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Depictions of eye images and messages encouraging compliance with social norms have successfully motivated behavioral change in a variety of experimental and applied settings. We studied the effect of these 2 visual cues on hand hygiene adherence in a cohort of hospital-based healthcare providers participating in an electronic monitoring and feedback program.
Prospective, quasi-experimental study utilizing an interrupted time-series design. Intervention placards depicting an image of eyes, a social norms message, or a control placard were placed near soap and alcohol-based hand-rub dispensers on 2 hospital units. Placards were alternated every 10 days. Hand hygiene opportunities and adherence rates were assessed electronically via the CenTrak Hand Hygiene Compliance Solution.
A total of 166 nurses and certified nursing assistants (74 on a medical-surgical unit and 92 on a progressive care unit) were monitored electronically over the 4-month study period. In total, 184,172 electronic observations were collected (110,903 on a medical-surgical unit and 73,269 on a progressive care unit). The median daily number of electronic observations was 1,471 (interquartile range, 1,337–1,584). The preintervention baseline hand hygiene adherence rate was 70%. No statistically significant increase in hand hygiene adherence was observed as a result of either intervention.
Displaying eye images or a social norms message in the hospital environment did not result in measurable improvements in HH adherence in a cohort of healthcare providers participating in an electronic monitoring and feedback program.
During the past two decades, it has been amply documented that neuropsychiatric disorders (NPDs) disproportionately account for burden of illness attributable to chronic non-communicable medical disorders globally. It is also likely that human capital costs attributable to NPDs will disproportionately increase as a consequence of population aging and beneficial risk factor modification of other common and chronic medical disorders (e.g., cardiovascular disease). Notwithstanding the availability of multiple modalities of antidepressant treatment, relatively few studies in psychiatry have primarily sought to determine whether improving cognitive function in MDD improves patient reported outcomes (PROs) and/or is cost effective. The mediational relevance of cognition in MDD potentially extrapolates to all NPDs, indicating that screening for, measuring, preventing, and treating cognitive deficits in psychiatry is not only a primary therapeutic target, but also should be conceptualized as a transdiagnostic domain to be considered regardless of patient age and/or differential diagnosis.
Gona in the Afar region of Ethiopia has yielded the earliest Oldowan stone tools in the world. Artefacts from the East Gona (EG) 10 site date back 2.6 million years. Analysis of the lithic assemblage from EG 10 reveals the earliest-known evidence for refitting and conjoining stone artefacts. This new information supplements data from other Oldowan sites in East Africa, and provides an important insight into the technological capacities and evolutionary development of hominins during this period.
Background: Acquired brain injury is the leading cause of death and disability in children after infancy. Childhood brain injury has long-term consequences for children and parents, including challenges with returning to school, ongoing health and behaviour concerns, family functioning and demands on carers. Community-based case management interventions are a vital contribution to community supports.
Aims: This scoping study aims to scope and map the literature on case management, to identify how case management is described in the literature for children and adolescents with acquired brain injury (0–17 years).
Methods: A scoping review was completed of published articles on case management from four major databases (CINAHL, MEDLINE, PUBMed and Embase) between 2005 and 2015. Articles were selected against inclusion criteria and reviewed.
Results: Eight articles of 2688 records met the inclusion criteria and were reviewed. Case management was provided by case managers and other health professionals. The case management interventions described were mapped to the International Classification of Health Interventions and the Brain Injury Case Management Taxonomy (BICM-T). Case management addressed a range of needs including return to school, family issues and ongoing medical needs. There were anecdotal reports of effectiveness of case management during the return to school process.
Conclusion: This scoping study reveals a lack of information on this topic. Improved reporting of case management interventions and more research on case management is needed for children and adolescents with brain injury.
Mixed states in bipolar disorder have been neglected, and the data concerning treatment of these conditions have been relatively obscure. To address this, we systematically reviewed published pharmacological treatment data for “mixed states/episodes” in mood disorders, including “with mixed features” in DSM–5. We searched PubMed, MEDLINE, The Cochrane Library, clinicaltrials.gov, and controlled-trials.com (with different combinations of the following keywords: “mixed states/features,” “bipolar,” “depressive symptoms/bipolar depression,” “manic symptoms,” “treatment,” “DSM–5”) through to October 2016. We applied a quality-of-evidence approach: first-degree evidence=randomized placebo-controlled studies of pharmacological interventions used as monotherapy; second-degree evidence=a similar design in the absence of a placebo or of a combination therapy as a comparative group; third-degree evidence=case reports, case series, and reviews of published studies. We found very few primary double-blind, placebo-controlled studies on the treatment of mixed states: the preponderance of available data derives from subgroup analysis performed on studies that originally involved manic patients. Future research should study the effects of treatments in mixed states defined using current criteria.
