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Despite the critical role families play in the care and recovery journeys of people who experience enduring mental distress, they are often excluded by the mental health services in the care and decision-making process. International trends in mental health services emphasise promoting a partnership approach between service users, families and practitioners within an ethos of recovery.
This paper evaluated the acceptability of and initial outcomes from a clinician and peer co-led family information programme.
A sequential design was used involving a pre-post survey to assess changes in knowledge, confidence, advocacy, recovery and hope following programme participation and interviews with programme participants. Participants were recruited from mental health services running the information programme. In all, 86 participants completed both pre- and post-surveys, and 15 individuals consented to interviews.
Survey findings indicated a statistically significant change in family members’ knowledge about mental health issues, recovery attitudes, sense of hope and confidence. In addition, the interviews suggested that the programme had a number of other positive outcomes for family members, including increased communication with members of the mental health team and increased awareness of communication patterns within the family unit. Family members valued the opportunity to share their experiences in a ‘safe’ place, learn from each other and provide mutual support.
The evaluation highlights the importance of developing information programmes in collaboration with family members as well as the strength of a programme that is jointly facilitated by a family member and clinician.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
Prehospital physicians balance the need to stabilize patients prior to transport, minimizing the delay to transport patients to the appropriate level of care. Literature has focused on which interventions should be performed in the prehospital environment, with airway management, specifically prehospital intubation (PHI), being a commonly discussed topic. However, few studies have sought additional factors which influence scene time or quantify the impact of mission characteristics or therapeutic interventions on scene time.
The goal of this study was to identify specific interventions, patient demographics, or mission characteristics that increase scene time and quantify their impact on scene time.
A retrospective, database model-building study was performed using the prehospital mission database of South Australian Ambulance Service (SAAS; Adelaide, South Australia) MedSTAR retrieval service from January 1, 2015 through August 31, 2016. Mission variables, including patient age, weight, gender, retrieval platform, physician type, PHI, arterial line placement, central line placement, and finger thoracostomy, were assessed for predictors of scene time.
A total of 506 missions were included in this study. Average prehospital scene time was 34 (SD = 21) minutes. Four mission variables significantly increased scene time: patient age, rotary wing transport, PHI, and arterial line placement increased scene time by 0.09 (SD = 0.08) minutes, 13.6 (SD = 3.2) minutes, 11.6 (SD = 3.8) minutes, and 34.4 (SD = 8.4) minutes, respectively.
This study identifies two mission characteristics, patient age and rotary wing transport, and two interventions, PHI and arterial line placement, which significantly increase scene time. Elderly patients are medically complex and more severely injured than younger patients, thus, may require more time to stabilize on-scene. Inherent in rotary wing operations is the time to prepare for the flight, which is shorter during ground transport. The time required to safely execute a PHI is similar to that in the literature and has remained constant over the past two years; arterial line placement took longer than envisioned. The SAAS MedSTAR has changed its clinical practice guidelines for prehospital interventions based on this study’s results. Retrieval services should similarly assess the necessity and efficiency of interventions to optimize scene time, knowing that the time required to safely execute an intervention may reach a minimum duration. Defining the scene time enables mission planning, team training, and audit review with the aim of improved patient care.
