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An “escape room” is a game requiring teamwork and problem-solving during which a series of puzzles are solved to escape a locked room. Various escape room activities have been designed for healthcare professionals, including internal medicine residents and nursing students (Anderson et al. Simulation & Gaming 2021; 52(1) 7-17; Rodríguez-Ferrer et al. BMC Med Educ 2022; 22:901; Khanna et al. Cureus 2021; 13 (9) e18314). Escape rooms provide an opportunity for social activity, an important component of resident wellness (Mari et al. BMC Med Educ 2019; 19(1):437). This abstract describes an escape room challenge designed and implemented at our psychiatry residency program quarterly wellness afternoon event, which is an afternoon session dedicated to resident wellness.
Objectives
The objective of this project was to design and implement an escape room challenge containing multiple game mechanics, including hidden roles, information asymmetry, acting, logical deduction, and spying. This activity was conducted to enhance bonding among residents while reinforcing knowledge in psychiatry.
Methods
We designed and implemented an escape room for 22 residents. Residents were divided into four teams each tasked with completing a sequence of puzzles to open the final lockbox. Two novel mechanics were added to the activity. Each team had a “clue holder” with clues to help solve all the puzzles. This team member had to conceal their identity because, if any of the other teams identified this person, the original winning team would have to give up the prize to the team that guessed the identity of this person. One member of each team was assigned a “spy” role whose mission was to make it hard for the clue holder to reveal all the clues. An anonymous post-activity survey was completed using Google Forms.
Results
The script was set in a fictional, abandoned psychiatric emergency room. The first task was a visual puzzle of a historic figure in psychiatry. The second activity involved residents guessing the psychotropic medication being acted out by another resident in the style of charades. The third activity required residents to apply developmental milestones to decode a combination lock. The fourth puzzle involved residents solving riddles by using information gathered from resident profiles on the residency program website.
Eleven (50%) residents completed the post-game survey. All residents answered true or very true that they enjoyed the game and that participation helped them better connect with their peers. Eight (73%) residents answered true or very true that they learned something from the activity.
Conclusions
An adapted escape room challenge is a novel wellness activity that enhance resident collegiality, teamwork, and bonding. All residents who completed the post-activity survey indicated that they enjoyed the activity and felt more connected to their peers afterwards.
The adsorption of sodium, chloride, and phosphate ions by allophane, imogolite, and halloysite has been studied in relation to the surface structure of the mineral samples. The high adsorption of phosphate (>200 μmole/g) and chloride (10–30 meq/100 g at pH 4) by allophane is ascribed to the small particle size of allophane, its high surface area (∼800 m2/g), and the presence at the surface of Al-OH-Al groups and defect sites. In contrast, halloysite has a relatively large particle size and a Si-O-Si surface. Accordingly, the adsorption of phosphate (5–10 μmole/g) and chloride (1 meq/100 g) by halloysite is very much lower as compared with allophane. Phosphate adsorption by halloysite is also related to particle morphology and the number of edge sites. Thus, a sample consisting entirely of spheroidal particles adsorbed only 5 μmole/g at a solution concentration of 1 × 10−4 M, whereas the tubular types of comparable surface area adsorbed 7–10 μmole/g at the same concentration. This is because spheroidal halloysite particles have few, if any, edge sites at which phosphate can adsorb. The relative degree of order and hydration of halloysite, as indicated by infrared spectroscopy, also affects phosphate adsorption. However, this factor is apparently less important than particle morphology and surface structure. Although imogolite also has an Al-OH-Al surface, it contains relatively few defect sites where phosphate can adsorb. Consequently, much less phosphate (120 μmole/g) was adsorbed as compared with allophane.
The slow adoption of evidence-based interventions reflects gaps in effective dissemination of research evidence. Existing studies examining designing for dissemination (D4D), a process that ensures interventions and implementation strategies consider adopters’ contexts, have focused primarily on researchers, with limited perspectives of practitioners. To address these gaps, this study examined D4D practice among public health and clinical practitioners in the USA.
