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There is limited empirical information on service-level outcome domains and indicators for the large number of people with intellectual disabilities being treated in forensic psychiatric hospitals.
This study identified and developed the domains that should be used to measure treatment outcomes for this population.
A systematic review of the literature highlighted 60 studies which met eligibility criteria; they were synthesised using content analysis. The findings were refined within a consultation and consensus exercises with carers, patients and experts.
The final framework encompassed three a priori superordinate domains: (a) effectiveness, (b) patient safety and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviours, reactive and restrictive interventions, quality of life and patient satisfaction.
To index recovery, services need to measure treatment outcomes using this framework.
Carbapenem-resistant Enterobacteriaceae (CRE) are a significant clinical and public health concern. Understanding the distribution of CRE colonization and developing a coordinated approach are key components of control efforts. The prevalence of CRE in the District of Columbia is unknown. We sought to determine the CRE colonization prevalence within healthcare facilities (HCFs) in the District of Columbia using a collaborative, regional approach.
This study included 16 HCFs in the District of Columbia: all 8 acute-care hospitals (ACHs), 5 of 19 skilled nursing facilities, 2 (both) long-term acute-care facilities, and 1 (the sole) inpatient rehabilitation facility.
Inpatients on all units excluding psychiatry and obstetrics-gynecology.
CRE identification was performed on perianal swab samples using real-time polymerase chain reaction, culture, and antimicrobial susceptibility testing (AST). Prevalence was calculated by facility and unit type as the number of patients with a positive result divided by the total number tested. Prevalence ratios were compared using the Poisson distribution.
Of 1,022 completed tests, 53 samples tested positive for CRE, yielding a prevalence of 5.2% (95% CI, 3.9%–6.8%). Of 726 tests from ACHs, 36 (5.0%; 95% CI, 3.5%–6.9%) were positive. Of 244 tests from long-term-care facilities, 17 (7.0%; 95% CI, 4.1%–11.2%) were positive. The relative prevalence ratios by facility type were 0.9 (95% CI, 0.5–1.5) and 1.5 (95% CI, 0.9–2.6), respectively. No CRE were identified from the inpatient rehabilitation facility.
A baseline CRE prevalence was established, revealing endemicity across healthcare settings in the District of Columbia. Our study establishes a framework for interfacility collaboration to reduce CRE transmission and infection.
Biologics are a promising new class of drugs based on complex macromolecules such as proteins and nucleic acids. However, delivery of these macromolecules into the cytoplasm of target cells remains a significant challenge. Here we present one potential solution: bacterial nanomachines that have evolved over millions of years to efficiently deliver proteins and nucleic acids across cell membranes and between cells. In this review, we provide a brief overview of the different bacterial systems capable of direct delivery into the eukaryotic cytoplasm and the medical applications for which they are being investigated, along with a perspective on the future directions of this exciting field.
The present multi-centre randomised weight-loss trial evaluated the efficacy of a low-intensity 12-week online behavioural modification programme, with or without a fortified diet beverage using a 2 × 2 factorial design. A total of 572 participants were randomised to: (1) an online basic lifestyle information (OBLI) intervention, consisting of one online informational class about tips for weight management; (2) an online behavioural weight management (OBWM) intervention, entailing 12 weekly online classes focused on weight-loss behaviour modification; (3) an OBLI intervention plus a fortified diet cola beverage (BEV) containing green tea extract (total catechin 167 mg), soluble fibre dextrin (10 g) and caffeine (100 mg) (OBLI+BEV); (4) OBWM+BEV. Assessments included height, weight, dual-energy X-ray absorptiometry-derived body composition, and waist circumference (WC). Attrition was 15·7 %. Intention-to-treat (ITT) models demonstrated a main effect for type of Internet programme, with those assigned to the OBWM condition losing significantly more weight (F= 7·174; P= 0·008) and fat mass (F= 4·491; P= 0·035) than those assigned to the OBLI condition. However, there was no significant main effect for the OBWM condition on body fat percentage (F= 2·906; P= 0·089) or WC (F= 3·351; P= 0·068), and no significant main effect for beverage use or significant interactions between factors in ITT models. A 12-week, low-intensity behaviourally based online programme produced a greater weight loss than a basic information website. The addition of a fortified diet beverage had no additional impact.
Background: On June 8 and 9, 2008, more than 4 inches of rain fell in the Iowa-Cedars River Basin causing widespread flooding along the Cedar River in Benton, Linn, Johnson, and Cedar Counties. As a result of the flooding, there were 18 deaths, 106 injuries, and over 38 000 people displaced from their homes; this made it necessary for the Iowa Department of Health to conduct a rapid needs assessment to quantify the scope and effect of the floods on human health.
Methods: In response, the Iowa Department of Public Health mobilized interview teams to conduct rapid needs assessments using Geographic Information Systems (GIS)-based cluster sampling techniques. The information gathered was subsequently employed to estimate the public health impact and significant human needs that resulted from the flooding.
Results: While these assessments did not reveal significant levels of acute injuries resulting from the flood, they did show that many households had been temporarily displaced and that future health risks may emerge as the result of inadequate access to prescription medications or the presence of environmental health hazards.
Conclusions: This exercise highlights the need for improved risk communication measures and ongoing surveillance and relief measures. It also demonstrates the utility of rapid needs assessment survey tools and suggests that increasing use of such surveys can have significant public health benefits.
