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Mary Wollstonecraft (1759–1797) was one of the most influential and controversial women of her age. No writer, except perhaps her political foe, Edmund Burke, and her fellow reformer, Thomas Paine, inspired more intense reactions. In her brief literary career before her untimely death in 1797, Wollstonecraft achieved remarkable success in an unusually wide range of genres: from education tracts and political polemics, to novels and travel writing. Just as impressive as her expansive range was the profound evolution of her thinking in the decade when she flourished as an author. In this collection of essays, leading international scholars reveal the intricate biographical, critical, cultural, and historical context crucial for understanding Mary Wollstonecraft's oeuvre. Chapters on British radicalism and conservatism, French philosophes and English Dissenters, constitutional law and domestic law, sentimental literature, eighteenth-century periodicals and more elucidate Wollstonecraft's social and political thought, historical writings, moral tales for children, and novels.
Despite United States national learning objectives referencing research fundamentals and the critical appraisal of medical literature, many paramedic programs are not meeting these objectives with substantive content.
The objective was to develop and implement a journal club educational module for paramedic training programs, which is all-inclusive and could be distributed to Emergency Medical Services (EMS) educators and EMS medical directors to use as a framework to adapt to their program.
Four two-hour long journal club sessions were designed. First, the educator provided students with four types of articles on a student-chosen topic and discussed differences in methodology and structures. Next, after a lecture about peer-review, students used search engines to verify references of a trade magazine article. Third, the educator gave a statistics lecture and critiqued the results section of several articles found by students on a topic. Finally, students found an article on a topic of personal interest and presented it to their classmates, as if telling their paramedic partner about it at work. Before and after the series, students from two cohorts (2017, 2018) completed a survey with questions about demographics and perceptions of research. Students from one cohort (2017) received a follow-up survey one year later.
For the 2016 cohort, 13 students participated and provided qualitative feedback. For the 2017 and 2018 cohorts, 33 students participated. After the series, there was an increased self-reported ability to find, evaluate, and apply medical research articles, as well as overall positive trending opinions of participating in and the importance of prehospital research. This ability was demonstrated by every student during the final journal club session. McNemar’s and Related-Samples Cochran’s Q testing of questionnaire responses suggested a statistically significant improvement in student approval of exceptions from informed consent.
The framework for this paramedic journal club series could be adapted by EMS educators and medical directors to enable paramedics to search for, critically appraise, and discuss the findings of medical literature.
To increase the proportion of patients with no psychotropic drug discrepancies at the community mental health team (CMHT)–general practice interface. Three CMHTs participated. Over a 14 month period, quality improvement methodologies were used: individual patient-level feedback to patient's prescribers, run charts and meetings with CMHTs.
One CMHT improved medicines reconciliation accuracy and demonstrated significant reductions in prescribing discrepancies. One in three (119/356) patients had ≥1 discrepancy involving 20% (166/847) of all prescribed psychotropics. Discrepancies were graded as: ‘fatal’ (0%), ‘serious’ (17%) and ‘negligible/minor harm’ (83%) but were associated with extra avoidable prescribing costs. For medicines routinely supplied by secondary care, 68% were not recorded in general practice electronic prescribing systems.
Improvements in medicines reconciliation accuracy were achieved for one CMHT. This may have been partly owing to a multidisciplinary team approach to sharing and addressing prescribing discrepancies. Improving prescribing accuracy may help to reduce avoidable drug-related harms to patients.
Inadequate protein quality may be a risk factor for poor growth. To examine the effect of a macronutrient–micronutrient supplement KOKO Plus (KP), provided to infants from 6 to 18 months of age, on linear growth, a single-blind cluster-randomised study was implemented in Ghana. A total of thirty-eight communities were randomly allocated to receive KP (fourteen communities, n 322), a micronutrient powder (MN, thirteen communities, n 329) and nutrition education (NE, eleven communities, n 319). A comparison group was followed cross-sectionally (n 303). Supplement delivery and morbidity were measured weekly and anthropometry monthly. NE education was provided monthly. Baseline, midline and endline measurements at 6, 12 and 18 months included venous blood draws, diet, anthropometry, morbidity, food security and socio-economics. Length-for-age Z-score (LAZ) was the primary outcome. Analyses were intent-to-treat using mixed-effects regressions adjusted for clustering, sex, age and baseline. No differences existed in mean LAZ scores at endline (−1·219 (sd 0·06) KP, −1·211 (sd 0·03) MN, −1·266 (sd 0·03) NE). Acute infection prevalence was lower in the KP than NE group (P = 0·043). Mean serum Hb was higher in KP infants free from acute infection (114·02 (sd 1·87) g/l) than MN (107·8 (sd 2·5) g/l; P = 0·047) and NE (108·8 (sd 0·99) g/l; P = 0·051). Compliance was 84·9 % (KP) and 87·2 % (MN) but delivery 60 %. Adjusting for delivery and compliance, LAZ score at endline was significantly higher in the KP v. MN group (+0·2 LAZ; P = 0·026). A macro- and micronutrient-fortified supplement KP reduced acute infection, improved Hb and demonstrated a dose–response effect on LAZ adjusting consumption for delivery.
