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Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or psychosocial intervention.
We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone.
A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16–25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation.
We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was −4.44 (95% CI −10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm.
We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes.
We sought to determine who is involved in the care of a trauma patient.
We recorded hospital personnel involved in 24 adult Priority 1 trauma patient admissions for 12 h or until patient demise. Hospital personnel were delineated by professional background and role.
We cataloged 19 males and 5 females with a median age of 50-y-old (interquartile range [IQR], 35.5-67.5). The average number of hospital personnel involved was 79.71 (standard deviation, 17.62; standard error 3.6). A median of 51.2% (IQR, 43.4%-59.8%) of personnel were first involved within hour 1. More personnel were involved in direct versus indirect care (median 54.5 [IQR, 47.5-67.0] vs 25.0 [IQR, 22.0-30.5]; P < 0.0001). Median number of health-care professionals and auxiliary staff were 74.5 (IQR, 63.5-90.5) and 6.0 (IQR, 5.0-7.0), respectively. More personnel were first involved in hospital locations external to the emergency department (median, 53.0 [IQR, 41.5-63.0] vs 27.5 [IQR, 24.0-30.0]; P < 0.0001). No differences existed in total personnel by Injury Severity Score (P = 0.1266), day (P = 0.7270), or time of admission (P = 0.2098).
A large number of hospital personnel with varying job responsibilities respond to severe trauma. These data may guide hospital staffing and disaster preparedness policies.
The impact of change in socio-economic status (SES) from childhood to adulthood (SES mobility) on adult diet is not well understood. This study examined associations between three SES mobility variables (area disadvantage, education, occupation) and adult diet quality. 1482 Australian participants reported childhood area-level SES in 1985 (aged 10–15 years) and retrospectively reported highest parental education and main occupation (until participant age 12) and own area-level SES, education, occupation and dietary intake in 2004–2006 (aged 26–36 years). A Dietary Guidelines Index (DGI) was calculated from food frequency and habit questionnaires. A higher score (range 0–100) indicated better diet quality. Sex-stratified linear regression models adjusted for confounders. Area-level SES mobility was not associated with diet quality. Compared with stable high (university) education, stable low (school only) was associated with lower DGI scores (males: β = –5·5, 95 % CI: −8·9, –2·1; females: β = –6·3, 95 % CI: −9·3, –3·4), as was downward educational mobility (participant’s education lower than their parents) (males: β = –5·3, 95 % CI: −8·5, –2·0; females: β = –4·5, 95 % CI: −7·2, –1·7) and stable intermediate (vocational) education among males (β = –3·9, 95 % CI: −7·0, −0·7). Compared with stable high (professional/managerial) occupation, stable low (manual/out of workforce) males (β = –4·9, 95 % CI: −7·6, –2·2), and participants with downward occupation mobility (males: β = –3·2, 95 % CI: −5·3, –1·1; females: β = –2·8, 95 % CI: −4·8, –0·8) had lower DGI scores. In this cohort, intergenerational low education and occupation, and downward educational and occupational mobility, were associated with poor adult diet quality.
We aimed to describe associations between diet quality in adolescence and adulthood and knee symptoms in adulthood. Two hundred seventy-five participants had adolescent diet measurements, 399 had adult diet measurements and 240 had diet measurements in both time points. Diet quality was assessed by Dietary Guidelines Index (DGI), reflecting adherence to Australian Dietary Guidelines. Knee symptoms were collected using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Data were analysed using zero-inflated negative binomial regressions. The overall adolescent DGI was not associated with adult knee symptoms, although lower intake of discretionary foods (e.g. cream, alcohol, bacon and cake) in adolescence was associated with lower pain (mean ratio (MR) 0·96) and dysfunction (MR 0·94). The overall adult DGI was not associated with knee symptoms; however, limiting saturated fat was associated with lower WOMAC (Pain: MR 0·93; stiffness: MR 0·93; dysfunction: MR 0·91), drinking water was associated with lower stiffness (MR 0·90) and fruit intake was associated with lower dysfunction (MR 0·90). Higher DGI for dairy products in adulthood was associated with higher WOMAC (Pain: MR 1·07; stiffness: MR 1·13; dysfunction: MR 1·11). Additionally, the score increases from adolescence to adulthood were not associated with adult knee symptoms, except for associations between score increase in limiting saturated fat and lower stiffness (MR 0·89) and between score increase in fruit intake and lower dysfunction (MR 0·92). In conclusion, the overall diet quality in adolescence and adulthood was not associated with knee symptoms in adulthood. However, some diet components may affect later knee symptoms.
The use of online platforms for pediatric healthcare research is timely, given the current pandemic. These platforms facilitate trial efficiency integration including electronic consent, randomization, collection of patient/family survey data, delivery of an intervention, and basic data analysis.
