To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Sociocultural developmental psychology can drive new directions in gadgetry science. We use autobiographical memory, a compound capacity incorporating episodic memory, as a case study. Autobiographical memory emerges late in development, supported by interactions with parents. Intervention research highlights the causal influence of these interactions, whereas cross-cultural research demonstrates culturally determined diversity. Different patterns of inheritance are discussed.
A fragment of Roman monumental bronze sculpture was discovered near Lincoln in 2015 and reported to the Portable Antiquities Scheme. This note offers identification of the piece as an over-life-size finger, describes comparable examples and similar pieces from the local area, and makes suggestions as to the original form of the sculpture from which it may have derived. The statue's metallurgical characteristics and making, the possible context of display and the circumstances of deposition are also considered.
To determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website (http://medicare.gov/hospitalcompare) can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals.
Secondary analysis of publicly available HAI data for calendar year 2013.
We assessed the availability of HAI data for geographically proximate hospitals (ie, hospitals within the same referral region) and then analyzed these data to determine whether they are useful to differentiate hospitals. We assessed data for the 6 HAIs reported by hospitals to the Centers for Disease Control and Prevention (CDC).
Data were analyzed for 4,561 hospitals representing 88% of registered community and federal government hospitals in the United States. Healthcare-associated infection data are only useful for comparing hospitals if they are available for multiple hospitals within a geographic region. We found that data availability differed by HAI. Clostridium difficile infections (CDI) data were most available, with 82% of geographic regions (ie, hospital referral regions) having >50% of hospitals reporting them. In contrast, 4% of geographic regions had >50% of member hospitals reporting surgical site infections (SSI) for hysterectomies, which had the lowest availability. The ability of HAI data to differentiate hospitals differed by HAI: 72% of hospital referral regions had at least 1 pair of hospitals with statistically different risk-adjusted CDI rates (SIRs), compared to 9% for SSI (hysterectomy).
HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI. CDI and catheter-associated urinary tract infection (CAUTI) are more likely to differentiate hospitals than the other publicly reported HAIs.
Hospital-acquired infection (HAI) data are reported to the public on the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. We previously found that public understanding of these data is poor. Our objective was to develop an improved method for presenting HAI data that could be used on the CMS website.
Randomized controlled trial comparing understanding of data presented using the current CMS presentation strategy versus a new strategy.
A 760-bed tertiary referral hospital.
A total of 61 patients were randomly selected within 24 hours of admission.
Participants were shown HAI data as presented on the CMS Hospital Compare website (control arm) or data formatted using a new method (experimental arm).
No statistically significant demographic differences were identified between study arms. Although 47% percent of participants said a website for comparing hospitals would have been helpful, only 10% had ever used such a website. Participants viewing data using the new presentation strategy compared hospitals correctly 56% of the time, compared with 32% in the control arm (P=.0002).
Understanding of HAI data increased significantly with the new data presentation method compared to the method currently used on the CMS Hospital Compare website. Many participants expressed interest in a website for comparing hospitals. Improved methods for presenting CMS HAI data, such as the one assessed here, should be adopted to increase public understanding.
We have embarked on a program to directly compare spectroscopic and evolutionary masses with those obtained from a combination of spectroscopic and photometric orbital solutions for O-type binary systems. The ability to directly determine the spectroscopic masses of the individual components of O-type binary systems has been difficult, because of the severe line blending that is present in these systems. Doppler tomography is an iterative scheme, that uses an ensemble of spectra to reconstruct the individual component spectra. These individual spectra can then be analyzed.
Public reporting of hospital quality data is a key element of US healthcare reform. Data for hospital-acquired infections (HAIs) are especially complex.
To assess interpretability of HAI data as presented on the Centers for Medicare and Medicaid Services Hospital Compare website among patients who might benefit from access to these data.
We randomly selected inpatients at a large tertiary referral hospital from June to September 2014. Participants performed 4 distinct tasks comparing hypothetical HAI data for 2 hospitals, and the accuracy of their comparisons was assessed. Data were presented using the same tabular formats used by Centers for Medicare and Medicaid Services. Demographic characteristics and healthcare experience data were also collected.
Participants (N=110) correctly identified the better of 2 hospitals when given written descriptions of the HAI measure in 72% of the responses (95% CI, 66%–79%). Adding the underlying numerical data (number of infections, patient-time, and standardized infection ratio) to the written descriptions reduced correct responses to 60% (55%–66%). When the written HAI measure description was not informative (identical for both hospitals), 50% answered correctly (42%–58%). When no written HAI measure description was provided and hospitals differed by denominator for infection rate, 38% answered correctly (31%–45%).
Current public HAI data presentation methods may be inadequate. When presented with numeric HAI data, study participants incorrectly compared hospitals on the basis of HAI data in more than 40% of the responses. Research is needed to identify better ways to convey these data to the public.
Infect. Control Hosp. Epidemiol. 2016;37(2):182–187
Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice.
To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur.
Systematic evidence synthesis.
Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes.
Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs.
De-escalation techniques are a recommended non-physical intervention for
the management of violence and aggression in mental health. Although
taught as part of mandatory training for all National Health Service
(NHS) mental health staff, there remains a lack of clarity around
To conduct a systematic review of the learning, performance and clinical
safety outcomes of de-escalation techniques training.