Endophytes are microorganisms that colonise the internal compartments of host plants without harming the host. In many cases, endophytic bacteria have been shown to provide several beneficial effects to their host plant, including growth-promoting activity, modulation of plant metabolism and phytohormone signalling that leads to adaptation to environmental abiotic or biotic stresses. Endophytic bacterial community structure is influenced by plant genotype, soil type, abiotic and biotic factors, such as environmental conditions and microbe–microbe/plant–microbe interactions. In addition, agricultural management practices, such as soil tillage, crop rotation, and fertiliser and pesticide applications have a major effect on the function and structure of the soil, rhizosphere and endophytic bacterial communities. Oilseed rape (Brassica napus L.) is an important break crop in cereal crop rotation and can significantly reduce the rate of ‘take-all’ fungal disease (Gaeumannomyces graminis var. tritici) and, as a result, improves the yield of subsequent cereal crops. Additionally, oilseed rape is the world’s third largest source of vegetable oil used for human nutrition and as a source of oil for biodiesel production. Therefore, the promotion of agricultural practices that maintain the natural diversity of B. napus endophytic bacteria is receiving attention as an important element for a sustainable agricultural system that ensures crop productivity and quality while reducing inputs. This chapter reviews the existing literature on the role of endophytic bacteria in oilseed rape crop production, agricultural factors influencing oilseed rape bacterial diversity and discusses how meta-omics is enhancing our understanding of the endophytic bacteria and their function.
After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This multi-society meeting was dedicated to establish standards of practice in acute ischemic stroke intervention aiming for a consensus on the minimum requirements for centers providing such treatment. In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). However, for geographical reasons, some patients are unable to reach such a center in a reasonable period of time. With this in mind, the group paid special attention to define recommendations on the prerequisites of organizing stroke centers providing medical thrombectomy for acute ischemic stroke, but not for other neurovascular diseases (level 2 centers). Finally, some centers will have a stroke unit and offer intravenous thrombolysis, but not any endovascular stroke therapy (level 3 centers). Together, these level 1, 2, and 3 centers form a complete stroke system of care. The multi-society group provides recommendations and a framework for the development of medical thrombectomy services worldwide.
Mental illness recovery has been described as an outcome (symptom free) or process (symptom management) where peer supporters are essential. Whereas, substance use disorder recovery endorses outcome alone: achieving recovery once abstinent. Peer supporters with an abstinence agenda use confrontation for those in denial. Herein, we unpack this distinction.
The Gravettian settlements of Europe are considered as an expression of human adaptation to harsh climates. In Southern Europe, however, favorable vegetation-climate conditions supported hunters-gatherer subsistence and the maintenance of their large-scale networks. This was also the case of the North-Adriatic plain and the Apennine mountain ridge in Italy. Traditionally considered lacking evidence, the northern part of the Apennine ridge has recently yielded the Early Gravettian site of Piovesello, located at 870 m a.s.l. Survey and excavation revealed lithic artifacts in primary position embedded in loamy sediments. Radiocarbon dating, anthracological and extended palynological and microcharcoal analyses have been integrated to reconstruct the palaeoecological context of this camp which was probably positioned above the timberline in an arid rocky landscape, bounding the fronts of local glaciers close to their maximum expansion at the time of Greenland Stadial (GS) 5 (32.04 - 28.9 ka cal BP). Human activity left ephemeral traces represented by lithic artefacts, charcoal, and the introduction of radiolarites from sources in proximity to the site and of chert from very far western sources. Evidence from Piovesello contributes to the reconstruction of human and vegetation ecology during Late Pleistocene glaciations and also provides hints for the historical biogeography of petrophytic plants and their orographic relics in the northern Apennine.
Recent advances in biotechnology have resulted in crops that are tolerant to the synthetic auxin 2,4-D, expanding the weed management versatility of this herbicide. With potential expansions of use, concerns have been raised about the increased risk of herbicide drift, leading to damage to nontarget crops. A field-scale study was conducted with the objective to measure drift deposition and the potential for drift reduction conferred by a proprietary pre-mixture formulation of 2,4-D choline salt plus glyphosate dimethylammonium salt compared to an in-tank mixture of 2,4-D dimethylamine salt plus glyphosate potassium salt. Treatments were made with field-scale spray equipment under typical application conditions in McCook, NE, using three widely used nozzle tips. Deposition was captured in triplicate downwind collector lines and assayed for tracer dye and 2,4-D. In comparison to the in-tank mixture, the pre-mixture formulation exhibited lower downwind depositions when applied through a flat-fan (TeeJet Extended Range; XR) and air induction (TeeJet Air Induction Extended Range; AIXR) nozzles, but not with a pre-orifice (TeeJet TurboTeeJet Induction; TTI) nozzle. Based upon median deposition at 30 m downwind, the pre-mixture formulation reduced drift by 62% and 91%, for the XR and AIXR nozzles, respectively. From a drift reduction perspective, the pre-mixture formulation performance with the AIXR nozzle was equivalent to a much coarser TTI nozzle while still offering sufficient foliar coverage for acceptable weed control.
