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Mental disorders cause high burden in adolescents, but adolescents often underutilise potentially beneficial treatments. Perceived need for and barriers to care may influence whether adolescents utilise services and which treatments they receive. Adolescents and parents are stakeholders in adolescent mental health care, but their perceptions regarding need for and barriers to care might differ. Understanding patterns of adolescent-parent agreement might help identify gaps in adolescent mental health care.
A nationally representative sample of Australian adolescents aged 13–17 and their parents (N = 2310), recruited between 2013–2014, were asked about perceived need for four types of adolescent mental health care (counselling, medication, information and skill training) and barriers to care. Perceived need was categorised as fully met, partially met, unmet, or no need. Cohen's kappa was used to assess adolescent-parent agreement. Multinomial logistic regressions were used to model variables associated with patterns of agreement.
Almost half (46.5% (s.e. = 1.21)) of either adolescents or parents reported a perceived need for any type of care. For both groups, perceived need was greatest for counselling and lowest for medication. Identified needs were fully met for a third of adolescents. Adolescent-parent agreement on perceived need was fair (kappa = 0.25 (s.e. = 0.01)), but poor regarding the extent to which needs were met (kappa = −0.10 (s.e. = 0.02)). The lack of parental knowledge about adolescents' feelings was positively associated with adolescent-parent agreement that needs were partially met or unmet and disagreement about perceived need, compared to agreement that needs were fully met (relative risk ratio (RRR) = 1.91 (95% CI = 1.19–3.04) to RRR = 4.69 (95% CI = 2.38–9.28)). Having a probable disorder was positively associated with adolescent-parent agreement that needs were partially met or unmet (RRR = 2.86 (95% CI = 1.46–5.61)), and negatively with adolescent-parent disagreement on perceived need (RRR = 0.50 (95% CI = 0.30–0.82)). Adolescents reported most frequently attitudinal barriers to care (e.g. self-reliance: 55.1% (s.e. = 2.39)); parents most frequently reported that their child refused help (38.7% (s.e. = 2.69)). Adolescent-parent agreement was poor for attitudinal (kappa = −0.03 (s.e. = 0.06)) and slight for structural barriers (kappa = 0.02 (s.e. = 0.09)).
There are gaps in the extent to which adolescent mental health care is meeting the needs of adolescents and their parents. It seems important to align adolescents' and parents' needs at the beginning and throughout treatment and to improve communication between adolescents and their parents. Both might provide opportunities to increase the likelihood that needs will be fully met. Campaigns directed towards adolescents and parents need to address different barriers to care. For adolescents, attitudinal barriers such as stigma and mental health literacy require attention.
De Dreu and Gross's distinction between attack and defense is complicated in real-world conflicts because competing leaders construe their position as one of defense, and power imbalances place status quo challengers in a defensive position. Their account of defense as vigilant avoidance is incomplete because it avoids a reference to anger which transforms anxious avoidance into collective and unified action.
The burden of tuberculosis (TB) among adolescents and young adults in endemic settings is poorly characterised. This study aimed to review published and unpublished estimates of the incidence and prevalence of bacteriologically confirmed TB among young people aged 10–24 years. We searched PubMed and World Health Organization archives for publications and unpublished data from population-based epidemiologic studies reporting confirmed pulmonary TB among young people, conducted from January 2000 onwards. We identified 27 publications and unpublished data from two national surveys, representing a total of 26 studies in 19 countries. The prevalence of bacteriologically confirmed TB ranged from 45 to 799 per 100 000 in the Asia-Pacific region and from 160 to 462 per 100 000 in African settings. We did not identify any epidemiologic studies of confirmed TB among adolescents living with human immunodeficiency virus (HIV). Many studies were excluded due to absent or inadequately reported age-specific data. Adolescents and young adults living in many endemic settings appear to be at substantial risk of developing active TB. There is a pressing need to improve the routine reporting of age in epidemiologic studies of TB, and to generate high-quality epidemiologic data regarding TB among adolescents living with HIV.
