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Identifying routes of transmission among hospitalized patients during a healthcare-associated outbreak can be tedious, particularly among patients with complex hospital stays and multiple exposures. Data mining of the electronic health record (EHR) has the potential to rapidly identify common exposures among patients suspected of being part of an outbreak.
We retrospectively analyzed 9 hospital outbreaks that occurred during 2011–2016 and that had previously been characterized both according to transmission route and by molecular characterization of the bacterial isolates. We determined (1) the ability of data mining of the EHR to identify the correct route of transmission, (2) how early the correct route was identified during the timeline of the outbreak, and (3) how many cases in the outbreaks could have been prevented had the system been running in real time.
Correct routes were identified for all outbreaks at the second patient, except for one outbreak involving >1 transmission route that was detected at the eighth patient. Up to 40 or 34 infections (78% or 66% of possible preventable infections, respectively) could have been prevented if data mining had been implemented in real time, assuming the initiation of an effective intervention within 7 or 14 days of identification of the transmission route, respectively.
Data mining of the EHR was accurate for identifying routes of transmission among patients who were part of the outbreak. Prospective validation of this approach using routine whole-genome sequencing and data mining of the EHR for both outbreak detection and route attribution is ongoing.
To determine the preliminary feasibility, acceptability, and effects of Meaning-Centered Grief Therapy (MCGT) for parents who lost a child to cancer.
Parents who lost a child to cancer and who were between six months and six years after loss and reporting elevated levels of prolonged grief were enrolled in open trials of MCGT, a manualized, one-on-one cognitive-behavioral-existential intervention that used psychoeducation, experiential exercises, and structured discussion to explore themes related to meaning, identity, purpose, and legacy. Parents completed 16 weekly sessions, 60–90 minutes in length, either in person or through videoconferencing. Parents were administered measures of prolonged grief disorder symptoms, meaning in life, and other assessments of psychological adjustment preintervention, mid-intervention, postintervention, and at three months postintervention. Descriptive data from both the in-person and videoconferencing open trial were pooled.
Eight of 11 (72%) enrolled parents started the MCGT intervention, and six of eight (75%) participants completed all 16 sessions. Participants provided positive feedback about MCGT. Results showed postintervention longitudinal improvements in prolonged grief (d = 1.70), sense of meaning (d = 2.11), depression (d = 0.84), hopelessness (d = 1.01), continuing bonds with their child (d = 1.26), posttraumatic growth (ds = 0.29–1.33), positive affect (d = 0.99), and various health-related quality of life domains (d = 0.46–0.71). Most treatment gains were either maintained or increased at the three-month follow-up assessment.
Significance of results
Overall, preliminary data suggest that this 16-session, manualized cognitive-behavioral-existential intervention is feasible, acceptable, and associated with transdiagnostic improvements in psychological functioning among parents who have lost a child to cancer. Future research should examine MCGT with a larger sample in a randomized controlled trial.
Understanding the underlying mechanisms of recovery from insomnia is an important goal for improving existing treatments. In a randomised controlled trial, 57 participants with insomnia disorder were given either cognitive therapy (CT) or mindfulness-based therapy (MBT) following 4 sessions of CBT. Each participant was assessed on process measures related to CT and MBT. MBT resulted in improvement on mindfulness process measures and the size of the improvement was significantly greater than achieved in the CT condition. Interestingly, CT and MBT both resulted in significant improvement on the cognitive process measures. Treatment outcome on the primary outcome measure (Insomnia Severity Index) was not predicted by type of treatment but was predicted by posttreatment scores on the cognitive process measures. The results suggest that changes in cognitive processes are especially important in treating insomnia, and that there are different therapeutic modalities through which this can be achieved.
We numerically model the dynamics of the Enceladus plume ice grains and define our nominal plume model as having a particle size distribution n(R) ~ R−q with q = 4 and a total particulate mass rate of 16 kg s−1. This mass rate is based on average plume brightness observed by Cassini across a range of orbital positions. The model predicts sample volumes of ~1600 µg for a 1 m2 collector on a spacecraft making flybys at 20–60 km altitudes above the Enceladus surface. We develop two scenarios to predict the concentration of amino acids in the plume based on these assumed sample volumes. We specifically consider Glycine, Serine, α-Alanine, α-Aminoisobutyric acid and Isovaline. The first ‘abiotic’ model assumes that Enceladus has the composition of a comet and finds abundances between 2 × 10−6 to 0.003 µg for dissolved free amino acids and 2 × 10−5 to 0.3 µg for particulate amino acids. The second ‘biotic’ model assumes that the water of Enceladus's ocean has the same amino acid composition as the deep ocean water on Earth. We compute the expected captured mass of amino acids such as Glycine, Serine, and α-Alanine in the ‘biotic’ model to be between 1 × 10−5 to 2 × 10−5 µg for dissolved free amino acids and dissolved combined amino acids and about 0.0002 µg for particulate amino acids. Both models consider enhancements due to bubble bursting. Expected captured mass of amino acids is calculated for a 1 m2 collector on a spacecraft making flybys with a closest approach of 20 km during mean plume activity for the given nominal particle size distribution.
