We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save 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 saving content to .
To save content items to your Kindle, first ensure coreplatform@cambridge.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 saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved 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.
The purpose of this document is to highlight practical recommendations to assist acute care hospitals to prioritize and implement strategies to prevent ventilator-associated pneumonia (VAP), ventilator-associated events (VAE), and non-ventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates. This document updates the Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA), and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
University and college students are vulnerable to developing depressive symptoms. People in low-income countries are disproportionately impacted by mental health problems, yet few studies examine routes to accessing clinical services. Examining motivation and barriers toward seeking clinical mental health services in university students in Bangladesh is important.
Method
Using a cross-sectional survey (n = 350), we assess the relationship between the constructs of autonomy, relatedness, and competency toward using clinical mental health practices (i.e. using professional resources, taking medication) with (1) positive views, (2) perceived need, and (3) use of clinical mental health services among Bangladeshi university students.
Results
Results showed that the perceived need for mental health support was the predictor of the largest magnitude (aOR = 4.99, p = 0.005) for using clinical services. Having a positive view of clinical services was predictive of clinical service use (aOR = 2.87, p = 0.033); however, that association became insignificant (p = 0.054) when adjusting for the perceived need for mental health care. Of the SDT constructs, social influences were predictive of perceiving a need for mental health support, and mental health knowledge was predictive (aOR = 1.10, p = 0.001) of having a positive view of clinical mental health care.
Conclusion
Our findings show that knowledge of mental health is associated with positive views of mental health services, and that higher levels of stress and the presence of people with mental health problems are associated with the perception of a need for mental health care, which is ultimately responsible for using the services.
The COVID-19 pandemic has disrupted lives and livelihoods, and people already experiencing mental ill health may have been especially vulnerable.
Aims
Quantify mental health inequalities in disruptions to healthcare, economic activity and housing.
Method
We examined data from 59 482 participants in 12 UK longitudinal studies with data collected before and during the COVID-19 pandemic. Within each study, we estimated the association between psychological distress assessed pre-pandemic and disruptions since the start of the pandemic to healthcare (medication access, procedures or appointments), economic activity (employment, income or working hours) and housing (change of address or household composition). Estimates were pooled across studies.
Results
Across the analysed data-sets, 28% to 77% of participants experienced at least one disruption, with 2.3–33.2% experiencing disruptions in two or more domains. We found 1 s.d. higher pre-pandemic psychological distress was associated with (a) increased odds of any healthcare disruptions (odds ratio (OR) 1.30, 95% CI 1.20–1.40), with fully adjusted odds ratios ranging from 1.24 (95% CI 1.09–1.41) for disruption to procedures to 1.33 (95% CI 1.20–1.49) for disruptions to prescriptions or medication access; (b) loss of employment (odds ratio 1.13, 95% CI 1.06–1.21) and income (OR 1.12, 95% CI 1.06 –1.19), and reductions in working hours/furlough (odds ratio 1.05, 95% CI 1.00–1.09) and (c) increased likelihood of experiencing a disruption in at least two domains (OR 1.25, 95% CI 1.18–1.32) or in one domain (OR 1.11, 95% CI 1.07–1.16), relative to no disruption. There were no associations with housing disruptions (OR 1.00, 95% CI 0.97–1.03).
Conclusions
People experiencing psychological distress pre-pandemic were more likely to experience healthcare and economic disruptions, and clusters of disruptions across multiple domains during the pandemic. Failing to address these disruptions risks further widening mental health inequalities.
This paper explores whether regular involvement in a rural, country sport, frequently practised by older individuals, builds social capital and friendships, reduces loneliness, and positively impacts individuals’ health and wellbeing. Taking a critical realist, mixed-methods approach, using a recognised social impact assessment methodology theoretically underpinned by social capital theory, this study identifies that driven-game shooting participation creates social impact via social capital creation and identity reinforcement. Results indicate a statistically significant, positive impact on mental health and wellbeing (N = 2,424), which varies by shoot size and/or type. The results are discussed in relation to implications for managing elderly health and wellbeing in rural areas.
To describe a pilot project infection prevention and control (IPC) assessment conducted in skilled nursing facilities (SNFs) in New York State (NYS) during a pivotal 2-week period when the region became the nation’s epicenter for coronavirus disease 2019 (COVID-19).
