance), while several less abundant taxa contributed to inter-annual and spatial differences. Amphipods and salps comprised <3% and their abundances were positively correlated. Fifty-six hyperiid and 10 salp species were identified. The dominant amphipod species were: Lestrigonus bengalensis (summer 2015), Anchylomera blossevillei and Primno spp. juveniles (summer 2016). Dominant salp species were Ihlea punctata, Iasis cylindrica and Thalia spp. Lower salp and amphipod species richness and abundance were associated with anticyclonic structures. Spatial and temporal differences were partly associated with symbiotic relationships between the groups. This study supports previous evidence of high spatial and temporal variability in zooplankton abundance in off-shelf waters of the GOM.
Multiple sclerosis (MS) is the most common cause of neurological disability in young adults and is frequently accompanied by symptoms of depression and anxiety. The aim of this study was to explore the association of depression and anxiety with health status in younger and older MS patients.
223 MS patients (67.3% female; mean age 38.9±10.8 years; mean disease duration 5.8±5.2 years) were divided into younger and older age groups (< 45 and ≥45 years). They completed questionnaires focusing on sociodemographic data, depression and anxiety (HADS), and physical and mental health status (SF-36). Functional disability (EDSS) was assessed by a neurologist. To analyse the data, a U-test and multiple linear regression analyses were performed.
A model consisting of age, gender, marital status, EDSS, depression and anxiety explained 46.6% of the variance in physical health status and 60.8% of the variance in mental health status (p≤.001). Depression was a significant predictor of physical health status in older MS patients and was associated with mental health status in both age groups (p≤0.001). Anxiety was related to worse physical and mental health status in younger MS patients, but not in the older ones.
Depression in MS patients is associated with mental health status and with physical health status only in the older group; anxiety is associated only in younger MS patients with regard to their health status. Psychiatric diagnostics focusing on depression and anxiety might be important for treatment of MS patients in order to contribute to improving a patient's health status.
Results of a recent study designed to evaluate varying schedules by which cognitive behavioural group treatment of panic disorder with and without agoraphobia (PD) is delivered will be presented. Thirty-nine PD patients were randomly assigned to one of two group treatment schedules: (a) a standard CBT program (S-CBT) which consisted of 13 consecutive weekly two hours sessions, or (b) a massed CBT program (M-CBT) which consisted of daily four-hour sessions for five days in week one and two two-hour sessions in week two and one two-hour session in week three. Content of the treatment programs were identical. It was found that treatment led to significant improvements on all measures. Between-group analyses showed that the S-CBT and M-CBT were equally effective immediate after treatment as well as at three-month follow-up with no between-group differences in the number of patients who achieved clinically significant improvement. Also, there were no differences in drop-out rates or patient satisfaction between groups. The results are discussed in relation to prior research and advantages and disadvantages of both treatment schedules are considered.
One year follow-up data will be obtained in January 2008 and will be presented too.
A self-medication hypothesis has been proposed to explain the association between cannabis use and a number of psychiatric and behavioral problems. However, there is little knowledge on reasons for use and reactions while intoxicated, in cannabis users who suffer from depression or problems controlling violent behavior.
We assessed 119 cannabis dependent subjects using the Schedules of Clinical Assessment in Neuropsychiatry (SCAN), parts of the Addiction Severity Index (ASI), and questionnaires on reasons for cannabis use and reactions to cannabis use while intoxicated. Participants with lifetime depression, and problems controlling violent behavior, were compared to subjects without such problems. Validity of the groupings was corroborated by use of a psychiatric treatment register, previous use of psychotropic medication, and convictions for violence.
Subjects with lifetime depression used cannabis for the same reasons as others. While under the influence of cannabis, they more often experienced depression, sadness, anxiety and paranoia, and they were less likely to report happiness or euphoria. Participants reporting problems controlling violent behavior more often used cannabis to decrease aggression, decrease suspiciousness, and for relaxation; while intoxicated they more often reacted with aggression.
