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Research mentor training is a valuable professional development activity. Options for training customization (by delivery mode, dosage, content) are needed to address the many critical attributes of effective mentoring relationships and to support mentors in different institutional settings.
We conducted a pilot randomized controlled trial to evaluate a hybrid mentor training approach consisting of an innovative, 90-minute, self-paced, online module (Optimizing the Practice of Mentoring, OPM) followed by workshops based on the Entering Mentoring (EM) curriculum. Mentors (n = 59) were randomized to intervention or control arms; the control condition was receipt of a two-page mentoring tip sheet. Surveys (pre, post, 3-month follow up) and focus groups assessed training impact (self-appraised knowledge, skills, behavior change) and participants’ perceptions of the blended training model.
The intervention (∼6.5 hours) produced significant improvements in all outcomes, including skills gains on par with those reported previously for the 8-hour EM model. Knowledge gains and intention-to-change mentoring practices were realized after completion of OPM and augmented by the in-person sessions. Mentors valued the synergy of the blended learning format, noting the unique strengths of each modality and specific benefits to completing a foundational online module before in-person engagement.
Findings from this pilot trial support the value of e-learning approaches, both as standalone curricula or as a component of hybrid implementation models, for the professional development of research mentors.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Hospitals may implement admission screening cultures and may review transfer documentation to identify patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) to implement isolation precautions; however, outcomes and logistical considerations have not been well described.
At an academic hospital in Chicago, we retrospectively studied the implementation and outcomes of CRE admission screening from 2013 to 2016 during 2 periods. During period 1, we implemented active CRE rectal culture screening for all adults patients admitted to intensive care units (ICUs) and for those transferred from outside facilities to general wards. During period 2, screening was restricted only to adults transferred from outside facilities. For a subset of transferred patients who were previously reported to the health department as CRE positive, we reviewed transfer paperwork for appropriate documentation of CRE.
Overall, 11,757 patients qualified for screening; rectal cultures were performed for 8,569 patients (73%). Rates of CRE screen positivity differed by period, previous facility type (if transferred), and current inpatient location. A higher combined CRE positivity rate was detected in the medical and surgical ICUs among period 2 patients (3.3%) versus all other ward-period comparisons (P<.001). Among 13 transferred patients previously known to be CRE colonized, appropriate CRE transfer documentation was available for only 4 patients (31%).
Active screening for CRE is feasible, and screening patients transferred from outside facilities to the medical or surgical ICU resulted in the highest screen positivity rate. Furthermore, CRE carriage was inconsistently documented in transfer paperwork, suggesting that admission screening or enhanced inter-facility communication are needed to improve the identification of CRE-colonized patients.
Background: Central neuropathic pain syndromes are a result of central nervous system injury, most commonly related to stroke, traumatic spinal cord injury, or multiple sclerosis. These syndromes are distinctly less common than peripheral neuropathic pain, and less is known regarding the underlying pathophysiology, appropriate pharmacotherapy, and long-term outcomes. The objective of this study was to determine the long-term clinical effectiveness of the management of central neuropathic pain relative to peripheral neuropathic pain at tertiary pain centers. Methods: Patients diagnosed with central (n=79) and peripheral (n=710) neuropathic pain were identified for analysis from a prospective observational cohort study of patients with chronic neuropathic pain recruited from seven Canadian tertiary pain centers. Data regarding patient characteristics, analgesic use, and patient-reported outcomes were collected at baseline and 12-month follow-up. The primary outcome measure was the composite of a reduction in average pain intensity and pain interference. Secondary outcome measures included assessments of function, mood, quality of life, catastrophizing, and patient satisfaction. Results: At 12-month follow-up, 13.5% (95% confidence interval [CI], 5.6-25.8) of patients with central neuropathic pain and complete data sets (n=52) achieved a ≥30% reduction in pain, whereas 38.5% (95% CI, 25.3-53.0) achieved a reduction of at least 1 point on the Pain Interference Scale. The proportion of patients with central neuropathic pain achieving both these measures, and thus the primary outcome, was 9.6% (95% CI, 3.2-21.0). Patients with peripheral neuropathic pain and complete data sets (n=463) were more likely to achieve this primary outcome at 12 months (25.3% of patients; 95% CI, 21.4-29.5) (p=0.012). Conclusion: Patients with central neuropathic pain syndromes managed in tertiary care centers were less likely to achieve a meaningful improvement in pain and function compared with patients with peripheral neuropathic pain at 12-month follow-up.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
Both Zuckert and Strauss take the “surface” of Machiavelli's work as the necessary starting point for their interpretations. Zuckert differs from Strauss, however, with respect to what she takes the surface to be. She focuses more attentively on the literary character of the work, as written or literary, and so is led to a different series of observations and emphases in her interpretation of Machiavelli.