Design:
A telephone and video assessment of IPC measures in SNFs at high risk or experiencing COVID-19 activity.
Participants:
SNFs in 14 New York counties, including New York City.
Intervention:
A 3-component remote IPC assessment: (1) screening tool; (2) telephone IPC checklist; and (3) COVID-19 video IPC assessment (ie, “COVIDeo”).
Results:
In total, 92 SNFs completed the IPC screening tool and checklist: 52 (57%) were conducted as part COVID-19 investigations, and 40 (43%) were proactive prevention-based assessments. Among the 40 proactive assessments, 14 (35%) identified suspected or confirmed COVID-19 cases. COVIDeo was performed in 26 (28%) of 92 assessments and provided observations that other tools would have missed: personal protective equipment (PPE) that was not easily accessible, redundant, or improperly donned, doffed, or stored and specific challenges implementing IPC in specialty populations. The IPC assessments took ∼1 hour each and reached an estimated 4 times as many SNFs as on-site visits in a similar time frame.
Conclusions:
Remote IPC assessments by telephone and video were timely and feasible methods of assessing the extent to which IPC interventions had been implemented in a vulnerable setting and to disseminate real-time recommendations. Remote assessments are now being implemented across New York State and in various healthcare facility types. Similar methods have been adapted nationally by the Centers for Disease Control and Prevention.
There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness.
Aims
This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK.
Method
We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012–2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages.
Results
The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14–68) and 24% were from primary care (median, 10; IQR, 5–20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years.
Conclusions
The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.
United States certified organic and conventional dairy farms are compared on the basis of economic, financial, and technological measures using dairy data from the 2016 USDA Agricultural Resource Management Survey. A stochastic production frontier model using an input distance function framework is estimated for U.S. dairy farms to examine technical efficiency and returns to scale (RTS) of farms of both systems and by multiple size categories. Financial and economic measures such as net return on assets and input costs, as well as technological adoption measures are compared by system and size. For both systems, size is the major determinant of competitiveness based on selected measures of productivity and RTS.
The catastrophic declines of three species of ‘Critically Endangered’ Gyps vultures in South Asia were caused by unintentional poisoning by the non-steroidal anti-inflammatory drug (NSAID) diclofenac. Despite a ban on its veterinary use in 2006 (India, Nepal, Pakistan) and 2010 (Bangladesh), residues of diclofenac have continued to be found in cattle carcasses and in dead wild vultures. Another NSAID, meloxicam, has been shown to be safe to vultures. From 2012 to 2018, we undertook covert surveys of pharmacies in India, Nepal and Bangladesh to investigate the availability and prevalence of NSAIDs for the treatment of livestock. The purpose of the study was to establish whether diclofenac continued to be sold for veterinary use, whether the availability of meloxicam had increased and to determine which other veterinary NSAIDs were available. The availability of diclofenac declined in all three countries, virtually disappearing from pharmacies in Nepal and Bangladesh, highlighting the advances made in these two countries to reduce this threat to vultures. In India, diclofenac still accounted for 10–46% of all NSAIDs offered for sale for livestock treatment in 2017, suggesting weak enforcement of existing regulations and a continued high risk to vultures. Availability of meloxicam increased in all countries and was the most common veterinary NSAID in Nepal (89.9% in 2017). Although the most widely available NSAID in India in 2017, meloxicam accounted for only 32% of products offered for sale. In Bangladesh, meloxicam was less commonly available than the vulture-toxic NSAID ketoprofen (28% and 66%, respectively, in 2018), despite the partial government ban on ketoprofen in 2016. Eleven different NSAIDs were recorded, several of which are known or suspected to be toxic to vultures. Conservation priorities should include awareness raising, stricter implementation of current bans, bans on other vulture-toxic veterinary NSAIDs, especially aceclofenac and nimesulide, and safety-testing of other NSAIDs on Gyps vultures to identify safe and toxic drugs.
Discovery tools and interfaces have emerged through a number of routes over the past 20 years: protocols to search across multiple sources (e.g. Z39.50) have had tools developed around them; library management systems have provided tools to bring to the surface the content they manage; specific library collection indices have been built and had tools developed to provide access to them; and the richness of the web has been surfaced through web search engines. The origins of these discovery tools have frequently informed how they have then evolved and matured, and how they have been adapted to meet changing needs within libraries and beyond. Blacklight is no different: because of its origin as part of a digital humanities project, it has been clear from the start that discovery had to be adaptable if it was to work across multiple types of resource and associated metadata. This starting point has enabled Blacklight to evolve to meet specific needs but always hold at its centre the need to be flexible with regard to what is being accessed and support the discovery needs of end-users.