We created an online digital platform for a multicenter study that delivered an intervention for sleep disorders to parents of children with autism spectrum disorder (ASD). An advisory parent group provided input. Participants were randomized to receive either a sleep education pamphlet only or the sleep education pamphlet plus three quick-tips sheets and two videos that reinforced the material in the pamphlet (multimedia materials). Three measures – Family Inventory of Sleep Habits (FISH), Children’s Sleep Habits Questionnaire modified for ASD (CSHQ-ASD), and Parenting Sense of Competence (PSOC) – were completed before and after 12 weeks of sleep education.
Enrollment exceeded recruitment goals. Trial efficiency was improved, especially in data entry and automatic notification of participants related to survey completion. Most families commented favorably on the study. While study measures did not improve with treatment in either group (pamphlet or multimedia materials), parents reporting an improvement of ≥3 points in the FISH score showed a significantly improved change in the total CSHQ (P = 0.038).
Our study demonstrates the feasibility of using online research delivery platforms to support studies in ASD, and more broadly, pediatric clinical and translational research. Online platforms may increase participant inclusion in enrollment and increase convenience and safety for participants and study personnel.
Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a frequent cause of healthcare-associated infections (HAIs). The CDC Emerging Infections Program (EIP) conducted population and laboratory-based surveillance of CRPA in selected areas in 8 states from August 1, 2016, through July 31, 2018. We aimed to describe the molecular epidemiology and mechanisms of resistance of CRPA isolates collected through this surveillance. Methods: We defined a case as the first isolate of P. aeruginosa resistant to imipenem, meropenem, or doripenem from the lower respiratory tract, urine, wounds, or normally sterile sites identified from a resident of the EIP catchment area in a 30-day period; EIP sites submitted a systematic random sample of isolates to CDC for further characterization. Of 1,021 CRPA clinical isolates submitted, 707 have been sequenced to date using an Illumina MiSeq. Sequenced genomes were classified using the 7-gene multilocus sequence typing (MLST) scheme, and a core genome MLST (cgMLST) scheme was used to determine phylogeny. Antimicrobial resistance genes were identified using publicly available databases, and chromosomal mechanisms of carbapenem resistance were determined using previously validated genetic markers. Results: There were 189 sequence types (STs) among the 707 sequenced genomes (Fig. 1). The most frequently occurring were high-risk clones ST235 (8.5%) and ST298 (4.7%), which were found across all EIP sites. Carbapenemase genes were identified in 5 (<1%) isolates. Overall, 95.6% of the isolates had chromosomal mutations associated with carbapenem resistance: 93.2% had porinD-associated mutations that decrease membrane permeability to the drugs; 24.8% had mutations associated with overexpression of the multidrug efflux pump MexAB-OprM; and 22.9% had mutations associated with overexpression of the endogenous β-lactamase ampC. More than 1 such chromosomal resistance mutation type was present in 37.8% of the isolates. Conclusions: The diversity of the sequence types demonstrates that HAIs caused by CRPA can arise from a variety of strains and that high-risk clones are broadly disseminated across the EIP sites but are a minority of CRPA strains overall. Carbapenem resistance in P. aeruginosa was predominantly driven by chromosomal mutations rather than acquired mechanisms (ie, carbapenemases). The diversity of the CRPA isolates and the lack of carbapenemase genes suggest that this ubiquitous pathogen can readily evolve chromosomal resistance mechanisms, but unlike carbapenemases, these cannot be easily spread through horizontal transfer.
Growing enough cover crop biomass to adequately suppress weeds is one of the primary challenges in reduced-tillage systems that rely on mulch-based weed suppression. We investigated two approaches to increasing cereal rye biomass for improved weed suppression: (1) increasing soil fertility and (2) increasing cereal rye seeding rate. We conducted a factorial experiment with three poultry litter application rates (0, 80, and 160 kg N ha−1) and three rye seeding rates (90, 150, and 210 kg seed ha−1) in Pennsylvania and Maryland in 2008 and 2009. We quantified rye biomass immediately after mechanically terminating it with a roller and weed biomass at 10 wk after termination (WAT). Rye biomass increased with poultry litter applications (675, 768, and 787 g m−2 in the 0, 80, and 160 kg N ha−1 treatments, respectively), but this increased rye biomass did not decrease weed biomass. In contrast, increasing rye seeding rate did not increase rye biomass, but it did reduce weed biomass (328, 279, and 225 g m−2 in the 90, 150, and 210 kg seed ha−1 treatments, respectively). In 2009, we also sampled ground cover before rolling and weed biomass and density at 4 WAT. Despite no treatment effects, we found a correlation between bare soil before rolling (%) and weed biomass at 4 WAT. Our results suggest that increased rye seeding rate can effectively reduce weed biomass and that ground cover in early spring can influence weed biomass later in the growing season.