An increasing number of external beam treatment modalities including intensity modulated radiation therapy, volumetric modulated arc therapy (VMAT) and stereotactic radiosurgery uses very small fields for treatment planning and delivery. However, there are major challenges in small photon field dosimetry, due to the partial occlusion of the direct photon beam source’s view from the measurement point, lack of lateral charged particle equilibrium, steep dose-rate gradient and volume averaging effect of the detector response and variation of the energy fluence in the lateral direction of the beam. Therefore, experimental measurements of dosimetric parameters such as percent depth doses (PDDs), beam profiles and relative output factors (ROFs) for small fields continue to be a challenge.
Materials and Methods:
In this study, we used a homogeneous water phantom and the heterogeneous anthropomorphic stereotactic end-to-end verification (STEEV) head phantom for all dose measurements and calculations. PDDs, lateral dose proﬁles and ROFs were calculated in the Eclipse Treatment Planning System version 13·6 using the Acuros XB (AXB) and the analytical anisotropic algorithms (AAAs) in a homogenous water phantom. Monte Carlo (MC) simulations and measurements using the Exradin W1 Scintillator were also accomplished for four photon energies: 6 MV, 6FFF, 10 MV and 10FFF. Two VMAT treatment plans were generated for two different targets: one located in the brain and the other in the neck (close to the trachea) in the head phantom (CIRS, Norfolk, VA, USA). A Varian Truebeam linear accelerator (Varian, Palo Alto, CA, USA) was used for all treatment deliveries. Calculated results with AXB and AAA were compared with MC simulations and measurements.
The average difference of PDDs between W1 Exradin Scintillator measurements and MC simulations, AAA and AXB algorithm calculations were 1·2, 2·4 and 3·2%, respectively, for all field sizes and energies. AXB and AAA showed differences in ROF of about 0·3 and 2·9%, respectively, compared with W1 Exradin Scintillator measured values. For the target located in the brain in the head phantom, the average dose difference between W1 Exradin Scintillator and the MC simulations, AAA and AXB were 0·2, 3·2 and 2·7%, respectively, for all field sizes. Similarly, for the target located in the neck, the respective dose differences were 3·8, 5·7 and 3·5%.
In this study, we compared dosimetric parameters such as PDD, beam profile and ROFs in water phantom and isocenter point dose measurements in an anthropomorphic head phantom representing a patient. We observed that measurements using the W1 Exradin scintillator agreed well with MC simulations and can be used efficiently for dosimetric parameters such as PDDs and dose profiles and patient-specific quality assurance measurements for small fields. In both homogenous and heterogeneous media, the AXB algorithm dose prediction agrees well with MC and measurements and was found to be superior to the AAA algorithm.
For patients with possible Staphylococcus aureus infection, providers must decide whether to treat empirically for methicillin-resistant S. aureus (MRSA). Nares MRSA colonization screening tests could inform decisions regarding empiric MRSA-active antibiotic use.1,2
The former Deep Sea Drilling Project (DSDP) automated X-ray diffraction data collection and analysis system located at the Riverside campus of the University of California has been upgraded for use in the characterization of samples from natural hydrothermal systems by the addition of an interactive graphics terminal and the rewriting of the computer programs.
The system has the capability of collecting and interpreting patterns from 25-30 samples in one night's unattended operation. The computer's interpretation can be monitored and corrected easily. The pattern and the computed baseline are displayed with the peak locations and intensities, as predicted by the mineral standards file, and calculated mineral intensities superimposed. The system can display a pattern and accept and remember corrections to its interpretation in less than two minutes. The system can also organize and display the interpretations of a suite of samples in both tabular and graphical form.