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.
OBJECTIVES/SPECIFIC AIMS: To diversify the biomedical research workforce by training postdoctoral scholars and junior faculty from 6 Minority Serving Institutions (MSIs) on practical research skills such as Critical and Creative Thinking, Formulating the Problem, Asking the Right Question, Grant Writing, and Team Science METHODS/STUDY POPULATION: In collaboration with our partners, we identified 11 topics where trainees lack research funding. Next, we identified instructors for these topics. We converted the topics to online module with modules ranging from 2 to 8 weeks. In working with an online education expert, we developed innovative online training using Moodle as the content management system. Scholars complete readings, videos, self-assessments and participate in discussion board each week. In addition, we have weekly synchronous sessions for each module. All scholars are required to take the grant writing module and 8 other modules. After each module, trainees complete a brief survey to evaluate the module. The leaders at the MSI participated in an intensive face-to-face training session on how to be a career coach so that they could be career coaches for the LEADS Scholars at their home institutions. RESULTS/ANTICIPATED RESULTS: In the first year, we selected 13 LEADS Scholars. All but 3 scholars elected to take every module. The 3 scholars did not enroll in the Peer Reviewing module. Results of the brief survey at the end of each module indicate that the scholars value each of the modules and rate them very highly. When 1 scholar wanted to leave the program, we decided to have a conference call with all of the LEADS Scholars to determine what was working and what was not working with the program. All scholars recognized the value of LEADS. Some scholars felt that the weekly synchronous session was too demanding as they have competing demands on their time. We consulted with the leadership at the MSI and decided to modify the requirements of the program such that every synchronous call was not required for successful completion of the module and to earn a badge. Scholars need to have at least 9 badges to earn a certificate. In addition to the training, we decided that scholars would also benefit from mock reviews of their grants. This will help them submit successful grants. We learned that the best way to serve the needs of the scholars is to work iteratively with the scholars and leadership to develop a successful program that most effectively meets their needs of the scholars and helps them launch a successful career. DISCUSSION/SIGNIFICANCE OF IMPACT: Postdoctoral scholars and junior faculty from MSI need practical research training to help launch their research career. We suspect that this is true of many institutions and plan to develop these modules so that they can be widely disseminated to other institutions.
Soft tissue-to-bone interfaces are complex structures that consist of gradients of extracellular matrix materials, cell phenotypes, and biochemical signals. These interfaces, called entheses for ligaments, tendons, and the meniscus, are crucial to joint function, transferring mechanical loads and stabilizing orthopedic joints. When injuries occur to connected soft tissue, the enthesis must be re-established to restore function, but due to structural complexity, repair has proven challenging. Tissue engineering offers a promising solution for regenerating these tissues. This prospective review discusses methodologies for tissue engineering the enthesis, outlined in three key design inputs: materials processing methods, cellular contributions, and biochemical factors.