The review process involved a systematic literature search of 20
electronic databases, eligibility screening of results, data extraction,
quality appraisal and data synthesis.
A total of 38 relevant studies were identified. The strongest impact of
training appears to be on de-escalation-related knowledge, confidence to
manage aggression and de-escalation performance (although limited to
artificial training scenarios). No strong conclusions could be drawn
about the impact of training on assaults, injuries, containment and
organisational outcomes owing to the low quality of evidence and
It is assumed that de-escalation techniques training will improve staff's
ability to de-escalate violent and aggressive behaviour and improve
safety in practice. There is currently limited evidence that this
training has these effects.
In this study, we identify the dominant storylines that were embedded in the narratives of younger people with dementia and their nominated family members. By implementing a longitudinal, narrative design underpinned by biographical methods we generated detailed family biographies with five families during repeated and planned research contacts (N=126) over a 12–15-month period between 2009 and 2010. The application of narrative analysis within and between each family biography resulted in the emergence of five family storyline types that were identified as: agreeing; colluding; conflicting; fabricating; and protecting. Whilst families were likely to use each of these storylines at different points and at different times in their exposure to young onset dementia, it was found that families that adopted a predominantly ‘agreeing’ storyline were more likely to find ways of positively overcoming challenges in their everyday lives. In contrast, families who adopted predominantly ‘conflicting’ and ‘colluding’ storylines were more likely to require help to understand family positions and promote change. The findings suggest that the identification of the most dominant and frequently occurring storylines used by families may help to further understand family experience in young onset dementia and assist in planning supportive services.
A defining aspect of national sovereignty is that nation states have the right to determine which people are permitted to come within their geographical borders. Individuals, like nations, appear to be inherently territorial. In addition to this, a defining aspect of many people's personhood (their core identity) is the place where they were born or live.
Despite the disparate range of interests and projects that individuals have and pursue, there are basic goals that communities invariably share. Thus, in Australia, the current generation (building on the work of earlier generations) has committed enormous resources to building state institutions (such as our political and legal system), hospitals, schools, roads and recreational and sporting amenities and facilities.
One of the most important and defining aspects of sovereignty is that a state can establish its own criteria regarding citizenship of the nation. Citizenship is the strongest connection that a person can have with Australia. Citizens have an unrestricted right to live and work in Australia and to travel in and out of the country without restriction. The presence and activities of citizens are not controlled by the Department of Immigration and Citizenship – it only has the authority to administer rules in relation to non-citizens. Thus, citizenship is not central to the topic of this book. However, for the sake of completeness we provide a brief overview of the topic.
As a general principle, permanent residents share the same rights and duties as citizens. However, there are some rights and duties that are unique to citizens. These include the right to an Australian passport, the right to stand for public office and for election for parliament, to serve in Australia's defence force and claim diplomatic protection while overseas, and to serve on juries. Only citizens can enrol on the electoral register to vote at Commonwealth, state and local elections.
Article 1A(2) of the Refugee Convention defines a refugee in terms of the reasons why a person fears being persecuted. A refugee must have a well-founded fear of being persecuted ‘for reasons of race, religion, nationality, membership of a particular social group, or political opinion’. After referring to Article 1 of the Convention, Gummow J explained in Applicant A v MIEA:
…[w]hilst as a matter of ordinary usage, a refugee might be one whose flight has been from invasion, earthquake, flood, famine or pestilence, the definition is not concerned with such persons. Accordingly, care is needed in resolving any apparent obscurity in the text of the definition by seeing the definition as reflecting, in a broad sense, humanitarian concerns for displaced persons.
Kirby J commented in the same case that the drafters of the Convention would not have included ‘categories of persecution’ in Article 1A(2) had they intended refugees to be defined as people who feared persecution for any reason.
A person in Australia who is not a citizen and does not have a current visa is an unlawful non-citizen. This is contrasted with a lawful non-citizen, which is defined as a person in the migration zone who holds a visa that is in effect. It is not an offence to become an unlawful non-citizen, but such people face mandatory detention, removal from Australia and the costs of enforcement action.
In 2004–05, 18 341 unlawful non-citizens were located, compared with 20 003 in 2003–04 (following a doubling over the previous three years). This includes those located through compliance fieldwork (9062) and those who voluntarily approached DIMIA at their own initiative or at departmental request (9279).
As noted in Chapter 11, in order to qualify for refugee status, the harm feared by a claimant must constitute ‘persecution’. This renders the notion of ‘persecution’ central to the concept of a refugee.
The term ‘persecution’ derives from the Latin persequi, which means ‘to follow with hostile intent, or pursue’. The Convention drafters deliberately did not define the term ‘persecution’ with any degree of exactness, to ensure that the concept could be applied to new situations. To judge if a person has suffered, or is at risk of suffering, persecution under the Convention, the severity of the harm and the importance of the right affected are measured on quantitative and qualitative levels. Although the level of severity of harm must generally be high, it may vary depending on the importance of the relevant human right. As is noted by the UNHCR, ‘there is no universally accepted definition of “persecution”, and various attempts to formulate such a definition have met with little success’. Thus states have a wide discretion in interpreting the term. This has resulted in numerous irreconcilable decisions regarding its meaning. Goodwin-Gill has commented in relation to the concept of persecution that ‘practice reveals no coherent or consistent jurisprudence’.