In their focal article, Chernyak-Hai and Rabenu (2018) argue that the foundational assumptions of social exchange theory (SET) should be revisited and revised because of recent changes in the workplace and the workforce. Using employee engagement data from recent research projects conducted in applied settings, we investigated a series of questions based on Chernyak-Hai and Rabenu's working hypotheses.
Structural transformation is a key indicator of economic development. We present the first time series of male labor sectoral shares for England and Wales before 1800, using a large sample of probate and apprenticeship data to produce national- and county-level estimates. England experienced a rapid decline in the share of workers in agriculture between the early seventeenth and the beginning of the eighteenth centuries, associated with rising agricultural and especially industrial productivity; Wales saw few changes. Our results show that England experienced unusually early structural change and highlight the mid-seventeenth century as a turning point.
Dietary phosphoglycerides and n-3 long-chain PUFA (LC-PUFA) play important functions in the development of pikeperch (Sander lucioperca) larvae. This study aimed to determine optimal dietary levels of soyabean lecithin (SBL)-derived phospholipids (PL) in starter feeds for pikeperch larvae 10–30 d post-hatch (DPH) and examine performance and ontogeny by additional supplementation of n-3 LC-PUFA in the form of Algatrium DHA 70 (glyceride product; 660–700 mg/g DHA; EPA 60–75 mg/g). In total, six isoproteic and isoenergetic extruded diets were formulated with increasing levels of PL (3·7, 8·3 or 14·5 % wet weight (w.w.), respectively); however, three of the diets were supplemented with three levels of Algatrium DHA 70 (0·6, 2·0 or 3·4 %, respectively). Liver proteomic analyses of larvae at 30 DPH were included for effects of PL and primarily DHA on performance, physiological expression and interactions in larval proteins. In addition, bone anomalies, digestive enzymatic activity, candidate gene expression and skeleton morphogenesis were examined. Results confirmed the importance of dietary PL levels of at least 8·2 % w.w., and an additional beneficiary effect of supplementation with DHA plus EPA. Thus, combined supplementation of SBL (up to 14·51 % w.w. PL) and n-3 LC-PUFA (1·004 % DM DHA and 0·169 % DM EPA) in the form of TAG resulted in highest growth and lowest incidence of anomalies, improved digestive enzyme activity and had differential effect on liver proteomics. The results denote that essential fatty acids can be supplemented as TAG to have beneficial effects in pikeperch larvae development.
Vertical hetero-structures made from stacked monolayers of transition metal dichalcogenides (TMDC) are promising candidates for next-generation optoelectronic and thermoelectric devices. Identification of optimal layered materials for these applications requires the calculation of several physical properties, including electronic band structure and thermal transport coefficients. However, exhaustive screening of the material structure space using ab initio calculations is currently outside the bounds of existing computational resources. Furthermore, the functional form of how the physical properties relate to the structure is unknown, making gradient-based optimization unsuitable. Here, we present a model based on the Bayesian optimization technique to optimize layered TMDC hetero-structures, performing a minimal number of structure calculations. We use the electronic band gap and thermoelectric figure of merit as representative physical properties for optimization. The electronic band structure calculations were performed within the Materials Project framework, while thermoelectric properties were computed with BoltzTraP. With high probability, the Bayesian optimization process is able to discover the optimal hetero-structure after evaluation of only ∼20% of all possible 3-layered structures. In addition, we have used a Gaussian regression model to predict not only the band gap but also the valence band maximum and conduction band minimum energies as a function of the momentum.