Introduction: Data regarding adverse events (AEs) (unintended harm to the patient from health care provided) among children seen in the emergency department (ED) are scarce despite the high risk setting and population. The objective of our study was to estimate the risk and type of AEs, and their preventability and severity, among children treated in pediatric EDs. Methods: Our prospective cohort study enrolled children <18 years of age presenting for care during 21 randomized 8 hr-shifts at 9 pediatric EDs from Nov 2014 to October 2015. Exclusion criteria included unavailability for follow-up or insurmountable language barrier. RAs collected demographic, medical history, ED course, and systems level data. At day 7, 14, and 21 a RA administered a structured telephone interview to all patients to identify flagged outcomes (e.g. repeat ED visits, worsening/new symptoms, etc). A validated trigger tool was used to screen admitted patients’ health records. For any patients with a flagged outcome or trigger, 3 ED physicians independently determined if an AE occurred. Primary outcome was the proportion of patients with an AE related to ED care within 3 weeks of their ED visit. Results: We enrolled 6377 (72.0%) of 8855 eligible patients; 545 (8.5%) were lost to follow-up. Median age was 4.4 years (range 3 months to 17.9 yrs). Eight hundred and seventy seven (13.8%) were triaged as CTAS 1 or 2, 2638 (41.4%) as CTAS 3, and 2839 (44.7%) as CTAS 4 or 5. Top entrance complaints were fever (11.2%) and cough (8.8%). Flagged outcomes/triggers were identified for 2047 (32.1%) patients. While 252 (4.0%) patients suffered at least one AE within 3 weeks of ED visit, 163 (2.6%) suffered an AE related to ED care. In total, patients suffered 286 AEs, most (67.9%) being preventable. The most common AE types were management issues (32.5%) and procedural complications (21.9%). The need for a medical intervention (33.9%) and another ED visit (33.9%) were the most frequent clinical consequences. In univariate analysis, older age, chronic conditions, hospital admission, initial location in high acuity area of the ED, having >1 ED MD or a consultant involved in care, (all p<0.001) and longer length of stay (p<0.01) were associated with AEs. Conclusion: While our multicentre study found a lower risk of AEs among pediatric ED patients than reported among pediatric inpatients and adult ED patients, a high proportion of these AEs were preventable.
Several studies demonstrating that central line–associated bloodstream infections (CLABSIs) are preventable prompted a national initiative to reduce the incidence of these infections.
We conducted a collaborative cohort study to evaluate the impact of the national “On the CUSP: Stop BSI” program on CLABSI rates among participating adult intensive care units (ICUs). The program goal was to achieve a unit-level mean CLABSI rate of less than 1 case per 1,000 catheter-days using standardized definitions from the National Healthcare Safety Network. Multilevel Poisson regression modeling compared infection rates before, during, and up to 18 months after the intervention was implemented.
A total of 1,071 ICUs from 44 states, the District of Columbia, and Puerto Rico, reporting 27,153 ICU-months and 4,454,324 catheter-days of data, were included in the analysis. The overall mean CLABSI rate significantly decreased from 1.96 cases per 1,000 catheter-days at baseline to 1.15 at 16–18 months after implementation. CLABSI rates decreased during all observation periods compared with baseline, with adjusted incidence rate ratios steadily decreasing to 0.57 (95% confidence intervals, 0.50–0.65) at 16–18 months after implementation.
Coincident with the implementation of the national “On the CUSP: Stop BSI” program was a significant and sustained decrease in CLABSIs among a large and diverse cohort of ICUs, demonstrating an overall 43% decrease and suggesting the majority of ICUs in the United States can achieve additional reductions in CLABSI rates.
In an effort to identify a forage legume with condensed tannins (CT) that reduce gastro-intestinal nematodes (GIN) in small ruminants without negative effects on nutrition, the following trial looked at the effects of two legumes containing CT on average daily gain (ADG) and faecal egg counts (FEC) in kid goats. Lespedeza cuneata (sericea lespedeza, SL) and Desmodium paniculatum (panicled tick-clover; PTC) were pelleted into isonitrogenous complete feeds containing 3.8% CT in a four week feeding trial. Compared to the alfalfa (Medicago sativa) control diet, SL decreased (P ≤ 0.05) feed efficiency and ADG while PTC had the same (P > 0.05) feed efficiency as alfalfa. The SL and PTC pelleted feeds increased (P = 0.006) daily feed intake by 4.5 kg and 3.7 kg, respectively, compared to alfalfa control, while kids consuming SL and PTC showed an average 44% reduction (P ≤ 0.05) in FEC compared to those fed alfalfa. The results showed that feeding PTC, an herbaceous, perennial legume native to much of North America, to goats may provide a natural means of reducing ruminant GIN while simultaneously providing a source of protein.
