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SHEA endorses adhering to the recommendations by the CDC and ACIP for immunizations of all children and adults. All persons providing clinical care should be familiar with these recommendations and should routinely assess immunization compliance of their patients and strongly recommend all routine immunizations to patients. All healthcare personnel (HCP) should be immunized against vaccine-preventable diseases as recommended by the CDC/ACIP (unless immunity is demonstrated by another recommended method). SHEA endorses the policy that immunization should be a condition of employment or functioning (students, contract workers, volunteers, etc) at a healthcare facility. Only recognized medical contraindications should be accepted for not receiving recommended immunizations.
Simeone v. Simeone is an ideal case for inclusion in this volume because of its breadth and its timing. The overarching question presented by Simeone was whether courts should treat signatories to prenuptial agreements (notably women) just like any other contracting parties or whether courts should scrutinize prenuptial agreements more carefully than ordinary contracts. In considering this question, the case addressed the intersections of women’s relative rights and status within both private contracts and intimate relationships, and also public economic, social, and political systems.
Objectives: Down syndrome (DS) is a population with known hippocampal impairment, with studies showing that individuals with DS display difficulties in spatial navigation and remembering arbitrary bindings. Recent research has also demonstrated the importance of the hippocampus for novel word-learning. Based on these data, we aimed to determine whether individuals with DS show deficits in learning new labels and if they may benefit from encoding conditions thought to be less reliant on hippocampal function (i.e., through fast mapping). Methods: In the current study, we examined immediate, 5-min, and 1-week delayed word-learning across two learning conditions (e.g., explicit encoding vs. fast mapping). These conditions were examined across groups (twenty-six 3- to 5-year-old typically developing children and twenty-six 11- to 28-year-old individuals with DS with comparable verbal and nonverbal scores on the Kaufman Brief Intelligence Test – second edition) and in reference to sleep quality. Results: Both individuals with and without DS showed retention after a 1-week delay, and the current study found no benefit of the fast mapping condition in either group contrary to our expectations. Eye tracking data showed that preferential eye movements to target words were not present immediately but emerged after 1-week in both groups. Furthermore, sleep measures collected via actigraphy did not relate to retention in either group. Conclusions: This study presents novel data on long-term knowledge retention in reference to sleep patterns in DS and adds to a body of knowledge helping us to understand the processes of word-learning in typical and atypically developing populations. (JINS, 2018, 24, 955–965)
This Review describes the objectives and methodology of the DairyWater project as it aims to aid the Irish dairy processing industry in achieving sustainability as it expands. With the abolition of European milk quotas in March 2015, the Republic of Ireland saw a surge in milk production. The DairyWater project was established in anticipation of this expansion of the Irish dairy sector in order to develop innovative solutions for the efficient management of water consumption, wastewater treatment and the resulting energy use within the country's dairy processing industry. Therefore, the project can be divided into three main thematic areas: dairy wastewater treatment technologies and microbial analysis, water re-use and rainwater harvesting and environmental assessment. In order to ensure the project remains as relevant as possible to the industry, a project advisory board containing key industry stakeholders has been established. To date, a number of large scale studies, using data obtained directly from the Irish dairy industry, have been performed. Additionally, pilot-scale wastewater treatment (intermittently aerated sequencing batch reactor) and tertiary treatment (flow-through pulsed ultraviolet system) technologies have been demonstrated within the project. Further details on selected aspects of the project are discussed in greater detail in the subsequent cluster of research communications.
Background: Measurement of cognitive behavioural therapy (CBT) competency is often resource intensive. A popular emerging alternative to independent observers’ ratings is using other perspectives for rating competency. Aims: This pilot study compared ratings of CBT competency from four perspectives – patient, therapist, supervisor and independent observer using the Cognitive Therapy Scale (CTS). Method: Patients (n = 12, 75% female, mean age 30.5 years) and therapists (n = 5, female, mean age 26.6 years) completed the CTS after therapy sessions, and clinical supervisor and independent observers rated recordings of the same session. Results: Analyses of variance revealed that therapist average CTS competency ratings were not different from supervisor ratings, and supervisor ratings were not different from independent observer ratings; however, therapist ratings were higher than independent observer ratings and patient ratings were higher than all other raters. Conclusions: Raters differed in competency ratings. Implications for potential use and adaptation of CBT competency measurement methods to enhance training and implementation are discussed.
The Florida Children’s Medical Services (CMS) has a long-standing history of ensuring that providers of multiple paediatric subspecialties abide by the highest standards. The cardiac sub-committee has written quality standard documents that participating programmes must meet or exceed. These standards oversee paediatric cardiology services including surgery, catheterisations, and outpatient services. On April, 2012, the cardiac sub-committee decided to develop similar standards in paediatric electrophysiology. A task force was created and began this process. These standards include a catalogue of required and optional equipment, as well as staff and physician credentials. We sought to establish expectations of procedural numbers by practitioner and facility. The task force surveyed the members of the Pediatric and Congenital Electrophysiology Society. Finding no consensus, the task force is committed to generate the data by requiring that the CMS participating programmes enrol and submit data to the Multicenter Pediatric and Adult Congenital EP Quality (MAP-IT™) Initiative. This manuscript details the work of the Florida CMS Paediatric Electrophysiology Task Force.