Methods:
We conducted a cross-sectional study among public health and primary care practitioners in April to June 2022 (analyzed in July 2022 to December 2022). Both groups were recruited through national-level rosters. The survey was informed by previous D4D studies and pretested using cognitive interviewing.
Results:
Among 577 respondents, 45% were public health and 55% primary care practitioners, with an overall survey response rate of 5.5%. The most commonly ranked sources of research evidence were email announcements for public health practitioners (43.7%) and reading academic journals for clinical practitioners (37.9%). Practitioners used research findings to promote health equity (67%) and evaluate programs/services (66%). A higher proportion of clinical compared to public health practitioners strongly agreed/agreed that within their work setting they had adequate financial resources (36% vs. 23%, p < 0.001) and adequate staffing (36% vs. 24%, p = 0.001) to implement research findings. Only 20% of all practitioners reported having a designated individual or team responsible for finding and disseminating research evidence.
Conclusions:
Addressing both individual and modifiable barriers, including organizational capacity to access and use research evidence, may better align the efforts of researchers with priorities and resources of practitioners.
Since the emergence of Omicron variant of SARS-CoV-2 in late 2021, a number of sub-lineages have arisen and circulated internationally. Little is known about the relative severity of Omicron sub-lineages BA.2.75, BA.4.6, and BQ.1. We undertook a case–control analysis to determine the clinical severity of these lineages relative to BA.5, using whole genome sequenced, PCR-confirmed infections, between 1 August 2022 and 27 November 2022, among those who presented to emergency care in England 14 days after and up to one day prior to the positive specimen. A total of 10,375 episodes were included in the analysis; of which, 5,207 (50.2%) were admitted to the hospital or died. Multivariable conditional regression analyses found no evidence of greater odds of hospital admission or death among those with BA.2.75 (odds ratio (OR) = 0.96, 95% confidence interval (CI): 0.84–1.09) and BA.4.6 (OR = 1.02, 95% CI: 0.88– 1.17) or BQ.1 (OR = 1.03, 95% CI: 0.94–1.13) compared to BA.5. Future lineages may not follow the same trend and there remains a need for continued surveillance of COVID-19 variants and their clinical outcomes to inform the public health response.
Lifetime radiation exposure for paediatric orthotopic heart transplant (OHT) patients is significant with cardiac catheterisation as the dominant source. Interventional cardiac magnetic resonance is utilised to obtain simultaneous, radiation-free haemodynamics and flow/function measurements. We sought to compare invasive haemodynamic measurements and radiation exposure in traditional cardiac catheterisation, to comprehensive interventional cardiac magnetic resonance.
Methods:
Twenty-eight OHT patients who underwent 67 interventional cardiac magnetic resonance procedures at Children’s National Hospital were identified. Both invasive oximetry with peripheral oxygen saturation (Fick) and cardiac magnetic resonance phase contrast measurements of pulmonary and systemic blood flow were performed. Systemic and pulmonary blood flow from the two modalities was compared using Bland–Altman, concordance analysis, and inter-reader correlation. A mixed model was implemented to account for confounding variables and repeat encounters. Radiation dosage data were collected for a contemporaneous cohort of orthotopic heart transplant patients undergoing standard, X-ray-guided catheterisation.
Results:
Simultaneous cardiac magnetic resonance and Fick have poor agreement in our study based on Lin’s correlation coefficient of 0.68 and 0.73 for pulmonary and systemic blood flow, respectively. Bland–Altman analysis demonstrated a consistent over estimation of cardiac magnetic resonance cardiac output by Fick. The average indexed dose area product for patients undergoing haemodynamics with endomyocardial biopsy was 0.73 (SD ±0.6) Gy*m2/kg. With coronary angiography added, the indexed dose area product was 14.6 (SD ± 7.8) Gy*m2/kg.
