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Patient assessment is a fundamental feature of community paramedicine, but the absence of a recognized standard for assessment practices contributes to uncertainty about what drives care planning and treatment decisions. Our objective was to summarize the content of assessment instruments and describe the state of current practice in community paramedicine home visit programs.
We performed an environmental scan of all community paramedicine programs in Ontario, Canada, and used content analysis to describe current assessment practices in home visit programs. The International Classification on Functioning, Disability, and Health (ICF) was used to categorize and compare assessments. Each item within each assessment form was classified according to the ICF taxonomy.
A total of 43 of 52 paramedic services in Ontario, Canada, participated in the environmental scan with 24 being eligible for further investigation through content analysis of intake assessment forms. Among the 24 services, 16 met inclusion criteria for content analysis. Assessment forms contained between 13 and 252 assessment items (median 116.5, IQR 134.5). Most assessments included some content from each of the domains outlined in the ICF. At the subdomain level, only assessment of impairments of the functions of the cardiovascular, hematological, immunological, and respiratory systems appeared in all assessments.
Although community paramedicine home visit programs may differ in design and aim, all complete multi-domain assessments as part of patient intake. If community paramedicine home visit programs share similar characteristics but assess patients differently, it is difficult to expect that the resulting referrals, care planning, treatments, or interventions will be similar.
Some studies found that providing micronutrient powder (MNP) causes adverse health outcomes; modifying factors are unknown. We aimed to investigate if iron status and inherited hemoglobin disorders (IHbD) modify the impact of MNP on growth and diarrhea among young Lao children. In a double-blind controlled trial, 1704 children ages 6-23mo were randomized to: daily MNP (with 6mg iron plus 14 micronutrients) or placebo for ~36wks. IHbD, and baseline and final hemoglobin (Hb), iron status, and anthropometrics were assessed. Caregivers provided weekly morbidity reports. At enrollment 55.6% were anemic; only 39.3% had no sign of clinically significant IHbD. MNP had no overall impact on growth and longitudinal diarrhea prevalence. Baseline Hb modified the effect of MNP on LAZ (P for interaction=0.082). Among children who were initially non-anemic, final mean LAZ in the MNP group was slightly lower (−1.93 (95%CI: −1.88, −1.97)) vs. placebo (−1.88 (95%CI: −1.83, −1.92)), and the opposite occurred among initially anemic children (final mean LAZ −1.90 (95% CI: −1.86, −1.94) in MNP vs. −1.92 (95% CI: −1.88, −1.96) in placebo). IHbD modified the effect on diarrhea prevalence (P=0.095). Among children with IHbD, the MNP group had higher diarrhea prevalence (1.37 (95%CI: 1.17, 1.59) vs. 1.21 (95%CI: 1.04, 1.41)), while it was lower among children without IHbD who received MNP (1.15 (95%CI: 0.95, 1.39) vs. 1.37 (95%CI: 1.13, 1.64)). In conclusion, there was a small adverse effect of MNP on growth among non-anemic children and on diarrhea prevalence among children with IHbD.
One generation's experience of childhood maltreatment is associated with that of the next. However, whether this intergenerational transmission is specific to distinct forms of maltreatment and what factors may contribute to its continuity remains unclear. Borderline personality pathology is predicted by childhood maltreatment and characterized by features (e.g., dysregulated emotion, relationship instability, impulsivity, and inconsistent appraisals of others) that may contribute to its propagation. Among 364 older adults and 573 of their adult children (total n = 937), self-reported exposure to distinct forms of childhood maltreatment (i.e., emotional, physical, and sexual abuse, and emotional and physical neglect as assessed by the Childhood Trauma Questionnaire) showed homotypic and heterotypic associations across generations with little evidence that latent factors unique to specific forms of maltreatment show generational continuity. General nonspecific indices of childhood maltreatment showed evidence of intergenerational transmission after accounting for demographic factors and parent socioeconomic status (b = 0.126, p = 9.21 × 10−4). This continuity was partially mediated by parental borderline personality pathology (assessed longitudinally through a variety of measures and sources, indirect effect: b = 0.031, 95% confidence interval [0.003, 0.060]). The intergenerational continuity of childhood maltreatment may largely represent general risk for nonspecific maltreatment that may, in part, be propagated by borderline personality pathology and/or shared risk factors.