Blacklight (http://projectblacklight.org) itself is an open source Ruby on Rails engine that provides a discovery interface for an Apache Solr index (Blacklight Project, 2019a). Its flexibility comes from two places:
Apache Solr (http://lucene.apache.org/solr/), built on the underlying Apache Lucene search engine, offers a very flexible way of indexing the content to be searched. It is widely used around the world for many search applications. While Blacklight's default Solr configuration settings will often be sufficient, there is real additional value to be gained from exploiting how Solr indexes resources to meet specific needs.
Blacklight itself can be used to provide discovery across heterogeneous resources. It exploits Solr's capability of being able to index different types of metadata together (acknowledging the need for a mapping between them), and can also display different resources via different templates, allowing for specific views onto resources.
The flexibility is also inherent in the separation of the discovery interface from the underlying data. Blacklight operates by taking a feed from a data source (e.g. a library catalogue) and presenting it in a way that is not constrained by the underlying data structure: the Solr indexing and configuration of views can apply its own structure, so that discovery can focus on user behaviour and needs instead of database tables.
The Oxford English Dictionary defines psychopharmacology as ‘the scientific study of the effect of drugs on the mind and behaviour’ (Oxford English Dictionary Online, 2018). The earliest reference to the term was in 1548 when Reinhard Lorichius published the prayer book Psychopharmakon, hoc est Medicina Animae (Lehmann, 1993; Wolman, 1977). Lorichius coined the term ‘psychopharmakon’ to refer to spiritual medicine that could reduce human suffering. The word psychopharmacology was first used in a scientific paper in 1920 by a pharmacologist working at Johns Hopkins University who wrote a short paper entitled Contributions to psychopharmacology (Macht, 1920).
WHILE MUCH SCHOLARLY ATTENTION has been devoted to John Gower's revisions in Confessio Amantis, most of it has had to do with the political conditions under which he was working. One prominent exception involves his rewriting of what Peter Nicholson has called, “the two most famous lines in the entire poem” – a process that C.S. Lewis in The Allegory of Love characterized as purely aesthetic:
The famous line
The beaute faye upon her face
attained its present form only by successive revisions – revisions which demonstrate, so far as such things can be demonstrated, the working of a fine, and finely self-critical, poetic impulse. The first version –
The beaute of hire face schon
Wel bryhtere than the Cristall ston,
– is just what would have contented the ordinary ‘unconscious’ spinner of yarns in rhyme; but it did not content Gower.
Gower, Lewis goes on to suggest, excelled at what Dryden was to call “the fairy way of writing” (220), and his careful revision of this passage from “The Tale of Rosiphilee” offers one instance of his responding to its appeal.
John Lawlor, in an oddly disputatious piece intended for a volume published in Lewis’ memory, takes issue with this reading. It betrays, he suggests, an overly romanticized view of Gower – Lewis had gone so far as to claim that Gower was “‘romantic’ in the nineteenth-century sense of the word” (220) – because it fails to appreciate that the word faye represents “a possible mode of being.” “The apparatus of past belief,” he writes, in an interesting anticipation of Todorov's distinction between the fantastic and the marvelous, “can become the vehicle of ‘romantic’ treatment only when it is freed from every touch of objective likelihood” (126). In other words, in a world where people might still believe in their existence, fairies could not possibly function as the vehicles of romantic fantasy. I agree with Lawlor's criticism here – though in general it seems to me far more appropriate to the Lewis of the Allegory of Love (written in 1936) than to the one of The Discarded Image (published posthumously thirty years later) – but I suspect that there are even more cogent objections to be raised to Lewis’ argument.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
${\sim}60\%$
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
Q: Why is it important that people with learning disabilities tell their stories?
A: I think it's to let other people know what's happened to them and make it aware of people so that it doesn't happen. People doesn't go around hurting other people, it's not fair. So I think if they write their story it makes people aware, because years ago it wasn't aware of people with learning disability because they were put away. So now it's time for people with learning disability to write their story and to let other people know. (Cooper, 2008)
Mabel Cooper, former resident St Lawrence's Hospital, self-advocate, broadcaster and founder member of the Open University's Social History of Learning Disability Group.