Fossil catostomids were very rare prior to the Eocene. After the Eocene, they suddenly decreased in diversity in Asia while becoming common fishes in the North American fauna. Knowledge of the taxonomy, diversity, and distribution of Eocene catostomids is critical to understanding the evolution of this fish group. We herein describe a new catostomid species of the genus †Amyzon Cope, 1872 from the Eocene Kishenehn Formation in Montana, USA. The new species, †Amyzon kishenehnicum, differs from known species of †Amyzon in having hypurals 2 and 3 consistently fused to the compound centrum proximally, and differs from other Eocene catostomids in that the pelvic bone is intermediately forked. All our phylogenetic analyses suggest that the new species is the sister group of †A. aggregatum Wilson, 1977 and that †Amyzon is the most basal clade of the Catostomidae. We reassessed the osteological characters of the North American species of †Amyzon from a large number of well-preserved specimens of the new species, as well as †A. gosiutense Grande et al., 1982 and †A. aggregatum. Osteological characters newly discovered indicate that †A. gosiutense is not a junior synonym of †A. aggregatum, but should be retained as a distinct species.
This article describes a review undertaken in 2012–2013 by Nutrition and Dietetics, Flinders University, to assess the Indigenous health curriculum of the Bachelor of Nutrition and Dietetics (BND) and Masters of Nutrition and Dietetics (MND). An action research framework was used to guide and inform inquiry. This involved four stages, each of which provided information to reach a final decision about how to progress forward. First, relevant information was collected to present to stakeholders. This included identification of acknowledged curriculum frameworks, a review of other accredited nutrition and dietetics courses in Australia, a review of Indigenous health topics at Flinders University, including liaison with the Poche Centre for Indigenous Health and Well-Being (Indigenous health teaching and research unit), and a review of BND and MND current curriculum related to Indigenous health. Second, input was sought from stakeholders. This involved a workshop with practising dietitians and nutritionists from South Australia and the Northern Territory and discussions with Flinders University Nutrition and Dietetics academic staff. Third, a new curriculum was developed. Nine areas were identified for this curriculum, including reflexivity, approach and role, history and health status, worldview, beliefs and values, systems and structures, relationship building and communication, food and food choice, appreciating and understanding diversity, and nutrition issues and health status. Fourth, a final outcome was achieved, which was the decision to introduce a core, semester-long Indigenous health topic for BND students. A secondary outcome was strengthening of Indigenous health teaching across the BND and MND. The process and findings will be useful to other university courses looking to assess and expand their Indigenous health curriculum.
Organisational culture of institutions providing care for older people is increasingly recognised as influential in the quality of care provided. There is little research, however, that specifically examines the processes of care home culture and how these may be associated with quality of care. In this paper we draw from an empirical study carried out in the United Kingdom (UK) investigating the relationship between care home culture and residents' experience of care. Eleven UK care homes were included in an in-depth comparative case study design using extensive observation and interviews. Our analysis indicates how organisational cultures of care homes impact on the quality of care residents receive. Seven inter-related cultural elements were of key importance to quality of care. Applying Schein's conceptualisation of organisational culture, we examine the dynamic relationship between these elements to show how organisational culture is locally produced and shifting. A particular organisational culture in a care home cannot be achieved simply by importing a set of organisational values or the ‘right’ leader or staff. Rather, it is necessary to find ways of resolving the everyday demands of practice in ways that are consistent with espoused values. It is through this everyday practice that assumptions continuously evolve, either consistent with or divergent from, espoused values. Implications for policy makers, providers and practitioners are discussed.
Internationally there is an increasing amount of peer-reviewed literature pertaining to disaster nursing. The literature includes personal anecdotes, reflections, and accounts of single case studies. Furthermore, issues such as the willingness of nurses to assist in disasters, the role of nurses in disasters, leadership, competencies, and educational preparedness for nurses have been the focus of the literature.
The aim of this research was to determine the international research priorities for disaster nursing.
This research used a three-round Delphi technique. The first round used a face-to-face workshop to generate research statements with nursing members of the World Association for Disaster and Emergency Medicine (WADEM). The second and third rounds included the ranking of statements on a 5-point Likert scale with nursing members of WADEM and the World Society of Disaster Nursing (WSDN). Statements that achieved a mean of four or greater were considered a priority and progressed.