In a policy landscape dominated by forces that seek to continually reshape education according to market logics, there are particular impacts on the seemingly intractable crisis of Indigenous education policy making. Entrenched discourses of deficit result in education policy continually being ‘done to’ communities, with little heed paid to the effects of such efforts on the learning opportunities available to young Indigenous learners, particularly those living in remote communities. This paper examines the contemporary network of policy levers that come to shape how literacy policy is framed for Indigenous Australians through narratives of failure and crisis. In doing so, we ask what learning is made (im)possible and what are some of the ‘flattening’ effects on literacy curriculum and pedagogy as a result? Further, this paper seeks to open up the conversation around what learning is possible when the policy landscape is unflattened, when policy is ‘done with’ communities, and when pedagogical practices are opened up, rather than closed down.
Operational stress describes individual behavior in response to the occupational demands and tempo of a mission. The stress response of military personnel involved in combat and peace-keeping missions has been well-described. The spectrum of effect on medical professionals and support staff providing humanitarian assistance, however, is less well delineated. Research to date concentrates mainly on shore-based humanitarian missions.
The goal of the current study was to document the pattern of operational stress, describe factors responsible for it, and the extent to which these factors impact job performance in military and civilian participants of Continuing Promise 2011 (CP11), a ship-based humanitarian medical mission.
This was a retrospective study of Disease Non-Battle Injury (DNBI) data from the medical sick-call clinic and from weekly self-report questionnaires for approximately 900 US military and civilian mission participants aboard the USNS COMFORT (T-AH 20). The incidence rates and job performance impact of reported Operational Stress/Mental Health (OS/MH) issues and predictors (age, rank, occupation, service branch) of OS/MH issues (depression, anxiety) were analyzed over a 22-week deployment period.
Incidence rates of OS/MH complaints from the sick-call clinic were 3.7% (4.5/1,000 persons) and 12.0% (53/1,000 persons) from the self-report questionnaire. The rate of operational stress increased as the mission progressed and fluctuated during the mission according to ship movement. Approximately 57% of the responders reported no impact on job performance. Younger individuals (enlisted ranks E4-6, officer ranks O1-3), especially Air Force service members, those who had spent only one day off ship, and those who were members of specific directorates, reported the highest rates of operational stress.
The overall incidence of OS/MH complaints was low in participants of CP11 but was under-estimated by clinic-based reporting. The OS/MH complaints increased as the mission progressed, were more prevalent in certain groups, and appeared to be related to ship’s movement. These findings document the pattern of operational stress in a ship-based medical humanitarian mission and confirm unique ship-based stressors. This information may be used by planners of similar missions to develop mitigation strategies for known stressors and by preventive medicine, behavioral health specialists, and mission leaders to develop sensitive surveillance tools to better detect and manage operational stress while on mission.
ScoutenWT, MehalickML, YoderE, McCoyA, BrannockT, RiddleMS. The Epidemiology of Operation Stress during Continuing Promise 2011: A Humanitarian Response and Disaster Relief Mission aboard a US Navy Hospital Ship. Prehosp Disaster Med. 2017;32(4):393–402.
What makes a government legitimate? Why do people voluntarily comply with laws, even when no one is watching? The idea of political legitimacy captures the fact that people obey when they think governments' actions accord with valid principles. For some, what matters most is the government's performance on security and the economy. For others, only a government that follows democratic principles can be legitimate. Political legitimacy is therefore a two-sided reality that scholars studying the acceptance of governments need to take into account. The diversity and backgrounds of East Asian nations provides a particular challenge when trying to determine the level of political legitimacy of individual governments. This book brings together both political philosophers and political scientists to examine the distinctive forms of political legitimacy that exist in contemporary East Asia. It is essential reading for all academic researchers of East Asian government, politics and comparative politics.
A political order enjoys legitimacy when its citizens or subjects have reason to believe that its claim to power is based on rightful authority, and its exercise of power can be justified according to accepted principles or norms. Political legitimacy is thus always a two-sided affair; intrinsically, it entails both empirical and normative dimensions. Understood from an empirical or sociological point of view, a state or regime is legitimate to the extent that its people accept its authority and see its actions as justifiable according to reasons they accept as valid. The normative dimension of legitimacy concerns the question of whether the norms by which the political order justifies its power ought to be regarded as valid norms. A state can enjoy sociological legitimacy without meeting coherent criteria of normative legitimacy. A state that can be rationally justified according to a particular conception of normative legitimacy may not be legitimate in the eyes of its people if they do not embrace the normative premises that underwrite this justification. To fully understand the dynamics of political legitimation in a given context requires attentiveness to both its empirical and normative aspects.