This article considers the international retailing activities of Tiffany of New York between 1837 and 1914. Using data from the company archive alongside other sources, the findings indicate that five factors were determinants of sustainable international retailing: a centralized organizational structure, a stable ownership structure, existing international engagement, a strong brand identity, and a relevant international retail format. Placing Tiffany's activities in its wider commercial and consumer context, the findings illustrate the organizational changes and asset combination required to support the development of early international retail operations. The article contributes to theoretical understanding of the dynamics of retail internationalization.
Between the eleventh and thirteenth centuries AD, the Lower Vistula valley represented a permeable and shifting frontier between Pomerelia (eastern Pomerania), which had been incorporated into the Polish Christian state by the end of the tenth century, and the territories of western Prussian tribes, who had resisted attempts at Christianization. Pomeranian colonization eventually began to falter in the latter decades of the twelfth and early thirteenth centuries, most likely as a result of Prussian incursions, which saw the abandonment of sites across the borderland. Subsequently, the Teutonic Order and its allies led a protracted holy war against the Prussian tribes, which resulted in the conquest of the region and its incorporation into a theocratic state by the end of the thirteenth century. This was accompanied by a second wave of colonization, which resulted in the settlement pattern that is still visible in the landscape of north-central Poland today. However, not all colonies were destroyed or abandoned in between the two phases of colonization. The recently excavated site of Biała Góra, situated on the western side of the Forest of Sztum overlooking the River Nogat, represents a unique example of a transitional settlement that included both Pomeranian and Teutonic Order phases. The aim of this paper is to situate the site within its broader landscape context which can be characterized as a militarized frontier, where, from the later twelfth century and throughout much of the thirteenth century, political and economic expansion was combined with the ideology of Christian holy war and missionary activity. This paper considers how the colonists provisioned and sustained themselves in comparison to other sites within the region, and how Biała Góra may be tentatively linked to a documented but otherwise lost outpost in this volatile borderland.
The maximum safe storage interval after endoscope reprocessing remains unknown. We assessed the association between storage interval and endoscope contamination to evaluate the need for scope reprocessing prior to use.
We conducted a study in 2 phases. In phase 1, we cultured 9 gastrointestinal (GI) endoscopes that had been stored for at least 7 days since reprocessing. Each scope was cultured in 3 places: external surfaces of hand piece, insertion tube, and internal channels. In phase 2, after reprocessing these scopes, we hung and cultured them prospectively in a similar fashion at 1-, 2-, 4-, 6-, and 8-week intervals without patient use. We defined clinically relevant contamination as >100 colony-forming units per milliliter (CFU/mL).
In phase 1, median hang time was 69 days (range, 8–555 days). Considering the 27 total cultures, 3 of 27 GI endoscopes (11.1%) had positive cultures, all with nonpathogenic skin flora at ≤100 CFU/mL. Median hang time was not statistically different between scopes with positive and negative cultures (P=.82). In phase 2, 7 of 131 prospective cultures (5.3%) from 6 of 9 GI endoscopes at varying storage intervals were positive, all at ≤100 CFU/mL. At 56 days after reprocessing (the longest storage interval studied), 1 of 24 cultures (4.2%) was positive (100 CFU/mL of Bacillus species from external biopsy/suction ports).
No endoscopes demonstrated clinically relevant contamination at hang times ranging from 7 to 555 days, and most scopes remained uncontaminated up to 56 days after reprocessing. Our data suggest that properly cleaned and disinfected GI endoscopes could be stored safely for longer intervals than currently recommended.
Measurements of the radiocarbon concentration of several carbonate background materials, either mineral (IAEA C1 Carrara marble and Icelandic double spar) or biogenic (foraminifera and molluscs), show that the apparent ages of diverse materials can be quite different. Using 0.07 pMC obtained from mineral samples as a processing blank, the results from foraminifera and mollusc background samples, varying from 0.12 to 0.58 pMC (54.0-41.4 ka), show a species-specific contamination that reproduces over several individual shells and foraminifera from several sediment cores. Different cleaning attempts have proven ineffective, and even stronger measures such as progressive hydrolization or leaching of the samples prior to routine preparation, did not give any indication of the source of the contamination. In light of these results, the use of mineral background material in the evaluation of the age of older unknown samples of biogenic carbonate (>30 ka) proves inadequate. The use of background samples of the same species and provenance as the unknown samples is essential, and if such material is unavailable, generic biogenic samples such as mixed foraminifera samples should be used. The description of our new modular carbonate sample preparation system is also introduced.
