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There is a lack of critical research addressing racism as a dynamic of mental health in schools. In the critical view, US schools mirror a social system built on an ideology of white supremacy; the US school system may perpetuate racial trauma for students of color. Teachers who demonstrate culturally competent identities in practice have important roles to play in counteracting racial trauma and promoting the mental health of students of color. Extending critical race theory and relational cultural theory, this chapter proposes a new framework for understanding cultural competence at the intersection of racism and mental health, Critical School Mental Health Praxis (CrSMHP). CrSMHP challenges models of resiliency that put the onus on the victim to overcome circumstances. It instead targets the root cause of the traumas, oppressive social systems, and their perpetuation in schools. Cultural competence in CrSMHP focuses on dismantling oppressive systems through systematic critical reflection and practice. In proposing CrSMHP, we suggest specific recommendations for professionals as a method for improving the mental wellness of underserved and underrepresented populations.
During our tenure on Google's People Analytics team, we have participated in dozens of research partnerships. Some have been wildly successful, resulting in changes to our own organizational practices or policies as well as academic publications. Other partnerships have been less fruitful, largely because both science and organizations are messy and unpredictable. But no matter the outcome, nearly all of our partnerships have come about in the same way—a way overlooked by the authors in their article (Lapierre et al., 2018).
We sought to evaluate the role healthcare providers play in carbapenem-resistant Enterobacteriaceae (CRE) acquisition among hospitalized patients.
A 1:4 case-control study with incidence density sampling.
Academic healthcare center with regular CRE perirectal screening in high-risk units.
We included case patients with ≥1 negative CRE test followed by positive culture with a length of stay (LOS) >9 days. For controls, we included patients with ≥2 negative CRE tests and assignment to the same unit set as case patients with a LOS >9 days.
Controls were time-matched to each case patient. Case exposure was evaluated between days 2 and 9 before positive culture and control evaluation was based on maximizing overlap with the case window. Exposure sources were all CRE-colonized or -infected patients. Nonphysician providers were compared between study patients and sources during their evaluation windows. Dichotomous and continuous exposures were developed from the number of source-shared providers and were used in univariate and multivariate regression.
In total, 121 cases and 484 controls were included. Multivariate analysis showed odds of dichotomous exposure (≥1 source-shared provider) of 2.27 (95% confidence interval [CI], 1.25–4.15; P=.006) for case patients compared to controls. Multivariate continuous exposure showed odds of 1.02 (95% CI, 1.01–1.03; P=.009) for case patients compared to controls.
Patients who acquire CRE during hospitalization are more likely to receive care from a provider caring for a patient with CRE than those patients who do not acquire CRE. These data support the importance of hand hygiene and cohorting measures for CRE patients to reduce transmission risk.
We assessed the feasibility and impact on knowledge, attitudes, and reported practices of psychological first-aid (PFA) training in a sample of Medical Reserve Corps (MRC) members. Data have been limited on the uptake of PFA training in surge responders (eg, MRC) who are critical to community response.
Our mixed-methods approach involved self-administered pre- and post-training surveys and within-training focus group discussions of 76 MRC members attending a PFA training and train-the-trainer workshop. Listen, protect, connect (a PFA model for lay persons) focuses on listening and understanding both verbal and nonverbal cues; protecting the individual by determining realistic ways to help while providing reassurance; and connecting the individual with resources in the community.
From pre- to post-training, perceived confidence and capability in using PFA after an emergency or disaster increased from 71% to 90% (P < .01), but no significant increase was found in PFA-related knowledge. Qualitative analyses suggest that knowledge and intentions to use PFA increased with training. Brief training was feasible, and while results were modest, the PFA training resulted in greater reported confidence and perceived capability in addressing psychological distress of persons affected by public health threats.
PFA training is a promising approach to improve surge responder confidence and competency in addressing postdisaster needs. (Disaster Med Public Health Preparedness. 2014;0:1-6)
The goal of this study was to quantify the impact of the suggested education correction on the sensitivity and specificity of the Montreal Cognitive Assessment (MoCA).
Twenty-five outpatients with dementia and 39 with amnestic mild cognitive impairment (aMCI) underwent a diagnostic evaluation, which included the MoCA. Thirty-seven healthy controls also completed the MoCA and psychiatric, medical, neurological, functional, and cognitive difficulties were ruled out.