Yet despite repeated admonitions from scholars who study political legitimacy, most scholarly work on the concept tends to address its normative and empirical dimensions as separate enterprises. Political philosophers seek to identify the principles for evaluating the moral justifiability of political power. Empirical social scientists investigate the factors behind a people's acceptance or rejection of political elites’ claims to govern. Neither approach seems to be entirely satisfactory on its own. A purely normative approach that abstracts away from particular contexts in constructing an ideal theory of legitimacy is vulnerable to the challenge that it has little practical relevance. Legitimacy is about power relations between rulers and ruled; surely a consideration of the reasons that motivate agents in a particular order is relevant to evaluating the legitimacy of power relations in that order. Likewise, a social scientific approach that takes citizens’ statements of support for a state as indicators of political legitimacy has not shed much light on the state's legitimacy or illegitimacy if it has not also probed the normative principles according to which they believe the state's actions to be justified.
Legitimacy is much more than a matter of theoretical or philosophical speculation; it rather constitutes the basis of very real differences in the empirical structure of domination. The reason for this fact lies in the generally observable need of any power, or even of any advantage of life, to justify itself.
– Max Weber
We have to speak of “multiple modernities,” different ways of erecting and animating the institutional forms that are becoming inescapable.
– Charles Taylor
Political legitimacy is centrally concerned with the justification of political authority: what reasons do people have to obey the commands (comply with the law, follow the rules) of a political order? So understood, legitimacy is an intrinsically normative construct: not any reason counts toward legitimacy, but only reasons that are valid from a moral point of view. As Max Weber acknowledged, people have many different reasons to comply with the dictates of political power holders, but only some of these reasons – the normative ones – count toward the legitimacy of a regime. Hope of benefits and fear of sanctions constitute prudential reasons for obedience, but they do not reflect the people's judgment whether the political order is justified in its exercise of power. Thus while many interpreters of the distinction between empirical and normative accounts of political legitimacy characterize the former as “descriptive” and the latter as “prescriptive,” this is misleading. It makes perfect sense for empirical social scientists to seek to understand the degree to which a particular political order enjoys legitimacy in the eyes of its people, but to be meaningful this endeavor must take account of whether the people believe its power of command to be justifiable according to some normative principle that they endorse.
In Western intellectual traditions, theoretical accounts of political legitimacy are deeply connected to the circumstances of modernity. The connection between modernity and theories of political legitimacy is equally strong for the social scientific tradition inaugurated by Max Weber and for the normative tradition of political philosophy stretching from Locke and Rousseau to Rawls and Habermas.
This volume grows out of a multiyear international research collaboration, East Asian Perspectives on Politics, whose broad purpose is to help advance the emerging field of comparative political theory. Our aim, like that of the growing number of scholars working on non-Western political thought, is to “deparochialize political theory,” that is, to decenter European traditions of thought in defining the parameters of our field. The project on East Asian Perspectives on Politics proceeded through a series of six workshops, held between 2010 and 2012, at leading universities in East Asia and Canada: Fudan University, the National University of Singapore, Seoul National University, the University of Hong Kong, Keio University, and the University of Victoria. The project has also received significant institutional support from the Centre for Ethics at the University of Toronto and the Peter Wall Institute at the University of British Columbia.
The project would not have been possible without the generous financial support and visionary leadership of the Shibusawa Ei'ichi Memorial Foundation, based in Tokyo, Japan. It is exceedingly rare for research foundations to take a chance on a research field that has not yet garnered widespread recognition in the academy. Comparative political theory has come into common parlance in the past several years, and a small but growing number of universities have designated the field as a target for faculty recruitment. But the field was barely on the horizon in 2005, when the Shibusawa Foundation sponsored a special panel on cross-cultural political thought at a colloquium at the University of Toronto. We are deeply indebted to the foundation, and in particular to its president, Masahide Shibusawa; its managing director, Jun'etsu Komatsu; and its research director, Masato Kimura.
We also owe an enormous debt of gratitude to the Social Sciences and Humanities Research Council of Canada for significant financial support for this project. This support not only made it possible to involve many Canadian scholars in the project but also to foster the work of talented younger scholars through the graduate workshops that accompanied each conference.
Thanks to the encouragement and sage guidance of Dr. Kimura, the initial panel discussion in Toronto led to a series of planning workshops for a more ambitious research collaboration.