Subjects with prior depression do not use cannabis as a mean of self-medication. They are more likely to experience specific increases of adverse symptoms while under the influence of cannabis, and are less likely to experience specific symptom relief. There is some evidence that cannabis is used as a mean of self-medication for problems controlling aggression.
This study examines the influence of chronic health conditions and socio-economic status on overnight admission and length of stay among Canadian seniors. Incremental multivariate logistic and zero-inflated negative binomial regression models assessed the relationship between selected predictors, overnight admission, and duration of stay. The findings show that all chronic health conditions and socio-economic factors examined were significantly associated with overnight hospital admission. However, seniors with cardiovascular health conditions, the very old, and seniors living in lower-income households had a greater risk of longer stays. Canadian seniors diagnosed with hypertension, cancer, diabetes, and stroke had greater risk of longer overnight hospital stays. Seniors aged 75 to 79 years, 80 years or older, and those living in lower-income households (≤ $39,999) were more likely to have a longer overnight hospital stay. Findings suggest that improving seniors’ health and socio-economic status may reduce the risk of overnight admission and longer stays of hospitalisation.
Health insurance schemes are important for bridging gaps in health-care needs between the rich and poor, especially in contexts where poverty is higher among seniors (persons aged 65 years and above). In this study we examined (a) gender-based predictors of unmet health-care need among seniors and (b) whether access was influenced by wealth status (measured by income quintiles). Gender-specific negative log–log regression models were fitted to data from the Study on Global Ageing and Health to examine associations between unmet health-care need and health insurance status controlling for theoretically relevant covariates. Insurance status was an important determinant of men and women's unmet health-care need but the relationship was moderated by income quintile for women and not men. While occupation was important for men, religion, marital status and income quintile were significantly associated with women's unmet health-care need. Based on the observed gender differences, we recommend the implementation of programmes aimed at improving the economic situation of older people, particularly women.
Cognitive behavioural therapy (CBT) is an evidence-based psychotherapy and one of the most widely used treatments for mental health problems. It is generally acknowledged that supervision improves the quality of treatment although systematic descriptions and empirical evaluation of supervision have been sparse. Moreover, there are relatively few valid and reliable instruments to evaluate supervision. Based on a comprehensive review of the supervision literature, six competency domains were identified to cover the scope of CBT supervision: Theory, Focus, Learning strategy, Techniques, Structure, and Interpersonal style. The Moeller, Moerch, Rosenberg Supervision Scale (MMRSS) was developed to evaluate supervisor performance within each of these domains after observation of supervision. The present study examined the psychometric properties of the MMRSS (inter-rater reliability and construct validity), the clinical utility, and satisfaction when using MMRSS to evaluate CBT supervision. CBT supervisors (n = 8) were recruited for the study and provided videos of group supervision. A total of 21 videos were rated using the MMRSS and the Supervisory Competency Scale (SCS) by two independent raters. Supervisees and supervisors completed a satisfaction questionnaire to capture their experience of using the MMRSS during supervision of supervision. The MMRSS showed acceptable internal consistency and validity. Several domains in MMRSS (Structure, Learning strategy, and Interpersonal style) correlated significantly with the corresponding domains in the SCS for cognitive supervision. Preliminary results indicate that the MMRSS may be a valid and clinically useful tool to evaluate CBT supervision, although further systematic evaluation is needed.
Key learning aims
(1) To understand that empirically founded evaluation of cognitive behavioural supervision is essential for good training.
(2) To argue that a modern view of supervision places an emphasis on learning principles.
(3) To describe the Moeller, Moerch, Rosenberg Supervision Scale (MMRSS) and the scale’s preliminary psychometric properties.
(4) To describe the supervisors’ and supervisees’ reported satisfaction using the MMRSS.