(Disaster Med Public Health Preparedness. 2011;5:287–292)
Recent research has suggested that understanding and addressing the high prevalence of sleep difficulties in older women requires going beyond a purely physiological focus to address the role of social contextual pressures and demands. We take a gendered lifecourse approach to explore how sleep difficulties have evolved and how their management might reflect the position of older women in society more broadly. We conducted in-depth interviews with 12 oldest-old (average age 86) community-dwelling women who currently experienced sleep difficulties. Five themes emerged from the analysis: significant life stages; contingent lives; daily concerns in relation to ageing; attitudes and responses of women and general practitioners; and stigma and sleeping pills, which provided a conceptual framework through which to explain the reality of sleep difficulties for these women. For all women, sleep difficulties were not related to physical aspects such as pain or discomfort, but were largely shaped by demands associated with family relationships at different times in the lifecourse. Furthermore, our findings suggest that responses by women themselves, and health professionals, reflect a sense of stigma around sleep difficulties and use of sleeping pills. More emphasis on the social contextual explanations underpinning sleep difficulties might lead to better prevention and treatment of such problems, and increase quality of life.
Carbon overcoat films are used extensively in thin film disk applications to provide wear resistance. A nano-indentation technique and wafer curvature measurements have been used to study the mechanical properties of carbon films sputtered under various processing conditions. Specifically, the effects of substrate/target spacing, power, pressure, and substrate bias have been studied for films sputtered in an argon plasma. The relationship of these properties to contact start-stop performance of hydrocarbon lubricated disks is further described. The frictional performance during the test can be related to film hardness, while the durability can be affected by the residual film stress.
Blue light emitting diodes (LEDs) based on an AlGaN/GaN/AlGaN double heterojunction structure were electrically characterized as a function of temperature. Current-voltage (I-V), capacitance-voltage (C-V) and reverse recovery storage time measurements were conducted at temperatures in the range between -8° and 75° C. Capacitance-voltage measurements as a function frequency (20 Hz – 1 MHz) and electroluminescence study at room temperature were also performed. It was observed that the diode turn-on voltage decreased with increasing temperature, however, reverse leakage currents monitored at -1, -5 and -10 V showed only a slight increase with increasing temperature. The concentration of deep states and their position in the bandgap, as extracted from logarithmic plots of the forward characteristics, were not influenced by the measurement temperature. Recombination lifetimes, as obtained from experimentally determined reverse recovery storage times, remained constant over the range of temperature considered. A higher value of diode capacitance was observed at low measurement frequencies (20 Hz – 1 kHz), gradually dropping to a lower value over a frequency range between (1 kHz – 100 kHz) and remained constant from 100 kHz to 1 MHz. A loss peak centered about 10 kHz was observed in the corresponding plot of gm/ω as a function of frequency, f. The position of the peak in the gm/ω - frequency (f) plot and dC/dω(for f in the range 1 kHz – 100 kHz ), yielded a concentration of deep-states of approximately 2.2 × 1015/cm3, located at 0.39 eV above the valence bandedge.
Metaphycus flavus (Howard) (Hymenoptera: Encyrtidae) is a facultatively gregarious endoparasitoid of soft scales (Hemiptera: Coccidae). When it develops in superparasitised hosts, the larvae often attack and consume brood mates six or more days post oviposition. Under our laboratory conditions (25±1°C and 14 hours of light followed by 18±1°C and ten hours of darkness in 50–70% R.H.), M. flavus eggs hatched three days after oviposition. Measurements of the mandibles and tentorium indicate there are four larval instars, and M. flavus reaches the fourth instar by day six post oviposition, and pupates on day eight. Thus, cannibalism among M. flavus larvae occurs during the fourth instar. During this instar, M. flavus larvae separate from their attachment to the scale cuticle, to which they were tethered by a respiratory structure during the previous three larval instars. Once detached, they are free to move within the scale, which increases the probability of larval encounters and aggressive behaviours. Moreover, the mandibles of the fourth instar are better adapted for fighting than are those of the first three larval instars, since they are larger and more sclerotized. The cranium and mouthparts of M. flavus have four different types of sensory organs, some of which are almost certainly olfactory, an unexpected function for a larva that presumably is surrounded by an aqueous medium where gustatory sensilla would seem to be more appropriate. The cranium also bears two pairs of what appear to be secretory pores.
The roles and responsibilities of special educators in both special and regular school settings are changing rapidly. More than two decades ago the move towards more inclusive practices disrupted the traditional, niche separatism of special educators to the extent that they are now an integral part of the regular school teaching staff. Today the broad agenda to facilitate access and participation for all students in education, not just students with disabilities, influences the roles and responsibilities of special educators. This article briefly identifies some of the generic pulses that are moving the special education profession from a focus on low incidence disabilities towards a more comprehensive approach to inclusion, school responsiveness and individualised learning pathways. From the foundation of inclusive practice, this article will describe how a qualitative study was used to understand the changing roles and responsibilities of special educators. A case-study analysis of 17 schools formed the basis of the investigation. Principals, lead teachers in special education and special education teachers were asked to identify trends and priorities in special education and also to identify rewards and challenges in their jobs. Further cross-referencing with teacher and special educator standards, a focus group, a stakeholder group and research in the field increased the opportunity for academics and special educators to critically reflect on the emerging demands placed on special educators and the attributes that are needed to be professionally effective.
We present the first results of a comprehensive HST study of the star-formation history of Fornax dSph, based on WFPC2 imaging of 7 Fornax fields. Our observations reach the oldest main-sequence turnoffs, allowing us to address fundamental questions of dwarf galaxy evolution, such as the spatial variations in the stellar content, and whether the old stellar population is made up of stars formed in a very early burst or the result of a more continuous star formation.