A significant minority of people presenting with a major depressive episode (MDE) experience co-occurring subsyndromal hypo/manic symptoms. As this presentation may have important prognostic and treatment implications, the DSM–5 codified a new nosological entity, the “mixed features specifier,” referring to individuals meeting threshold criteria for an MDE and subthreshold symptoms of (hypo)mania or to individuals with syndromal mania and subthreshold depressive symptoms. The mixed features specifier adds to a growing list of monikers that have been put forward to describe phenotypes characterized by the admixture of depressive and hypomanic symptoms (e.g., mixed depression, depression with mixed features, or depressive mixed states [DMX]). Current treatment guidelines, regulatory approvals, as well the current evidentiary base provide insufficient decision support to practitioners who provide care to individuals presenting with an MDE with mixed features. In addition, all existing psychotropic agents evaluated in mixed patients have largely been confined to patient populations meeting the DSM–IV definition of “mixed states” wherein the co-occurrence of threshold-level mania and threshold-level MDE was required. Toward the aim of assisting clinicians providing care to adults with MDE and mixed features, we have assembled a panel of experts on mood disorders to develop these guidelines on the recognition and treatment of mixed depression, based on the few studies that have focused specifically on DMX as well as decades of cumulated clinical experience.
We report the direct detection of cyclic diameter variations in the Mira variable χ Cygni. Interferometric observations made between 1997 July and 1998 September, using the Cambridge Optical Aperture Synthesis Telescope (COAST) indicate periodic changes in the apparent angular diameter with amplitude 45 per-cent of the smallest value.
The measurements were made in a 50 nm bandpass centred on 905 nm, which is only moderately contaminated by molecular absorption features. To assess the effects of atmospheric stratification on the apparent diameter measured in this band, we have also measured near-infrared diameters for a sample of five Miras, in both the J-band (1.3 μm) and Wing's (1971) 1.04 μm band, which is expected to isolate essentially pure continuum emission. We present J-band visibility curves which indicate that the intensity profiles of the stars in the sample differ greatly from each other.
In 1988, a Joint Commission (9 and 25) meeting on the causes of the well-known limitations on the precision of infrared astronomy led to several suggestions to improve matters (see Milone 1989). These included better reporting of the photometric systems in use by practitioners, redesign of the infrared passbands to be more optimally placed inside the atmospheric windows, and development of a method to ascertain the water vapor content of the atmosphere when the astronomical infrared measurements were being made. An Infrared Astronomy Working Group was formed to look into the matter. Advice and suggestions were solicited from the community at large. All who volunteered information became, de facto, members of the Working Group. A small subgroup composed of Andrew Young, Chris Stagg, and Milone set to work on the central of the recommendations: improvement of the passbands. Young, Milone, k Stagg (1994) (hereafter YMS) summarized the work: existing JHKLMN and Q infrared passbands were found to be both far from standardized, and all too frequently defined, to various degrees, by the water vapor and other components of the terrestrial atmosphere. Following extensive numerical simulations with a MODTRAN 3 terrestrial-atmospheres model package, and Kurucz stellar atmospheres, we suggested a set of improved infrared passbands designed explicitly to fit within, and not be defined by, the terrestrial atmospheric windows; however, we sought to optimize them so as to get the maximum throughput consistent with plausible limitations on precision of manufacture of the filters. In 1995 and again in 1997, a number of improvements were made in the code with which the improved passbands were designed. While they do not much affect the optimization trials and thus the passband recommendations, they have been used to extend the modeling.
The article is one of a number of articles stemming from a Ph.D research project researching learning and emotional difficulties amongst year eight students at a State High School in Adelaide. Twenty students identified as having learning and behaviour difficulties are participating in an alternative program for two days a week. The program involves camping, outdoor education and a good deal of intensive ‘direct instruction’ in basic literacy and numeracy. It is anticipated that this program will serve as a model for other state schools developing alternative programs for disaffected adolescent students.
The conservation of biodiversity is an increasingly challenging endeavour. Current pressures from a growing human population have led to concerns of a sixth mass extinction event, bringing mounting pressure to find effective ways of conserving biodiversity (Barnosky et al., 2011). However, our ability to meet this challenge is affected by the fact that not everyone supports conservation objectives. People naturally have different interests and priorities, some of which may be diametrically opposed to conservation objectives. In some cases, these differences lead to damaging and costly conflicts that we see emerging across the world and which present major challenges to modern conservation (MacDonald and Service, 2007).
At a cursory glance, the conflicts that surface around conservation often appear to be about impact: the impact of carnivores on livestock; the impact of wind farms on birds; or the impact of protected areas on livelihoods. Consequently, a common approach to these problems has been to build robust science and develop an evidence base to understand these impacts and find ways of reducing them, often through technical solutions. This approach, however, rarely works for the simple reason that many of these conflicts are about much more than impact. So even if we can develop the science to quantify impacts and show how they can be reduced, the conflicts can stubbornly persist. Indeed, beneath the surface of any of the conflicts discussed in this book is a complex layering of diverse issues related to different world views, issues of trust, power imbalances or latent historical issues – issues that lie well outside the sphere of the natural sciences. So, if we really want to understand and tackle these thorny problems, we need insights from other disciplines as well as from the practitioners specialising in resolving conflicts.