The purpose of this chapter is to provide a conceptual basis for using life-space to assess mobility resilience and maintenance of social participation among community dwelling older adults. The Life-Space Assessment (LSA) measures mobility and the geographic scope of participation in society over one month. It reflects distance, frequency, and use of equipment or personal help while ambulating through the environment. An LSA score of 60 or higher defines an unrestricted life-space – a level of mobility and participation that operationalizes resilience among older adults. After reporting results of a qualitative study examining attitudes toward life-space mobility, we report cross-sectional and prospective data from an observational cohort study of community-dwelling older adults. Significant associations between life-space mobility with social participation, as well as specific correlates and predictors of life-space mobility resilience, are defined.
The importance of life-space resilience as a reflection of mobility and social participation among community-dwelling older adults
An important aspect of resilience is the ability to maintain function in the context of chronic disease and age-associated physiological changes. Available data suggest that 80 percent of persons over the age of 65 years have at least one chronic condition and 20 percent have four or more such conditions (Chodosh et al., 2005). Age-associated physiological changes have been well documented in all organ systems (Hazzard et al., 2003).
One hundred and eighty–one stool specimens from patients with various types of diarrhoea (135 patients) or from non-diarrhoeal controls (23 acute medical patients, 23 inflammatory bowel disease in remission) were investigated using a colony–blot DNA hybridization assay for the presence of Verocytotoxin–producing (VTEC), enteroaggregative (EAggEC) and diffusely adherent (DAEC) Escherichia coli. Twelve patients had probe–positive EAggEC in the stool and 8 of these had diarrhoea, 6 following recent travel. Eight patients had DAEC, 7 of whom had travellers diarrhoea. Six of 10 (60%) travellers with gastroenteritis, but without a recognized enteric pathogen, were positive for EAggEC (4) or DAEC (2). Five of 10 (50%) travellers with gastroenteritis related to a recognized enteric pathogen also had DAEC identified in their stool. Of the 23 acute medical control patients 11 had been abroad, 4 of these were immigrants and had EAggEC. VTEC were not found and, with one exception, immunoassays for antibodies to E. coli O 157 and O 2 lipopolysaccharides were negative.
Acknowledgments: This work was supported, in part, by grant K23-AA015616 from the National Institute on Alcohol Abuse and Alcoholism (RDB and LMF).
Alcohol and drug use disorders are significant problems among older patients. These problems may be underappreciated by health care professionals because of limited clinical evidence and research data to form practice guidelines, insufficient training, and rushed office visits that tend to focus on acute and chronic physical problems, which can easily consume all the clinician's attention leaving little time to screen, diagnose, and perform an intervention for a substance use disorder.
Diagnosis of a substance use disorder can be difficult in the older patient. Embarrassment, shame, and fear of disapproval by family members may lead older individuals to conceal their drinking or drug use. Family members, who would be unlikely to ignore alcohol or drug abuse in a young person, may tolerate alcohol or drug abuse in an older person because they may think that after a long life the person “deserves it,” or that “it makes no difference anyway.” Family members may also believe that an oversedated elderly patient is “more manageable.” Furthermore, the signs and symptoms of substance abuse often mimic the clinical presentation of other common medical or psychiatric disorders and health care providers may perceive their diagnostic role as being directed mainly toward the chief complaint.
There is a confusing array of terms used to describe individuals who use and misuse alcohol and other drugs: “alcohol abuse,” “alcoholism,” “chemical dependency,” “drug addiction,” and “substance abuse.”
This paper presents the development of a sensor to detect the oxidative and radiation induced degradation of polypropylene. Recently we have examined the use of crosslinked assemblies of nanoparticles as a chemiresistor-type sensor for the degradation products. We have developed a simple method that uses a siloxane matrix to fabricate a chemiresistor-type sensor that minimizes the swelling transduction mechanism while optimizing the change in dielectric response. These sensors were exposed with the use of a gas chromatography system to three previously identified polypropylene degradation products including 4-methyl-2-pentanone, acetone, and 2-pentanone. The limits of detection 210 ppb for 4-methy-2-pentanone, 575 ppb for 2-pentanone, and the LoD was unable to be determined for acetone due to incomplete separation from the carbon disulfide carrier.