For the total MoCA score, unadjusted for education, a cut-off score of 26 yielded the best balance between sensitivity and specificity (80% and 89% respectively) in identifying cognitive impairment (people with either dementia or aMCI, versus controls). When applying the education correction, sensitivity decreased from 80% to 69% for a small specificity increase (89% to 92%). The cut-off score yielding the best balance between sensitivity and specificity for the education adjusted MoCA score fell to 25 (61% and 97%, respectively).
Adjusting the MoCA total score for education had a detrimental effect on sensitivity with only a slight increase in specificity. Clinically, this loss in sensitivity can lead to an increased number of false negatives, as education level does not always correlate to premorbid intellectual function. Clinical judgment about premorbid status should guide interpretation. However, as this effect may be cohortspecific, age and education corrected norms and cut-offs should be developed to help guide MoCA interpretation.
Although the newborn infant is born with an immature coagulation system, the well term and preterm infant rarely experiences bleeding or clotting. However, the neonate has very limited capacity to respond to hemostatic stresses and quickly develops severe acquired deficiencies of coagulation proteins, especially in the face of sepsis or hypoxia. Infection and associated inflammation, through reciprocal activation of coagulation, results in the consumption of protein C and other proteins, ultimately causing both thrombosis and bleeding. Infection and indwelling catheters promote thrombosis in a facilitative manner. Genetic thrombophilia also promotes thrombosis in the neonate, especially idiopathic thrombosis, and should be considered in the evaluation of a newborn infant with thrombosis. Imaging techniques for neonatal thrombosis range from Doppler and imaging ultrasound for extremity arterial and venous thrombosis, to magnetic resonance angiography for arterial ischemic stroke and cerebral sinovenous thrombosis. Risks for death, recurrence and long-term complications of thrombosis can be used to determine aggressiveness of antithrombotic approach required. Finally, dosing of antithrombotic agents is unique to this developmental age and cannot be extrapolated from older children or adults.
Bulleted list of salient points (5–10)
Thrombosis is a significant clinical problem in the newborn nursery affecting both term and preterm infants.
Most newborn infants presenting with thrombosis have predisposing underlying disorders and triggers.
Sepsis is a powerful promoter of prothrombotic hemostatic alterations resulting in DIC and thrombosis.
Genetic thrombophilia contributes to the thrombotic tendency of the newborn.
The imaging technique used to diagnose thrombosis in the newborn is dependent upon the anatomic site of the thrombus.
Newborn infants with thrombosis can be stratified by risk for poor outcome; antithrombotic therapies form a continuum from least to most aggressive approach that is dictated by clinical circumstances and patient factors.
Dosing of antithrombotic agents in the newborn is unique to the developmental age of the infant and competence of the hemostatic system.
Obstructive sleep apnea (OSA) is a fairly common nocturnal breathing
disorder, affecting 2–4% of individuals. Although OSA is
associated with medical morbidity, its most functionally disruptive
effects in adults appear to be neuropsychological in nature. Research
on the neuropsychological effects of pediatric OSA has been limited.
This study compared the neuropsychological functioning of school-aged
children with OSA to that of healthy children. The primary goal was to
clarify the presence and pattern of neuropsychological morbidity
associated with pediatric OSA. Sleep was assessed with parent-report
questionnaires and laboratory sleep studies. Neuropsychological
functioning was assessed by formal tests and parent- and teacher-report
questionnaires. Data indicated OSA-related cognitive and behavioral
impairment that was particularly marked on measures of behavior
regulation and some aspects of attention and executive functioning.
Minimal effects were observed on measures of intelligence, verbal
memory, or processing speed. Exploratory analyses failed to indicate
any clear relationship between neuropsychological functioning and
objective indexes of hypoxia or sleep disruption, though the sample was
small. These data add to a growing literature which suggests that
significant neuropsychological deficits are associated with pediatric
OSA. Findings suggest a pattern of neuropsychological morbidity that is
similar but not identical to that seen in adult OSA. (JINS,
2004, 10, 962–975.)
In an ideal world, fraud or even misconduct in clinical research would not exist; but we do not live in such a world. Accepting, therefore, that they can happen, research ethics committees – particularly local committees – have important roles to play in trying to prevent their occurrence and, if either does occur, to assist in their investigation.
Fraud is much less common than carelessness, though its incidence is difficult to quantify. Nevertheless some element of fraud in clinical trials has been variously estimated (Horton, 1996; Wells, 2001)at between 0.1 and 1% of research projects. As justification for this estimate, there are about 3000 sponsored clinical trials taking place at any one time in the United Kingdom. If the higher figure is assumed, this means that 30 studies may be currently being conducted that could include fraudulent or inaccurately compiled data. Even one case of fraud or other misconduct is one too many. Fraud is likely to exploit patients, deceive the sponsor and may skew the scientific database. Reports of proven cases of fraud in biomedical research are usually greeted with dismay and an element of surprise. Society expects doctors conducting research to be honest and honourable as well as competent – as, indeed, the vast majority of them are.