Conclusions:
Cardiac magnetic resonancemeasurements of cardiac output/index in paediatric orthotopic heart transplant patients have poor concordance with Fick estimates; however, cardiac magnetic resonance has good internal validity and inter-reader reliability. Radiation doses are small for haemodynamics with biopsy and increase exponentially with angiography, identifying a new target for cardiac magnetic resonance imaging.
A dynamical understanding of the physical process of surface gravity wave breaking remains an unresolved problem in fluid dynamics. Conceptually, breaking can be described by inception and onset, where breaking inception is the initiation of unknown irreversible processes within a wave crest that precede the visible manifestation of breaking onset. In the search for an energetic indicator of breaking inception, we use an ensemble of non-breaking and breaking crests evolving within unsteady wave packets simulated in a numerical wave tank to investigate the evolution of each term in the kinetic energy balance equation. We observe that breaking onset is preceded by around one quarter of a wave period by a rapid increase in the rate of convergence of kinetic energy that triggers an irreversible acceleration of the kinetic energy growth rate. This energetic signature, which is present only for crests that subsequently break, arises when the kinetic energy growth rate exceeds a critical threshold. At this point the additional kinetic energy convergence cannot be offset by converting excess kinetic energy to potential energy or by dissipation through friction. Our results suggest that the ratio of the leading terms of the kinetic energy balance equation at the time of this energetic signature is proportional to the strength of the breaking crest. Hence this energetic inception point both predicts the occurrence of breaking onset and indicates the strength of the breaking event.
This chapter examines the intersection of stigma and mental health in certain sects of Abrahamic religious traditions (including sects of Christianity, Islam, and Judaism). Research has shown people in many religious communities underutilize mental health services. Although there are numerous reasons for this underutilization, the stigma against mental health professionals and treatment in religious communities – religious mental health stigma – and the historical antagonism of psychologists against religious communities are two major reasons. This chapter reviews these factors and discusses how religious communities and mental health professionals can bridge the schism between their groups. We argue that by understanding the needs of religious communities, working within their worldviews, and engaging in respectful ways, psychological researchers and clinicians can build bridges that surmount stigma and other barriers and promote the best care for people in need.
A terrestrial (lacustrine and fluvial) palaeoclimate record from Hoxne (Suffolk, UK) shows two temperate phases separated by a cold episode, correlated with MIS 11 subdivisions corresponding to isotopic events 11.3 (Hoxnian interglacial period), 11.24 (Stratum C cold interval), and 11.23 (warm interval with evidence of human presence). A robust, reproducible multiproxy consensus approach validates and combines quantitative palaeotemperature reconstructions from three invertebrate groups (beetles, chironomids, and ostracods) and plant indicator taxa with qualitative implications of molluscs and small vertebrates. Compared with the present, interglacial mean monthly air temperatures were similar or up to 4.0°C higher in summer, but similar or as much as 3.0°C lower in winter; the Stratum C cold interval, following prolonged nondeposition or erosion of the lake bed, experienced summers 2.5°C cooler and winters between 5°C and 10°C cooler than at present. Possible reworking of fossils into Stratum C from underlying interglacial assemblages is taken into account. Oxygen and carbon isotopes from ostracod shells indicate evaporatively enriched lake water during Stratum C deposition. Comparative evaluation shows that proxy-based palaeoclimate reconstruction methods are best tested against each other and, if validated, can be used to generate more refined and robust results through multiproxy consensus.