This chapter argues that the empirical evidence cited by the authors, Cass Sunstein and Richard Thaler is capable of supporting a number of competing approaches, including what the author calls libertarian utilitarianism and libertarian justice. Central to Sunstein and Thaler's proposal is their claim that evidence from the social sciences justifies a distinctively paternalistic approach to public policy. The chapter considers three different arguments purporting to justify the use of a paternalist approach to public policy. The first argument comes from a series of publications by Sunstein and Thaler written prior to Nudge. The second reconstructs the argument of Nudge, where the authors merely claim that nudges are inevitable. Finally, the third provides a friendly argument, intended to establish that nudges ought to be paternalistic. This chapter uses an empirical evidence of framing effects to construct nudges aimed at promoting Rawls' theory of justice.
Patients with acute headache often undergo computed tomography (CT) followed by a lumbar puncture to rule out subarachnoid hemorrhage. Our international study examined current practice, the perceived need for a clinical decision rule for acute headache and the required sensitivity for such a rule.
We approached 2100 emergency physicians from 4 countries (Australia, Canada, the United Kingdom and the United States) to participate in our survey by sampling the membership of their emergency associations. We used a modified Dillman technique with 3–5 notifications and a prenotification letter employing a combination of electronic mail and postal mail. Physicians were questioned about neurologically intact patients who presented with headache. Analysis included both descriptive statistics for the entire sample and stratification by country.
The total response rate was 54.7% (1149/2100). Respondents were primarily male (75.5%), with a mean age of 42.5 years and a mean 12.3 years of emergency department (ED) experience. Of the physicians who responded, 49.5% thought all acute headache patients should be investigated with CT and 57.4% felt CT should always be followed by lumbar puncture. Of the respondents, 95.7% reported they would consider using a clinical decision rule for patients with acute headache to rule out subarachnoid hemorrhage. Respondents deemed the median sensitivity required by such a rule to be 99% (interquartile range 98%–99%). Approximately 1 in 5 physicians suggested that 100% sensitivity was required.
Emergency physicians report that they would welcome a clinical decision rule for headache that would determine which patients require costly or invasive tests to rule out subarachnoid hemorrhage. The required sensitivity of such a rule was realistic. These results will inform and inspire the development of clinical decision rules for acute headache in the ED.
Despite evidence for executive dysfunction in school-aged preterm children, less is known about the early development of these difficulties or their underlying neuropathology. This study used prospective longitudinal data from a regional cohort of 88 very preterm and 98 full-term comparison children to examine the executive functioning (EF) of preschool children born very preterm. The relationship between the severity of neonatal cerebral white matter (WM) abnormalities on magnetic resonance imaging (MRI) at term equivalent and children's EF at ages two and four years (corrected age) was examined. At age four, very preterm children with WM abnormalities performed less well than full-term children on the Detour Reaching Box, a measure of behavioral inhibition and cognitive flexibility, even after controlling for child IQ, SES, and medical background. Examination of patterns of EF performance between the ages of 2 and 4 years showed that the performance of all groups improved with age. However, very preterm children with mild and moderate-severe WM abnormalities were characterized by higher rates of consistent performance impairments. These findings support the presence of early and persistent executive difficulties in preschool children born very preterm, and highlight the importance of white matter pathology in the development of executive impairments. (JINS, 2008, 14, 90–101.)
Observers were placed on pelagic vessels in the Scottish fisheries for mackerel (Scomber scombrus), herring (Clupea harengus), "maatje" herring (herring caught just before their first spawning) and argentines (Argentina silus) to monitor by-catch composition and discarding practices. A total of 67 days was spent at sea, 11 on the argentine fleet, 28 on the herring fleet, 12 on the "maatje" herring fleet and 16 on the mackerel fleet. The level of by-catch generally ranged from <1% to around 2.5% of the total catch. The argentine fishery took a significant proportion of blue whiting (Micromesistius poutassou) (approx. 10% of the overall catch) but this was landed and sold in the market. The greatest range of by-catch species was found in the argentine fishery, including 11 species of fish and one species of squid. Discarding rates in the fisheries varied, with herring and argentine fisheries showing no discards, the mackerel fishery a discard rate of around 4% and the "maatje" herring fishery a discard rate of around 11%. By-catches included small numbers of gannets (Morus bassanus) but no marine mammals. If the sampled trips were representative, results indicate that marine mammal by-catch events typically occur during less than one in 20 hauls in the fisheries studied. A larger scale study is needed to confirm this. Cetaceans were sighted in the vicinity of the fishing boats during 4% of observed fishing activities.
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