At the Leibniz radiocarbon lab, art and archaeological objects, often chemically conserved and thus potentially contaminated with respect to their 14C content, are treated using a computer-controlled “Soxhlet”-type series extractor. This device uses a continuous procedure of boiling and condensation of different solvents for extraction and vacuum filtration under constant process conditions. An elutrope sequence of five solvents that dissolve most customary conservation chemicals was selected. A study of these different contaminants applied to reference wood samples with subsequent accelerator mass spectrometry (AMS) measurements demonstrates that their effective removal is dependent on the use of adequate solvents. For many contaminants (e.g. wood glue, methyl cellulose, Klucel®, sugar, and polyethylene glycol), routine acid-alkali-acid (AAA) treatment already yields satisfactory results, whereas for Caparol® and beeswax a relatively “mild” treatment with acetone, methanol, water, and subsequent standard AAA extraction is sufficient. Complete removal of rubber glue, epoxy resin, and paraffin can only be accomplished with our full set of solvents. The latter procedure is also appropriate when no or only incomplete information about the type of conservation material is available. For epoxy resin the contamination appears to be enriched in the alkali residue, and the easily soluble “humic acid” fraction, even after standard AAA treatment, gives satisfactory results. Two case studies on the application of the extraction procedures are presented.
Among dialysis facilities participating in a bloodstream infection (BSI) prevention collaborative, access-related BSI incidence rate improvements observed immediately following implementation of a bundle of BSI prevention interventions were sustained for up to 4 years. Overall, BSI incidence remained unchanged from baseline in the current analysis.
Recently, several case studies have demonstrated the presence of human radiocarbon dietary reservoir effects in inland contexts. Freshwater reservoir effects present a high degree of variability, making it difficult to define local reservoir effect reference values necessary for correcting chronologies based on 14C dating of human bone material. Here, we investigate the hypothesis that 14C ages of edible freshwater species are delimited by the 14C ages of the main water carbon pools (DIC, POC, and DOC).
Water, plant, algae, bivalve, and fish samples were collected from lakes Schwerin and Ostorf (Germany). 14C and isotopic measurements were performed on the floral and faunal species and on water DIC, POC, and DOC. The results demonstrate the potential of the study area for large and variable freshwater reservoir effects. In the case of Lake Schwerin, the working hypothesis was verified as the 14C ages of faunal and floral species were delimited by the 14C ages of water DIC and POC, probably associated with 2 extreme categories of food chains (grazing and detritus). While the results obtained confirm the working hypothesis and suggest a relatively straightforward interpretation, further research is necessary to investigate possible spatial and seasonal variations.
Radiocarbon measurements on bulk subaqueous sediments typically provide ages significantly older than actual time of deposition. This is generally caused by the presence of reworked organic compounds, which are depleted in 14C. To explore this issue of age heterogeneity, we collected 4 organic-rich samples from varying depths in a lake sediment core at the Gemündener Maar (Eifel, Germany), a lake of volcanic origin. We divided each sample into 5 standard grain-size fractions: gravel, sand, silt, clay, and 1 fraction smaller than 0.45 μm. These were cleaned separately using a standard acid-alkali-acid treatment. The highly organic gravel-size fraction provided the youngest 14C ages of all grain-size fractions and seems to be associated most closely with the time of deposition. By contrast, the silt and clay fractions show significantly older ages. If the investigated limnic sediment layer does not contain any identifiable terrestrial macrofossils, extracting and measuring coarser grain-size fractions instead of measuring bulk sediment samples will provide a better approximation of the time of sedimentation.