The nonlinear development of a low frequency beam-cyclotron instability in a collisional plasma composed of magnetized ions and electrons and unmagnetized, negatively charged dust is investigated using one-dimensional particle-in-cell simulations. Collisions of charged particles with neutrals are taken into account via a Langevin operator. The instability, which is driven by an ion
drift, excites a quasi-discrete wavenumber spectrum of waves that propagate perpendicular to the magnetic field with frequency of the order of the dust plasma frequency. In the linear regime, the unstable wavelengths are of the order of the ion gyroradius. As the wave energy density increases, the dominant modes shift to longer wavelengths, suggesting a transition to a Hall-current-type instability. Parameters are considered that reflect the ordering of plasma and dust quantities in laboratory dusty plasmas with high magnetic field. Comparison with the nonlinear development of this beam cyclotron instability in a collisionless dusty plasma is also briefly discussed.
Giardia duodenalis is the most common intestinal parasite of humans in the USA, but the risk factors for sporadic (non-outbreak) giardiasis are not well described. The Centers for Disease Control and Prevention and the Colorado and Minnesota public health departments conducted a case-control study to assess risk factors for sporadic giardiasis in the USA. Cases (N = 199) were patients with non-outbreak-associated laboratory-confirmed Giardia infection in Colorado and Minnesota, and controls (N = 381) were matched by age and site. Identified risk factors included international travel (aOR = 13.9; 95% CI 4.9–39.8), drinking water from a river, lake, stream, or spring (aOR = 6.5; 95% CI 2.0–20.6), swimming in a natural body of water (aOR = 3.3; 95% CI 1.5–7.0), male–male sexual behaviour (aOR = 45.7; 95% CI 5.8–362.0), having contact with children in diapers (aOR = 1.6; 95% CI 1.01–2.6), taking antibiotics (aOR = 2.5; 95% CI 1.2–5.0) and having a chronic gastrointestinal condition (aOR = 1.8; 95% CI 1.1–3.0). Eating raw produce was inversely associated with infection (aOR = 0.2; 95% CI 0.1–0.7). Our results highlight the diversity of risk factors for sporadic giardiasis and the importance of non-international-travel-associated risk factors, particularly those involving person-to-person transmission. Prevention measures should focus on reducing risks associated with diaper handling, sexual contact, swimming in untreated water, and drinking untreated water.
Factors associated with relapse among children who are discharged after reaching a threshold denoted ‘recovered’ from moderate acute malnutrition (MAM) are not well understood. The aim of this study was to identify factors associated with sustained recovery, defined as maintaining a mid-upper-arm circumference≥12·5 cm for 1 year after release from treatment. On the basis of an observational study design, we analysed data from an in-depth household (HH) survey on a sub-sample of participants within a larger cluster randomised controlled trial (cRCT) that followed up children for 1 year after recovery from MAM. Out of 1497 children participating in the cRCT, a subset of 315 children participated in this sub-study. Accounting for other factors, HH with fitted lids on water storage containers (P=0·004) was a significant predictor of sustained recovery. In addition, sustained recovery was better among children whose caregivers were observed to have clean hands (P=0·053) and in HH using an improved sanitation facility (P=0·083). By contrast, socio-economic status and infant and young child feeding practices at the time of discharge and HH food security throughout the follow-up period were not significant. Given these results, we hypothesise that improved water, sanitation and hygiene conditions in tandem with management of MAM through supplemental feeding programmes have the possibility to decrease relapse following recovery from MAM. Furthermore, the absence of associations between relapse and nearly all HH-level factors indicates that the causal factors of relapse may be related mostly to the child’s individual, underlying health and nutrition status.
The dust acoustic, or dust density, wave is a very low frequency collective mode in a dusty plasma that is associated with the motion of the charged and massive dust grains. An ion flow due to an electric field can excite these waves via an ion–dust streaming instability. Theories of this instability have often assumed a shifted-Maxwellian ion velocity distribution. Recently, the linear kinetic theory of this instability was considered using a non-Maxwellian ion velocity distribution (Kählert, Phys. Plasmas, vol. 22, 2015, 073703). In this paper, we present one-dimensional PIC simulations of the nonlinear development of the ion–dust streaming instability, comparing the results for these two types of ion velocity distributions, for several values of the ion drift speed and collision rate. Parameters are considered that reflect the ordering of plasma and dust quantities in laboratory dusty plasma experiments. It is found that, in general, the wave energy density is smaller in the simulations with a non-Maxwellian ion distribution.