The mineral identifications, minimum levels of detections and quantities calculated were tested using artificial mixtures of known composition and comparisons with other techniques and found to be adequate. As an example of the system's output, approximately 500 samples of cuttings from 12 boreholes drilled in the Salton Sea geothermal field in California have been run. The mineral modal analyses for samples from each well was produced in a diagrammatic format suitable for displaying on maps to show the three-dimensional distribution of mineral abundances.
The system gives adequate quality of analysis for the mapping of mineral abundances. The main benefit is the assumption of bookkeeping functions thus allowing the analyst to concentrate on the more difficult interpretation problems. The current drawback of the system is the difficulty in dealing with clays.
OBJECTIVES/SPECIFIC AIMS: To complete a needs assessment and action planning process that engaged clinical and translational research network members in identifying needs through survey feedback, characterizing the needs in small group sessions, and developing recommendations for action at the network’s annual scientific meeting. METHODS/STUDY POPULATION: The project included (1) a survey of 357 members across partner institutions from the Great Plains IDeA CTR Network, (2) 6 - 90 minute brainstorming sessions to characterize needs identified through survey assessment, and (3) 6 - 60 minute sessions to develop recommendations for network improvement based on the characterization activity. Approximately 75 members participated in the characterization and recommendation sessions. RESULTS/ANTICIPATED RESULTS: Seven areas of need from the survey were identified based upon the frequency of identification by network members (support to move research across the translational spectrum, database design and management, data access and sharing, data analysis, recruitment and retention of subjects, support for members who have submitted grants but were repeatedly unsuccessful, mentoring). Members indicated which characterization sessions they were interested in attending and based on the enrollment numbers needs related to unsuccessful grant submitters and mentoring were combined as were needs related to database design and data access-sharing. Sessions resulted in 8 inter-related recommendations for network action that included to (1) develop GP-CTR directory/registry of clinicians, researchers, system partners, that can be used to identify people that want to be involved in research partnerships or mentoring, (2) create a GP CTR Navigators Program to will provide support to network members throughout the collaborative research and grant preparation process, (3) identify and disseminate information about assets (funding, databases/registries) that exist amongst network partners that can be leveraged by member, (4) develop a searchable repository of evidence-based interventions for T3/T4 efforts, (5) review GP CTR supported professional development, and technological resource offerings and identify potential gaps, (6) facilitate opportunities for peer support/networking, (7) provide guidance to GP CTR network institutions looking to adopt policies that will support translational research collaboration, and (8) identify potential barriers to GP CTR network engagement (i.e., infrastructure, communication, marketing). DISCUSSION/SIGNIFICANCE OF IMPACT: This process allowed for a wide range of network members to contribute to actionable recommendations for CTR leadership to move into action and improve the scientific network’s ability to conduct clinical and translational research.
Adding Au to Pd nanoparticles (NPs) can impart high catalytic activity with respect to hydrogenation of a wide range of substances. These materials are often synthesized by reducing metallic precursors; hence, sonochemical and solvothermal processes are commonly used to anchor these bimetals onto thin supports, including graphene. Although similar NPs have been studied reasonably well, a clear understanding of structural characteristics relative to their synthesis parameters is lacking, due to limitations in characterization techniques, which may prevent optimization of this very promising catalyst. In this report, a strategic approach has been used to identify this structural and material synthesis correlation, starting with controlled sample preparation and followed by detailed characterization. This includes advanced scanning transmission electron microscopy and electron energy loss spectroscopy; the latter using a state-of-the-art instrumentation to map the distribution of Pd and Au, and to identify chemical state of the Pd NPs, which has not been previously reported. Results show that catalytic bimetal NP clusters were made of small zero-valent Pd NPs aggregating to form a shell around an Au core. Not only can the described characterization approach be applied to similar material systems, but the results can guide the optimization of the synthesis procedures.
The essay evaluates the general problem that, while most modern republican constitutions follow the U.S. and French models in declaring religious freedom, absolute religious freedom is impossible and undesirable. How are religious freedoms constrained, and how much should they be? The essay evaluates the strategies by which limitations on freedoms of religion are constructed and imposed, especially the powerful isomorphism of law and science described by Boaventura de Sousa Santos. Taking the example of Afro-Brazilian religions in relation to the Brazilian state since 1890, post-emancipation, the essay argues that pseudo-scientific discourses of “public health” constrained the religious practice of former slaves, thus allowing the trompel'oeil of religious freedom to continue in the new republic, even as freedoms were in fact constrained by the state.