Two introduced carnivores, the European red fox Vulpes vulpes and domestic cat Felis catus, have had extensive impacts on Australian biodiversity. In this study, we collate information on consumption of Australian birds by the fox, paralleling a recent study reporting on birds consumed by cats. We found records of consumption by foxes on 128 native bird species (18% of the non-vagrant bird fauna and 25% of those species within the fox’s range), a smaller tally than for cats (343 species, including 297 within the fox’s Australian range, a subset of that of the cat). Most (81%) bird species eaten by foxes are also eaten by cats, suggesting that predation impacts are compounded. As with consumption by cats, birds that nest or forage on the ground are most likely to be consumed by foxes. However, there is also some partitioning, with records of consumption by foxes but not cats for 25 bird species, indicating that impacts of the two predators may also be complementary. Bird species ≥3.4 kg were more likely to be eaten by foxes, and those <3.4 kg by cats. Our compilation provides an inventory and describes characteristics of Australian bird species known to be consumed by foxes, but we acknowledge that records of predation do not imply population-level impacts. Nonetheless, there is sufficient information from other studies to demonstrate that fox predation has significant impacts on the population viability of some Australian birds, especially larger birds, and those that nest or forage on the ground.
This report describes how stakeholder groups informed a web-based care planning tool’s development for addressing root causes of poor health. Stakeholders included community members (n = 6), researchers (n = 6), community care providers (n = 9), and patients (n = 17). Feedback was solicited through focus groups, semi-structured interviews, and user experience observations and then qualitatively analyzed to identify themes. Each group contributed a unique perspective. Researchers wanted evidence-based content; community members and providers focused on making goals manageable; patients wanted care team support and simple action-oriented language. Our findings highlight the benefits of stakeholder input. Blending perspectives from multiple groups results in a more robust intervention design.
Plasmodium coatneyi has been proposed as an animal model for human Plasmodium falciparum malaria as it appears to replicate many aspects of pathogenesis and clinical symptomology. As part of the ongoing evaluation of the rhesus macaque model of severe malaria, a detailed ultrastructural analysis of the interaction between the parasite and both the host erythrocytes and the microvasculature was undertaken. Tissue (brain, heart and kidney) from splenectomized rhesus macaques and blood from spleen-intact animals infected with P. coatneyi were examined by electron microscopy. In all three tissues, similar interactions (sequestration) between infected red blood cells (iRBC) and blood vessels were observed with evidence of rosette and auto-agglutinate formation. The iRBCs possessed caveolae similar to P. vivax and knob-like structures similar to P. falciparum. However, the knobs often appeared incompletely formed in the splenectomized animals in contrast to the intact knobs exhibited by spleen intact animals. Plasmodium coatneyi infection in the monkey replicates many of the ultrastructural features particularly associated with P. falciparum in humans and as such supports its use as a suitable animal model. However, the possible effect on host–parasite interactions and the pathogenesis of disease due to the use of splenectomized animals needs to be taken into consideration.
We present a broadband radio study of the transient jets ejected from the black hole candidate X-ray binary MAXI J1535–571, which underwent a prolonged outburst beginning on 2017 September 2. We monitored MAXI J1535–571 with the Murchison Widefield Array (MWA) at frequencies from 119 to 186 MHz over six epochs from 2017 September 20 to 2017 October 14. The source was quasi-simultaneously observed over the frequency range 0.84–19 GHz by UTMOST (the Upgraded Molonglo Observatory Synthesis Telescope) the Australian Square Kilometre Array Pathfinder (ASKAP), the Australia Telescope Compact Array (ATCA), and the Australian Long Baseline Array (LBA). Using the LBA observations from 2017 September 23, we measured the source size to be
$34\pm1$
mas. During the brightest radio flare on 2017 September 21, the source was detected down to 119 MHz by the MWA, and the radio spectrum indicates a turnover between 250 and 500 MHz, which is most likely due to synchrotron self-absorption (SSA). By fitting the radio spectrum with a SSA model and using the LBA size measurement, we determined various physical parameters of the jet knot (identified in ATCA data), including the jet opening angle (
$\phi_{\rm op} = 4.5\pm1.2^{\circ}$
) and the magnetic field strength (
$B_{\rm s} = 104^{+80}_{-78}$
mG). Our fitted magnetic field strength agrees reasonably well with that inferred from the standard equipartition approach, suggesting the jet knot to be close to equipartition. Our study highlights the capabilities of the Australian suite of radio telescopes to jointly probe radio jets in black hole X-ray binaries via simultaneous observations over a broad frequency range, and with differing angular resolutions. This suite allows us to determine the physical properties of X-ray binary jets. Finally, our study emphasises the potential contributions that can be made by the low-frequency part of the Square Kilometre Array (SKA-Low) in the study of black hole X-ray binaries.