This book's title – Communities, Archives and New Collaborative Practices – raises the question of who or what is collaborating. The reading of the title most immediately available might be that the collaboration is between communities and those that work in archives. Yet we want to focus on another type of collaboration here, one that is equally crucial in developing new collaborative practices for archives. In a recent action research project to develop an Inclusive Archive of Learning Disability History, it became clear that in seeking to produce an archive we needed to conceive of collaboration not only in terms of people but also in terms of a collaboration between different political theories. In developing the Inclusive Archive, we recognised that we needed to seek a collaborative relationship between the political ideas derived from public political logics – public service, public sphere, ‘on behalf of the public’ and for posterity – and those that derive from relational and personal-centred politics. While there was constant debate in the team with some of us favouring one set of political logic and some the other, we realised that for an archive to be an archive, and for it to be an inclusive one, we needed to develop an approach to archival practice that held both the public and the relational political traditions in dialogue.
The “Turn on the Night” associated event had presentations on the latest dark skies protection issues considered by the IAU’s Dark and Quiet Skies working groups. Presentations were also made on dark skies education programs and cultural/scientific heritage.
For decades, the U.S. Air Force has contemplated replacing the A-10 Thunderbolt II “Warthog” with a newer fighter aircraft. However, a quantitative analysis comparing the Warthog’s performance and costs with those of its intended replacement, the F-35 Lightning II Joint Strike Fighter, shows that retiring the Warthog would be operationally unsound and fiscally imprudent. The rationale for the replacement is that it would increase airpower capability while controlling costs. That rationale does not withstand scrutiny. An effectiveness analysis based on results from a survey of joint terminal attack controllers indicates that the A-10 vastly outperforms the F-35 in providing close-air support (CAS), a critical requirement for future conflicts against terrorists and insurgents. A cost analysis demonstrates that replacing the A-10 before its service life ends in 2035 would cost at least $20.9 billion. The replacement plan would waste substantial resources and seriously impair U.S. military capabilities. Given that constrained future budgets and low-intensity conflicts requiring precision CAS can be expected, the U.S. air fleet should include the A-10 Thunderbolt II.
Oxidative stress is implicated in the aetiology of schizophrenia, and the antioxidant defence system (AODS) may be protective in this illness. We examined the major antioxidant glutathione (GSH) in prefrontal brain and its correlates with clinical and demographic variables in schizophrenia.
Methods:
GSH levels were measured in the dorsolateral prefrontal region of 28 patients with chronic schizophrenia using a magnetic resonance spectroscopy sequence specifically adapted for GSH. We examined correlations of GSH levels with age, age at onset of illness, duration of illness, and clinical symptoms.
Results:
We found a negative correlation between GSH levels and age at onset (r = −0.46, p = 0.015), and a trend-level positive relationship between GSH and duration of illness (r = 0.34, p = 0.076).
Conclusion:
Our findings are consistent with a possible compensatory upregulation of the AODS with longer duration of illness and suggest that the AODS may play a role in schizophrenia.
Systems engineering and design thinking have been widely seen as distinctly different processes, systems engineering being more data-driven and analytical, and design thinking being more human- centred and creative. We use the term ‘design thinking’ to encompass the plurality of human-centered design processes that seek to unpack the core values behind design decisions. With the increased awareness that both systems engineering and design thinking need each other, the effects of a possibly persisting distinction on engineers’ attitudes toward these two processes are not well understood. In this paper, we describe the development and validation of a scale for measuring individual attitudes about systems engineering and design thinking. Thematic analysis of engineering and design literature is used to derive a Likert scale reflecting these attitudes. We use exploratory and confirmatory factor analysis to test and confirm this two-factor thematic representation, resulting in a 9-item Systems Engineering and Design Thinking Scale measure of attitudes.