Despite the rapid expansion of online educational resources for emergency medicine, barriers remain to their effective use by emergency physicians and trainees. This article expands on previous descriptions of techniques to aggregate online educational resources, outlining four strategies to help learners navigate, evaluate, and contribute online. These strategies include 1) cultivating digital mentors, 2) browsing the most popular free open access medical education (FOAM) websites, 3) using critical appraisal tools developed for FOAM, and 4) contributing new online content.
Objectives: We developed specific evaluation criteria to assess patient and public involvement in resource allocation decisions in health care.
Methods: We reviewed the literature from health and other sectors relevant to stakeholder involvement and conducted twenty-seven key informant interviews with stakeholders knowledgeable about patient and public involvement in Canadian drug resource allocation decisions. We used an inductive qualitative thematic approach to analyze the interviews with codes and categories developed directly from individuals’ interview transcripts.
Results: Integrating respondents’ comments and the literature review, we identified nine evaluation criteria of patient and the public involvement in healthcare resource allocation decision making: clarity regarding rationale and roles of patient and public members, sufficient support, adequate representation of relevant views, fair decision-making processes, legitimacy of committee processes, adequate opportunity for participation, meaningful degree of participation, noticeable effect on decisions, and considerations of the efficiency of patient and public involvement.
Conclusions: Our results will help to develop methods to evaluate patient and public involvement in healthcare decision making.
Dust acoustic (or dust density) waves have been observed in many laboratory dusty plasmas. These low-frequency waves involve the dynamics of highly charged and massive dust grains, and can be excited by the flow of ions relative to dust. In this paper, we consider the nonlinear development of the dust acoustic instability, excited by thermal ion flow, in a collisional plasma containing dust with high kinetic temperature (warm dust). It is shown that under certain conditions there may be a long-wavelength secondary instability in the nonlinear stage as dust gets heated by the waves. The characteristics of the nonlinear development are considered as a function of the relative charge density of the dust. Application to possible experimental parameters is discussed.
Placebo responses raise significant challenges for the design of clinical trials. We report changes in agitation outcomes in the placebo arm of a recent trial of citalopram for agitation in Alzheimer's disease (CitAD).
In the CitAD study, all participants and caregivers received a psychosocial intervention and 92 were assigned to placebo for nine weeks. Outcomes included Neurobehavioral Rating Scale agitation subscale (NBRS-A), modified AD Cooperative Study-Clinical Global Impression of Change (CGIC), Cohen-Mansfield Agitation Inventory (CMAI), the Neuropsychiatric Inventory (NPI) Agitation/Aggression domain (NPI A/A) and Total (NPI-Total) and ADLs. Continuous outcomes were analyzed with mixed-effects modeling and dichotomous outcomes with logistic regression.
Agitation outcomes improved over nine weeks: NBRS-A mean (SD) decreased from 7.8 (3.0) at baseline to 5.4 (3.2), CMAI from 28.7 (6.7) to 26.7 (7.4), NPI A/A from 8.0 (2.4) to 4.9 (3.8), and NPI-Total from 37.3 (17.7) to 28.4 (22.1). The proportion of CGI-C agitation responders ranged from 21 to 29% and was significantly different from zero. MMSE improved from 14.4 (6.9) to 15.7 (7.2) and ADLs similarly improved. Most of the improvement was observed by three weeks and was sustained through nine weeks. The major predictor of improvement in each agitation measure was a higher baseline score in that measure.
We observed significant placebo response which may be due to regression to the mean, response to a psychosocial intervention, natural course of symptoms, or nonspecific benefits of participation in a trial.