SPIRE, the Spectral and Photometric Imaging Receiver, is Herschel's submillimetre camera and spectrometer. It comprises a three-band imaging photometer operating at 250, 350 and 500 μm, and an imaging Fourier Transform Spectrometer (FTS) covering 194–672 μm. The design of SPIRE is described, and the expected scientific performance is summarised, based on modelling and flight instrument test results.
Dynamic friction, wear volumes and wear morphology have been studied for sliding wear in polysilicon in ambient air at μN normal loads using on-chip micron-scale test specimens. With increasing number of wear cycles, the friction coefficients show two distinct types of behavior: (i) an increase by a factor of two and a half to a steady-state regime after peaking at three times the initial value of about 0.10 ± 0.04, with no failure after millions of cycles; (ii) an increase by a factor larger than three followed by failure after ∼105 cycles. Additionally, the average nano-scale wear coefficient sharply increased in the first ∼105 cycles up to about 10−4 and then decayed by an order of magnitude over the course of several million cycles. For both modes of behavior, abrasive wear is the governing mechanism, the difference being attributed to variations in the local surface morphology (and wear debris) between the sliding surfaces. The oxidation of worn polysilicon surfaces only affects the friction coefficient after periods of inactivity (>30 min).
Ultrasonic Force Microscopy and Friction Force Microscopy have been applied to the characterization of the elastic and tribological responses of poly(acrylic acid) hydrogels at ambient conditions. The gels were prepared by free radical polymerization of acrylic acid monomers partially neutralized by sodium hydroxide, using N, N'-methylen-bis-acrylamide as a crosslinker. Nanoscale domains with different stiffness and friction are observed. Increasing the amount of crosslinker leads to the formation of smaller, more densely packed domains. The domains with higher stiffness also exhibit higher friction and lower topographic high. The results can be understood by assuming that (i) neutralization by sodium hydroxide leads to the formation of both acrylic acid and sodium acrylate polymeric strands (ii) the observed domains differ in their acrylic acid / sodium acrylate content. In the acrylic acid rich domains, hydrogen bonding among the polymeric strands explains a higher stiffness and lower topography. In the sodium acrylate rich domains, lubrication by water molecules linked by solvation to the sodium counterions accounts for a lower friction.
In Ultrasonic Force Microscopy, the mechanical diode response refers to the quasistatic cantilever deflexion in the presence of surface out-of-plane ultrasonic vibration of sufficiently high amplitude. The effect has been described by introducing ultrasonic-amplitude-dependent tip-sample force-distance curves [Phys. Rev. 61 (2000) 13997]. Here, we demonstrate that the ultrasonic hysteresis phenomenon is qualitatively explained taking into account that for certain ultrasonic amplitudes, the modified tip-sample forces lead to two stable quasi-static equilibrium states, separated by an energy barrier. Experimental UFM data obtained on mica at ambient conditions are discussed in terms of ultrasonic-induced quasi-static equilibrium states, taking into account the role of the surface water layer.
Basidiomes of Amanita alboverrucosa, A. ochrophylla, and A. pyramidifera were collected from native mixed sclerophyll forest sites and of A. conicoverrucosa and A. punctata from planted stands of Eucalyptus maculata in New South Wales, Australia. DNA was extracted from stipe tissue and subjected to inter-simple sequence repeat (ISSR) PCR analysis conducted using the primers (GTG)5 and (GACA)4 in order to determine genotype distribution at each site. Two to nine genotypes of one of the species were identified at each field site. Genotypes of A. ochrophylla, A. conicoverrucosa and A. punctata were spread over areas of ca 10–60 m diam, suggesting vegetative spread via large below-ground mycelial genets. In contrast, genotypes of A. alboverrucosa were more spatially restricted, suggesting recent establishment via basidiospores and more limited below-ground vegetative spread. Two groups of A. pyramidifera basidiomes that were separated by ca 600 m were found to be of the same genotype. While this might reflect long distance spread of below-ground mycelium in this taxon, the proximity of the basidiomes to a roadway makes movement of vegetative basidiome tissue via vehicular activity and subsequent establishment equally plausible.