Populations of Critically Endangered White-rumped Gyps bengalensis and Slender-billed G. tenuirostris Vultures in Nepal declined rapidly during the 2000s, almost certainly because of the effects of the use in livestock of the non-steroidal anti-inflammatory drug diclofenac, which is nephrotoxic to Gyps vultures. In 2006, veterinary use of diclofenac was banned in Nepal and this was followed by the gradual implementation, over most of the geographical range of the two vulture species in Nepal, of a Vulture Safe Zone (VSZ) programme to advocate vulture conservation, raise awareness about diclofenac, provide vultures with NSAID-free food and encourage the veterinary use in livestock of a vulture-safe alternative NSAID (meloxicam). We report the results of long-term monitoring of vulture populations in Nepal before and after this programme was implemented, by means of road transects. Piecewise regression analysis of the count data indicated that a rapid decline of the White-rumped Vulture population from 2002 up to about 2013 gave way to a partial recovery between about 2013 and 2018. More limited data for the Slender-billed Vulture indicated that a rapid decline also gave way to partial recovery from about 2012 onwards. The rates at which populations were increasing in the 2010s exceeded the upper end of the range of increase rates expected in a closed population under optimal conditions. The possibility that immigration from India is contributing to the changes cannot be excluded. We present evidence from open and undercover pharmacy surveys that the VSZ programme had apparently become effective in reducing the availability of diclofenac in a large part of the range of these species in Nepal by about 2011. Hence, community-based advocacy and awareness-raising actions, and possibly also provisioning of safe food, may have made an important contribution to vulture conservation by augmenting the effects of changes in the regulation of toxic veterinary drugs.
Disasters can damage the essential public health infrastructure and social protection systems required for vulnerable populations. This contributes to indirect mortality and morbidity as high as 70–90%, primarily due to an exacerbation of life-threatening conditions and chronic diseases. Despite this, the traditional focus of public health systems has been on communicable diseases. To address this challenge, disaster and health planners require access to repeatable and measurable methods to rank and prioritize the needs of people with life-threatening and chronic diseases before, during, and after a disaster.
Aim:
Propose a repeatable and measurable method for ranking and prioritizing the needs of people with life-threatening and chronic diseases before, during, and after a disaster.
Methods:
The research began with identifying the risk disasters pose to people with life-threatening and chronic diseases. The data gathered was then used to develop indicators and explore the use of DisasterAWARE™ (All-hazard Warnings, Analysis, and Risk Evaluation) to rank and prioritize the needs before, during, and after a disaster.
Results:
This research found people at greatest risk are those with underlying cardiovascular and respiratory diseases, unstable diabetes, renal diseases, and those undergoing cancer treatment. A sustainable method to help address this problem is to expand the use of DisasterAWARE™ (All-hazard Warnings, Analysis, and Risk Evaluation) to rank and prioritize needs at national and sub-national levels.
Discussion:
DisasterAWARE™ has been successfully applied to the assessment and prioritization of disaster risk and humanitarian assistance needs in Southeast Asia (ASEAN, Viet Nam), Central America (Guatemala, El Salvador, Honduras, Nicaragua), South America (Peru), and the Caribbean (Jamaica, Dominican Republic). Using the indicators developed through this research, this proven methodology can be seamlessly and easily translated to rank and prioritize the needs of people with life-threatening and chronic diseases before, during, and after a disaster.
Exposure to traumatic events is surprisingly common, yet little is known about its effect on decision making beyond the fact that those with post-traumatic stress disorder are more likely to have substance-abuse problems. We examined the effects of exposure to severe trauma on decision making in low-income, urban African Americans, a group especially likely to have had such traumatic experiences.
Method
Participants completed three decision-making tasks that assessed the subjective value of delayed monetary rewards and payments and of probabilistic rewards. Trauma-exposed cases and controls were propensity-matched on demographic measures, treatment for psychological problems, and substance dependence.
Results
Trauma-exposed cases discounted the value of delayed rewards and delayed payments, but not probabilistic rewards, more steeply than controls. Surprisingly, given previous findings that suggested women are more affected by trauma when female and male participants’ data were analyzed separately, only the male cases showed steeper delay discounting. Compared with nonalcoholic males who were not exposed to trauma, both severe trauma and alcohol-dependence produced significantly steeper discounting of delayed rewards.
Conclusions
The current study shows that exposure to severe trauma selectively affects fundamental decision-making processes. Only males were affected, and effects were observed only on discounting delayed outcomes (i.e. intertemporal choice) and not on discounting probabilistic outcomes (i.e. risky choice). These findings are the first to show significant differences in the effects of trauma on men's and women's decision making, and the selectivity of these effects has potentially important implications for treatment and also provides clues as to underlying mechanisms.