Definition of research misconduct
At a consensus conference held under the auspices of the Royal College of Physicians in Edinburgh in 1999, a number of definitions of misconduct were discussed. Research misconduct was viewed as including fabrication, falsification and/or suppression of data and plagiarism, as well as unintentional action that undermines the scientific value of the work.
To investigate an outbreak of invasive disease due to Enterobacter cloacae and Serratia marcescens in a surgical intensive care unit (ICU).
Pulsed-field gel electrophoresis (PFGE) analysis of restriction fragments was used to characterize the outbreak isolate genotypes. A retrospective cohort study of surgical ICU patients was conducted to identify risk factors associated with invasive disease. Unit staffing data were analyzed to compare staffing levels during the outbreak to those prior to and following the outbreak.
An urban hospital in San Francisco, California.
During the outbreak period, December 1997 through January 1998, there were 52 patients with a minimum ICU stay of ≥72 hours. Of these, 10 patients fit our case definition of recovery of E cloacae or S marcescens from a sterile site.
PFGE analysis revealed a highly heterogeneous population of isolates. Bivariate analysis of patient-related risk factors revealed duration of central lines, respiratory colonization, being a burn patient, and the use of gentamicin or nafcillin to be significantly associated with invasive disease. Both respiratory colonization and duration of central lines remained statistically significant in a multivariate analysis. Staffing data suggested a temporal correlation between understaffing and the outbreak period.
Molecular epidemiological techniques provided a rapid means of ruling out a point source or significant cross-contamination as modes of transmission. In this setting, patient-related risk factors, such as respiratory colonization and duration of central lines, may provide a focus for heightened surveillance, infection control measures, and empirical therapy during outbreaks caused by common nosocomial pathogens. In addition, understaffing of nurses may have played a role in this outbreak, highlighting the importance of monitoring staffing levels.
The aim of the study was to compare the psychophysiological pattern associated with obsessive–compulsive disorder (OCD) in clinical patients (n = 13) and checking behaviours in a nonclinical population (n = 13) to evaluate the validity of the anxiety reduction hypothesis. A second objective was to examine the psychophysiological pattern associated with prevention of ritualistic behaviour in the OCD group and of checking behaviour in the control group. A guided imagery methodology was utilised in order to examine the progression of the behaviours over time. Various psychophysiological measures were incorporated to account for the response to personalised imagery presented in four distinct stages. The stages included setting the scene, approach, incident, and consequence. Both the psychophysiological and the subjective response to the ritual/checking and response-prevention/no-checking scripts were higher than to the neutral script for both groups. A trend towards significantly higher heart rate response to the response-prevention/no-checking than to the ritual/checking script was also observed. Higher levels of depersonalisation and anxiety in the OCD group were observed following prevention of the ritual. The patterns of response indicated obsessive–compulsive behaviour may act to prevent the level of anxiety experienced by an individual from escalating, rather than to reduce it from an already elevated level.
Four soil chronosequences in the southern Great Basin were examined in order to study and quantify soil development during the Quaternary. Soils of all four areas are developed in gravelly alluvial fans in semiarid climates with 8 to 40 cm mean annual precipitation. Lithologies of alluvium are granite-gneiss at Silver Lake, granite and basalt at Cima Volcanic Field, limestone at Kyle Canyon, and siliceous volcanic rocks at Fortymile Wash. Ages of the soils are approximated from several radiometric and experimental techniques, and rates are assessed using a conservative mathematical approach. Average rates for Holocene soils at Silver Lake are about 10 times higher than for Pleistocene soils at Kyle Canyon and Fortymile Wash, based on limited age control. Holocene soils in all four areas appear to develop at similar rates, and Pleistocene soils at Kyle Canyon and Fortymile Wash may differ by only a factor of 2 to 4. Over time spans of several millennia, a preferred model for the age curves is not linear but may be exponential or parabolic, in which rates decrease with increasing age. These preliminary results imply that the geographical variation in rates within the southern Great Basin-Mojave region may be much less significant than temporal variation in rates of soil development. The reasons for temporal variation in rates and processes of soil development are complexly linked to climatic change and related changes in water and dust, erosional history, and internally driven chemical and physical processes.
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