Among 469 US military veterans with an Escherichia coli clinical isolate (2012–2013), we explored healthcare and non-healthcare risk factors for having E. coli sequence type 131 and its H30 subclone (ST131-H30). Overall, 66 (14%) isolates were ST131; 51 (77%) of these were ST131-H30. After adjustment for healthcare-associated factors, ST131 remained positively associated with medical lines and nursing home residence. After adjustment for environmental factors, ST131 remained associated with wild animal contact (positive), meat consumption (negative) and pet cat exposure (negative). Thus, ST131 was associated predominantly with healthcare-associated exposures, while non-ST131 E. coli were associated with some environmental exposures.
The prevalence and incidence of obesity are high in people with severe mental illness (SMI). In England, around 6000 people with SMI access care from secure mental health units. There is currently no specific guidance on how to reduce the risk of obesity-related morbidity and mortality in this population.
To identify international evidence that addresses the issue of obesity in mental health secure units.
A mixed method review of evidence (published 2000–2015) was carried out to assess obesity prevalence, intervention and policy change, as well as barriers to change.
Evidence from 22 mainly small, non-comparator studies (reported in 21 papers) using a range of methods was reviewed. Dietary, physical activity and cultural interventions being implemented within secure units to address the problem of obesity showed some promising outcomes for physical health and health education. These were facilitated by adequate organisational resources, staff training and motivated staff. Holistic interventions that included a social and/or competitive element were more likely to be taken up. Involving patients in decision-making mediated the tension between facilitating behaviour change and imposing control. Barriers to successful outcomes included patient movement in and out of units, severity of mental health condition and resistance to change by patients and staff.
Despite the promising outcomes reported, further assessment is needed of the feasibility, acceptability and effectiveness of interventions and policies targeting the obesogenic environment, using robust research methods.
Palladium (Pd) and gold (Au) nanoparticles (NPs) hybridized on two types of carbon supports, graphene and granular activated carbon (GAC), were shown to be promising catalysts for the sustainable hydrodehalogenation of aqueous trichloroethylene (TCE). These catalysts are capable of degrading TCE more rapidly than commercial Pd-on-GAC catalysts. The catalysts were synthesized at room temperature without the use of any environmentally unfriendly chemicals. Pd was chosen for its catalytic potency to break down TCE, while Au acts as a strong promoter of the catalytic activity of Pd. The results indicate that both graphene and GAC are favorable supports for the NPs due to high surface-to-volume ratios, unique surface properties, and the prevention of NP aggregation. The properties of NP catalysts were characterized using electron microscopy and spectroscopy techniques. The TCE degradation results indicate that the GAC-supported catalysts have a higher rate of TCE removal than the commercial Pd-on-GAC catalyst, and the degradation rate is greatly increased when using graphene-supported samples.
For this study, we adapted the Montgomery Borgatta Caregiver Burden Scale, used widely in the United States, to the Saudi Arabian context. To produce an Arabic, culturally sensitive version of the scale, we conducted semi-structured interviews with 20 Saudi family caregivers. The Arabic version of the scale was tested, and participants were asked to comment on the appropriateness of items for the construct of “caregiver burden” using the repertory grid technique and laddering procedure – two constructivist methods derived from personal construct theory. From interview findings, we examined the content of the items and the caregiver burden construct itself. Our findings suggest that the use of constructivist methods to refine constructs and quantitative instruments is highly informative. This strategy is feasible even when little is known about the investigated constructs in the target culture and further elucidates our understanding of cross-cultural variations or invariance of different versions of the scale.
Collaborations between community colleges, non-research centered universities and research universities can enrich the flow of students into Science, Technology, Engineering and Mathematics (STEM) majors and careers. The nation is beginning to understand the importance of such interaction especially with under-represented minorities and those with disabilities. For over fifteen years our group has developed new ways to integrate these students and their faculty to the research culture. This will lead to increased diversity and inform research university faculty of the great talent that is latent in these underserved pools.
Subsolutions to the Hamilton–Jacobi–Bellman equation associated with a moderate deviations approximation are used to design importance sampling changes of measure for stochastic recursive equations. Analogous to what has been done for large deviations subsolution-based importance sampling, these schemes are shown to be asymptotically optimal under the moderate deviations scaling. We present various implementations and numerical results to contrast their performance, and also discuss the circumstances under which a moderate deviation scaling might be appropriate.