Evidence of status competition in the US Southwest is subtle and often devoid of material excess, pushing archaeologists to challenge the ways in which they think about and search for social differences. Using data from the large Mimbres site of Galaz, we focus on the concept of antecedence, a form of social status derived from being viewed as a first-comer or the descendant of first-comers. Our results suggest that while archaeology can offer insights into status and consumption in the ancient past, broadening our views of what is possible, we must be cautious in applying those insights directly to the contemporary world.
Understanding, categorizing, and using implementation science theories, models, and frameworks is a complex undertaking. The issues involved are even more challenging given the large number of frameworks and that some of them evolve significantly over time. As a consequence, researchers and practitioners may be unintentionally mischaracterizing frameworks or basing actions and conclusions on outdated versions of a framework.
Methods:
This paper addresses how the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework has been described, summarizes how the model has evolved over time, and identifies and corrects several misconceptions.
Results:
We address 13 specific areas where misconceptions have been noted concerning the use of RE-AIM and summarize current guidance on these issues. We also discuss key changes to RE-AIM over the past 20 years, including the evolution to Pragmatic Robust Implementation and Sustainability Model, and provide resources for potential users to guide application of the framework.
Conclusions:
RE-AIM and many other theories and frameworks have evolved, been misunderstood, and sometimes been misapplied. To some degree, this is inevitable, but we conclude by suggesting some actions that reviewers, framework developers, and those selecting or applying frameworks can do to prevent or alleviate these problems.
The occurrence of nonlocal objects, raw materials, and ideas in the southwestern United States (U.S. SW) has long been recognized as evidence of interaction between prehispanic peoples of this region and those of greater Mesoamerica. Although many archaeologists have analyzed the directionality and potential means by which these objects and concepts moved across the landscape, few have assessed the degree to which Mesoamerican practices and traditional assemblages remained intact as the artifacts and ideas moved farther from their places of origin. The current study analyzes the distribution and deposition of blue-green stone mosaics, a craft technology that was well established in Mesoamerica by the Late Preclassic period (300 BC–AD 250) and spread to the U.S. SW by the start of the Hohokam Pioneer period (AD 475). We assess the spatial distribution, contextual deposition, and morphology of mosaics at sites within Hohokam Canal System 2, located in the Phoenix Basin of Arizona. We use these data to infer mosaics’ social value and function within Hohokam social structure. Analyses suggest that, although the technology of mosaic making may have originated in Mesoamerica, the contexts and ways in which mosaics were used in the Hohokam regional system were decidedly Hohokam.
Mimbres painted pottery from the U.S. Southwest is renowned for its spectacular designs. Literature on style and identity suggests three concepts helpful for understanding its social significance: boundaries, multiple dimensions of variation, and historical context. This article investigates these concepts by synthesizing past studies with new analyses. The distribution of Mimbres pottery is strongly bounded, demonstrated with data from the cyberSW project. Variation in designs is multidimensional: (1) individual artists created distinctive styles; (2) specific designs are distributed homogeneously across the region, a conclusion demonstrated in part with new analyses of the geometric designs; and (3) pan-regionally, the designs’ content, regular structure, and appearance on multiple media suggest they were meaning-charged. Considering these findings in their historical context provides insights into the pottery's social significance and elaboration: population growth in the resource-rich Mimbres region engendered land tenure systems, marked in part by burials that included pottery. The pottery came to convey the message “I belong here” from two perspectives. By adopting the pottery, people, including migrants, signaled their acceptance of established ways of life in the region, and their access to the pottery indicated their acceptance in the social milieu.