Grounded in self-determination theory's (SDT; Ryan & Deci, 2017) organismic perspective, we present a process view of integrative emotion regulation. SDT describes three general types of emotion regulation: integrative emotion regulation, which focuses on emotions as carrying information that is brought to awareness; controlled emotion regulation, which is focused on diminishing emotions through avoidance, suppression, or enforced expression or reappraisal; and amotivated emotion regulation, in which emotions are uncontrolled or dysregulated. We review survey and experimental research contrasting these emotion regulation styles, providing evidence for the benefits of integrative emotion regulation for volitional functioning, personal well-being, and high-quality relationships, and for the costs of controlled emotion regulation and dysregulation. The development of emotion regulation styles is discussed, especially the role of autonomy-supportive parenting in fostering more integrative emotion regulation, and the role of controlling parenting in contributing to controlled or dysregulated emotion processing. Overall, integrative emotion regulation represents a beneficial style of processing emotions, which develops most effectively in a nonjudgmental and autonomy-supportive environment, an issue relevant to both development and psychotherapy.
Objective: The Boston Diagnostic Aphasia Examination (BDAE) is one of the most commonly used aphasia batteries. The newest edition has undergone significant revisions since its original publication in 1972, but existing evidence for its validity is lacking. We examined the construct validity of BDAE-3 and identified the factor structure of this battery. Method: A total of 355 people with aphasia of various types and severity completed neuropsychological evaluations to assess their patterns of language impairment. A principal component analysis with varimax rotation was conducted to examine the components of BDAE-3 subtests. Results: Five components accounting for over 70% of the BDAE-3 total variance were found. The five language factors identified were auditory comprehension/ideomotor praxis, naming and reading, articulation-repetition, grammatical comprehension, and phonological processing. Conclusions: Our results show that the BDAE-3 demonstrates good construct validity, and certain language functions remain primary, distinct language domains (i.e., receptive vs. expressive language) across severities of aphasia. Overall, our findings inform clinical practice by outlining the inherent structure of language abilities in people with aphasia. Clinicians can utilize the findings to select core BDAE-3 tests that are most representative of their respective functions, thereby reducing the total testing time while preserving diagnostic sensitivity. (JINS, 2019, 25, 772–776)
Dicamba-resistant (DR) kochia is an increasing concern for growers in the US Great Plains, including Kansas. Greenhouse and field experiments (Garden City and Tribune, KS, in the 2014 to 2015 growing season) were conducted to characterize the dicamba resistance levels in two recently evolved DR kochia accessions collected from fallow fields (wheat–sorghum–fallow rotation) near Hays, KS, and to determine the effectiveness of various PRE herbicide tank mixtures applied in fall or spring prior to the fallow year. Dicamba dose–response studies indicated that the KS-110 and KS-113 accessions had 5- to 8-fold resistance to dicamba, respectively, relative to a dicamba-susceptible (DS) accession. In separate field studies, atrazine-based PRE herbicide tank mixtures, dicamba + pendimethalin + sulfentrazone, and metribuzin + sulfentrazone when applied in the spring had excellent kochia control (85% to 95%) for 3 to 4 mo at the Garden City and Tribune sites. In contrast, kochia control with those PRE herbicide tank mixtures when applied in the fall did not exceed 79% at the later evaluation dates. In conclusion, the tested kochia accessions from western Kansas had evolved moderate to high levels of resistance to dicamba. Growers should utilize these effective PRE herbicide tank mixtures (multiple sites of action) in early spring to manage kochia seed bank during the summer fallow phase of this 3-yr crop rotation (wheat–corn/sorghum–fallow) in the Central Great Plains.
Recommending nitrofurantoin to treat uncomplicated cystitis was associated with increased nitrofurantoin use from 3.53 to 4.01 prescriptions per 1,000 outpatient visits, but nitrofurantoin resistance in E. coli isolates remained stable at 2%. Concomitant levofloxacin resistance was a significant risk for nitrofurantoin resistance in E. coli isolates (odds ratio [OR], 2.72; 95% confidence interval [CI], 1.04–7.17).
The US Navy utilizes numerous resources to encourage smoking cessation. Despite these efforts, cigarette smoking among service members remains high. Electronic cigarettes (EC) have provided an additional cessation resource. Little is known regarding the utilization efficacy of these cessation resources in the US Navy.
This study sought to explore the utilization and efficacy of ECs and other smoking cessation resources.
An anonymous cross-sectional survey was conducted at a military clinic from 2015 to 2016. Participants were active duty in the US Navy and reported demographics, smoking behaviors, and utilization of cessation resources.