Depression contributes to persistent opioid analgesic use (OAU). Treating depression may increase opioid cessation.
To determine if adherence to antidepressant medications (ADMs) v. non-adherence was associated with opioid cessation in patients with a new depression episode after >90 days of OAU.
Patients with non-cancer, non-HIV pain (n = 2821), with a new episode of depression following >90 days of OAU, were eligible if they received ≥1 ADM prescription from 2002 to 2012. ADM adherence was defined as >80% of days covered. Opioid cessation was defined as ≥182 days without a prescription refill. Confounding was controlled by inverse probability of treatment weighting.
In weighted data, the incidence rate of opioid cessation was significantly (P = 0.007) greater in patients who adhered v. did not adhered to taking antidepressants (57.2/1000 v. 45.0/1000 person-years). ADM adherence was significantly associated with opioid cessation (odds ratio (OR) = 1.24, 95% CI 1.05–1.46).
ADM adherence, compared with non-adherence, is associated with opioid cessation in non-cancer pain. Opioid taper and cessation may be more successful when depression is treated to remission.
Glyphosate-resistant (GR) common waterhemp (CW) is a localized weed in Ontario and one of the most problematic weeds in the US Corn Belt. First confirmed in Ontario in 2014, GR CW has now been confirmed in forty fields in three counties in Ontario as of 2015. Historically, the primary POST herbicides used for the control of CW in soybean were glyphosate, acifluorfen and fomesafen, but resistance to all three has been confirmed in many US states. Research was conducted in 2015 and 2016 to determine the control of GR CW with some of the new herbicide-resistant soybean technologies including glufosinate (LibertyLink), 2,4-D and glyphosate (Enlist), and isoxaflutole, mesotrione, and glufosinate (HPPD-resistant). Glyphosate-resistant CW was controlled (≥90%) all season with a two-pass weed control system across all herbicide-resistant soybean technologies evaluated. The two-pass weed control system in this research is defined as a PRE herbicide followed by a POST herbicide. At 12 WAA, the two-pass programs in LibertyLink, Enlist, and HPPD-resistant systems controlled GR CW up to 98, 98, and 92%, respectively, and reduced GR CW densities to 0 to 2% of the weedy control at 4 WAA. The two-pass programs provided greater GR CW control than PRE or POST herbicides alone. This study found that the use of two-pass weed control programs in glufosinate-resistant, glyphosate DMA/2,4-D choline-resistant and HPPD-resistant soybean can provide excellent control of GR CW, and can be valuable tools to reduce the selection intensity for herbicide-resistant weeds. Through the rotational use of different technologies, growers may be able to better manage their weed populations in reducing the risk of resistance when compared to the use of one herbicide repeatedly.
Glyphosate-resistant (GR) common waterhemp is the fifth GR weed species confirmed in Canada, and the fourth in Ontario. As of 2017, GR common waterhemp has been confirmed in Lambton, Essex, and Chatham-Kent counties in Ontario. Greenhouse and field dose–response experiments revealed that GR common waterhemp in Ontario had a resistance level of 4.5 and 28, respectively, when compared with known glyphosate-susceptible populations. At 12 wk after application, pyroxasulfone/flumioxazin (240 g ai ha−1), pyroxasulfone/sulfentrazone (300 g ai ha−1), and S-metolachlor/metribuzin (1,943 g ai ha−1) controlled GR common waterhemp 97%, 92%, and 87%, respectively. Pyroxasulfone/sulfentrazone or S-metolachlor/metribuzin applied PRE followed by acifluorfen (600 g ai ha−1) or fomesafen (240 g ai ha−1) applied POST controlled GR common waterhemp 98% and performed better than PRE or POST alone. This research is the first to determine the resistance factor of GR common waterhemp in Ontario and identifies control strategies in soybean to mitigate the impact of common waterhemp interference in soybean crop production.