The growing recognition of the complexity within conflicts has led many authors to suggest more cross-disciplinary approaches, especially through better integration of ecological and social science (Manfredo and Dayer, 2004; Sillero-Zubiri et al., 2007; Treves, 2009; Dickman, 2010; White and Ward, 2010).
This study aims to examine the longitudinal effects of a small-scale nursing home model on the change rates of psychological outcomes by comparing green house (GH) and traditional nursing home residents.
A total of 242 residents (93 GH and 149 traditional home residents) who resided at the home least 6 months from admission. Four minimum dataset assessments every six months from admission were included. The main psychological outcomes were depressive mood, and social engagement. The main independent variable was the facility type that the resident resided in: a GH or traditional unit. Age, gender, ADL function, and cognitive function at admission were controlled in the model. A zero-inflated Poisson (ZIP) growth curve model was utilized to compare change rates of two psychological outcomes between the two groups taking into account many zero counts of two outcome measures.
A rate of increase in depressive symptoms for GH home residents was higher than that of traditional home residents (β = 0.135, p-value = 0.025). GH home residents had a lower rate of increase of the probability of “not being socially engaged” over time compared to traditional home residents (β = −0.274, p-value = 0.010).
The GH nursing home model had a longitudinal effect on increasing the probability of residents’ social engagement over time, but also increasing the recognition of depressive symptoms compared to traditional nursing homes.
The formal commissioning of the IRWG occurred at the 1991 Buenos Aires General Assembly, following a Joint Commission meeting at the IAU GA in Baltimore in 1988 that identified the problems with ground-based infrared photometry. The meeting justification, papers, and conclusions, can be found in Milone (1989). In summary, the challenges involved how to explain the failure to achieve the milli-magnitude precision expected of infrared photometry and an apparent 3% limit on system transformability. The proposed solution was to redefine the broadband Johnson system, the passbands of which had proven so unsatisfactory that over time effectively different systems proliferated, although bearing the same “JHKLMNQ” designations; the new system needed to be better positioned and centered in the spectral windows of the Earth's atmosphere, and the variable water vapour content of the atmosphere needed to be measured in real time to better correct for atmospheric extinction.
We present an exploration of the integrated stellar populations of early-type galaxies (ETGs) from the ATLAS3D survey. We use two approaches: firstly the application of line-indices interpreted through single stellar population (SSP) models, which provide a single value of age, metallicity and abundance ratio. And secondly, by fitting a linear combination of SSP spectra to our data, smoothly weighted in the free parameters of age and metallicity, thereby inferring a star-formation history of these galaxies. Despite the significant differences in these approaches, we obtain generally consistent results, such that galaxies that are more massive appear older with enhanced abundance ratios using line indices, and have shorter star-formation histories weighted to early times. We highlight two limitations of the index-SSP approach. Firstly the SSP-equivalent ages belie the fact that ETGs are overwhelmingly composed of ancient stars. Secondly, the young stellar contributions implied in our star formation histories are required to obtain realistic UV-optical colours. We remark that, even fitting solar-abundance models, we can recover a star-formation duration that correlates with the measured alpha-enhancement, in agreement with other recent work.
A novel approach of fabricating 2-D arrays of SiO2 beads on a Si surface using the Langmuir-Blodgett (LB) technique is reported. The corrugated surfaces were tested as a separation media for surface electrophoresis of DNA molecules. The measured electrophoretic mobility for λ-DNA is only 20% slower than previously measured on a flat Si wafer. This indicates that the separation mechanism is due to surface friction rather than biased reptation as reported by Tinland in the three dimensional Silica bead matrix where the mobility is two orders of magnitude smaller.
Dihydrogen, copper, platinum, and lead octakis(2-ethylhexyloxy)phthalocyanines (Pc's) were studied in polystyrene films at 532 nm and in chloroform solutions at 1064 nm by picosecond degenerate four wave mixing. Resonant χ(3) values of Pc's at 532 nm (a local minimum in the absorption spectrum) at a time coincident with the 20 psec pump pulses were as high as 104 times that of CS2 by extrapolation of the response from 1 wt % PtPc in polystyrene film to a value for pure PtPc. Delay of the probe pulse as long as 3 nsec revealed acoustic responses stronger than the fast electronic responses. The films showed the expected quadratic dependence of the instantaneous reflectivity on incident intensity only for a decade of magnitude of intensity, 100–1000 MW/cm2, with the output saturating at higher intensities. Excited state absorption at 532 nm was detected in the film samples by pulse-probe spectroscopy and was shown to be a factor in the saturation observed in the NLO signals. Nonresonant χ(3) values at 1064 nm were as high as 120 times that of CS2 from measured responses of 1 wt % chloroform solutions of Pc's. Time delay of the probe revealed both fast electronic and slower acoustic responses at 1064 nm too.