Of the 977 participants in the study, 14.9% were current and 39.4% were former smokers. Most current smokers (83.6%) previously attempted cessation, smoked an average of 2–5 cigarettes per day (34.7%), and smoked every day of the month (26.4%). The number of daily cigarettes smoked and number of days cigarettes were smoked per month was not significantly different between cigarette-only smokers and EC dual users (p = 0.92, p = 0.75, respectively). Resources used by current and former smokers include: ‘cold turkey’ (44.6%, 57.1%, respectively), ECs (22.3%, 24.7%), nicotine patch (8.3%, 1.3%), medicine (6.6%, 3.9%), nicotine gum (5.8%, 10.4%), and quit programs (2.5%, 2.6).
Current and former cigarette smokers utilized similar resources to quit smoking. Electronic cigarettes are being used for cessation but do not significantly reduce the number of cigarettes smoked on a daily or monthly basis. Future studies may benefit from exploring the use of cessation resources and ECs within the military as a whole.
Cambodia supports populations of three Critically Endangered vulture species that are believed to have become isolated from the rest of the species’ global range. Until recently Cambodia’s vulture populations had remained stable. However a recent spike in the number of reports of the use of poisons in hunting practices suggests the need to re-evaluate the conservation situation in Cambodia. Population trend analysis showed that since 2010 populations of the White-rumped Vulture Gyps bengalensis and Red-headed Vulture Sarcogyps calvus have declined, while the Slender-billed Vulture Gyps tenuirostris may also have started to decline since 2013. These trends are supported by evidence of reduced nesting success. A survey of veterinary drug availability revealed that diclofenac, the non-steroid anti-inflammatory drug responsible for vulture declines in South Asia was not available for sale in any of the 74 pharmacies surveyed. However, a poisoned Slender-billed Vulture tested positive for carbofuran in toxicology tests. This provides the first evidence of a vulture mortality resulting from carbofuran in Cambodia. The findings suggest the urgent need to tackle use of carbamate pesticides in hunting. Proposed conservation actions are: a) prevention of poisoning through national bans on harmful carbamate pesticides and diclofenac and education campaigns to reduce demand and use; b) training of personnel in priority protected areas in detection and response to poisoning incidents; c) maintenance of a safe and reliable food source through vulture restaurants to ensure short-term survival, and d) protection and restoration of large areas of deciduous dipterocarp forests to enable long-term species recovery.
Excavations at several locations in Verteba Cave have uncovered a large amount of human skeletal remains in association with faunal bones and Tripolye material culture. We aim to establish radiocarbon (14C) dates for eight sites and to evaluate whether these deposits are singular events, or slow accumulations over time. 14C measurements, along with stable carbon and nitrogen isotope data from human and faunal remains, were collected from 18 specimens. Stable isotope values were used to evaluate human and animal diet, and whether freshwater reservoir effects offset measured dates. We found diets of the sampled species had limited to no influence from freshwater resources. Human diet appears to be dominated by terrestrial plants and herbivores. Four new sites were identified as Eneolithic. Comparisons of dates from top and bottom strata for two sites (7 and 20) reveal coeval dates, and we suggest that these deposits represent discrete events rather than slow continuous use. Lastly, we identified dates from the Mesolithic (8490±45 BP, 8765±30 BP), Iron Age (2505±20 BP), Slavic state era (1315±25 BP), and Medieval Period (585±15 BP), demonstrating periodic use of the cave by humans prior to and after the Eneolithic.
To date, Ireland has been a leading light in the provision of youth mental health services. However, cognisant of the efforts of governmental and non-governmental agencies working in youth mental health, there is much to be done. Barriers into care as well as discontinuity of care across the spectrum of services remain key challenges. This editorial provides guidance for the next stage of development in youth mental care and support that will require significant national engagement and resource investment.
Evangelicals garner much attention in polling and public opinion
research, yet measuring white evangelicals remains elusive, even
opaque. This paper provides practical guidance to researchers who
want to measure or analyze evangelicals. In the social sciences,
many have adopted a detailed religious affiliation approach that
categorizes evangelicals based on the religious tradition of the
denominations to which they belong. Others have used a simpler
self-identification scheme, which asks respondents if they consider
themselves “born-again or evangelical”. While the affiliation and
self-identification schemes are predominant, a practical examination
of these approaches has been absent. Using several waves of the
General Social Survey and the Cooperative Congressional Election
Study, we compare them. We find almost no statistical differences
between the two measurements in prominent demographic, political, or
religious factors. Thus, we suggest that for most a simple question
about broad religious affiliation followed by a born-again or
evangelical self-identification question will suffice.