Participants were from multiple countries. Research statements were generated in the areas of: education, training, and curriculum; psychosocial; strategy, relationship, and networking; and clinical practice. Psychosocial aspects of disaster nursing ranked the highest, with five statements appearing in the top ten research areas, followed by statements relating to: education, training, and curriculum; clinical practice; and finally, strategy, relationship, and networking.
Future disaster nursing research should focus on the area of psychosocial aspects of disaster nursing, in particular, both the psychosocial needs of a disaster-affected community and the psychosocial wellbeing of nurses who assist in disaster health activities.
RanseJ, HuttonA, JeeawodyB, WilsonR. What Are the Research Needs for the Field of Disaster Nursing? An International Delphi Study. Prehosp Disaster Med. 2014;29(5):1-7.
The aim of the study was to determine the association between dietary outcomes and the neighbourhood food environment (street network distance from home to stores) and consumer food environment (Nutrition Environment Measurement Survey-Stores (NEMS-S) audit).
The neighbourhood food environment was captured by creating 0·5-mile and 1-mile network distance (street distance) around each participant's home and the nearest food venue (convenience store, grocery store, supermarket, farmers' market and produce stand). The consumer food environment was captured by conducting NEMS-S in all grocery stores/supermarkets within 0·5 and 1 mile of participants’ homes.
Fayette County, KY, USA.
Supplemental Nutrition Assessment Program (SNAP) participants, n 147.
SNAP participants who lived within 0·5 mile of at least one farmers’ market/produce stand had higher odds of consuming one serving or more of vegetables (OR = 6·92; 95 % CI 4·09, 11·69), five servings or more of grains (OR = 1·76; 95 % CI 1·01, 3·05) and one serving or more of milk (OR = 3·79; 95 % CI 2·14, 6·71) on a daily basis. SNAP participants who lived within 0·5 mile of stores receiving a high score on the NEMS-S audit reported higher odds of consuming at least one serving of vegetables daily (OR = 3·07; 95 % CI 1·78, 5·31).
Taken together, both the neighbourhood food environment and the consumer food environment are associated with a healthy dietary intake among SNAP participants.
The Global Energy Assessment (GEA) emphasizes the importance of energy to all societies, which explains a longstanding tendency for governments to be closely involved in the energy sector. The nature and extent of this involvement – the degree and types of energy-related policies – depends on a government's ideological orientation, the particular energy resource endowment in its jurisdiction, the development level of its economy, and specific concerns of its society with respect to energy access, energy security, and the environmental and human health impacts of energy supply and use.
In every country, energy's critical role for the goal of sustainable development is widely acknowledged. This means that energy-related policies need to be assessed in terms of performance with respect to the social, economic, and environmental dimensions that are encompassed by the concept of sustainable development. Ideally, energyrelated policies will make advances with respect to all three of these critical sustainability dimensions. But frequently policymakers are faced with difficult trade-offs in which improvement in one dimension is at the cost of another. Thus, the first goal of energy-related policy design should be to seek win-win opportunities for simultaneously advancing social, economic, and environmental goals. When this is not possible, the goal should be to apply decision-support mechanisms that integrate diverse social objectives and values into the policy design process, such as the application of multi-criteria analysis as described by Munasinghe (1992; 2009).
Do twins have a lower mean IQ score than singletons? Previous studies have not examined whole populations and are likely to be biased. Twin data from two whole-population surveys of IQ at age 11 years were examined: the Scottish Mental Surveys of 1932 and 1947. Additional variables from childhood were examined as possible mediating effects. There were 1080 twins from the 1932 survey, and 949 from the 1947 survey. In both surveys twins scored lower on the Moray House Test of verbal reasoning, equivalent to a deficit of about 5 IQ points. In the Scottish Mental Survey of 1947 the whole-population group of twins was compared in detail with a representative population sample. The same mental ability difference of about 5 IQ points was found, and was not accounted for by father's occupation, overcrowding in the childhood home, childhood height, school attendance or the number of people in the family.
Tracheotomy is one of the oldest known surgical procedures, and one of the most common procedures for patients in the intensive care unit (ICU). The development of endotracheal tubes with low-pressure/high-volume cuffs pushed back the timing of tracheotomy due to concerns that the risk of injury from the procedure had become greater than the risk of prolonged orotracheal intubation. Spinal cord lesions are associated with a high incidence of severe respiratory failure and pneumonia, with increased risk generally corresponding to a higher level of injury. The number of tracheotomies performed on elderly and chronically ill patients due to ongoing respiratory failure has increased considerably in recent years, possibly due to the success of critical care treatment. Retrospective studies that examine the timing of tracheotomy describe three groups of patients undergoing tracheotomy in a mixed medical-surgical pediatric ICU: prolonged mechanical ventilation; elective tracheotomy; and emergent tracheotomy.