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Systematic reviews and meta-analyses suggest that behaviour change interventions have modest effect sizes, struggle to demonstrate effect in the long term and that there is high heterogeneity between studies. Such interventions take huge effort to design and run for relatively small returns in terms of changes to behaviour.
So why do behaviour change interventions not work and how can we make them more effective? This article offers some ideas about what may underpin the failure of behaviour change interventions. We propose three main reasons that may explain why our current methods of conducting behaviour change interventions struggle to achieve the changes we expect: 1) our current model for testing the efficacy or effectiveness of interventions tends to a mean effect size. This ignores individual differences in response to interventions; 2) our interventions tend to assume that everyone values health in the way we do as health professionals; and 3) the great majority of our interventions focus on addressing cognitions as mechanisms of change. We appeal to people’s logic and rationality rather than recognising that much of what we do and how we behave, including our health behaviours, is governed as much by how we feel and how engaged we are emotionally as it is with what we plan and intend to do.
Drawing on our team’s experience of developing multiple interventions to promote and support health behaviour change with a variety of populations in different global contexts, this article explores strategies with potential to address these issues.
Sonographic measurement of optic nerve sheath diameter (ONSD) is becoming increasingly accepted as a diagnostic modality to detect elevations in intracranial pressure. As this technique becomes more widespread, methods to address the inherent operator-dependent nature of this modality will need to be developed. We propose a novel low-cost model to accurately simulate sonographic ONSD measurement for purposes of training and assessment.
We designed models composed of medical tubing of various diameters readily available from typical hospital supplies and suspended them in gelatin. The models were evaluated by ultrasound by three expert point-of-care sonographers using a standard linear array probe and technique proposed in the literature.
This model generates faithful simulation of the ONS that closely approximates in vivo images and can be used to produce accurate, reproducible measurements. Materials are low cost and easy to acquire and assemble.
Our model provides realistic simulated images of the ONS. Through comparison of sonographic measurements to the known tube diameters, this model serves as a promising inexpensive tool to teach the method of ultrasound assessment of ONSD or as a way to determine accuracy of this novel ultrasound technology.
The deliberate use of chemical, biological, radiological, and nuclear (CBRN) materials in war or terrorist attacks is perceived as a great threat globally. In the event of a release of CBRN agents, protection by means of medical countermeasures (MedCMs) could reduce health vulnerability. Nonetheless, for some diseases caused by these agents, innovative MedCMs do not exist and many of those that do might not be readily available. Inappropriate research and development funding and government procurement efforts can result in adverse economic consequences (eg, lost income, cost per loss of life, medical expenses) far exceeding the costs of strong and comprehensive preparedness initiatives. By illustrating factors of demand-side rationale for CBRN MedCMs, this article aims to strengthen integrity of policy-making associated with current demand requirements. Namely, an approach to inspire broader assessment is outlined by compiling and adapting existing economic models and concepts to characterize both soft and hard factors that influence demand-side rationale. First, the soft factor context is set by describing the impact of behavioral and political economics. Then, lessons learned from past public health funding models and associated collaborative access infrastructure are depicted to represent hard factors that can enhance the viability of MedCM preparedness evaluations.
OBJECTIVES/SPECIFIC AIMS: To evaluate the ability of various techniques to track changes in body fluid volumes before and after a rapid infusion of saline. METHODS/STUDY POPULATION: Eight healthy participants (5M; 3F) completed baseline measurements of 1) total body water using ethanol dilution and bioelectrical impedance analysis (BIA) and 2) blood volume, plasma volume and red blood cell (RBC) volume using carbon monoxide rebreathe technique and I-131 albumin dilution. Subsequently, 30mL saline/kg body weight was administered intravenously over 20 minutes after which BIA and ethanol dilution were repeated. RESULTS/ANTICIPATED RESULTS: On average, 2.29±0.35 L saline was infused with an average increase in net fluid input-output (I/O) of 1.56±0.29 L. BIA underestimated measured I/O by −3.4±7.9%, while ethanol dilution did not demonstrate a measurable change in total body water. Carbon monoxide rebreathe differed from I-131 albumin dilution measurements of blood, plasma and RBC volumes by +0.6±2.8%, −5.4±3.6%, and +11.0±4.7%, respectively. DISCUSSION/SIGNIFICANCE OF IMPACT: BIA is capable of tracking modest changes in total body water. Carbon monoxide rebreathe appears to be a viable alternative for the I-131 albumin dilution technique to determine blood volume. Together, these two techniques may be useful in monitoring fluid status in patients with impaired fluid regulation.
Over the past decade, NASA, under a succession of rotary-wing programs, has been moving towards coupling multiple discipline analyses to evaluate rotorcraft conceptual designs. Handling qualities is one of the component analyses to be included in such a future Multidisciplinary Analysis and Optimization framework for conceptual design of Vertical Take-Off and Landing (VTOL) aircraft. Similarly, the future vision for the capability of the Concept Design and Assessment Technology Area of the U.S Army Aviation Development Directorate also includes a handling qualities component. SIMPLI-FLYD is a tool jointly developed by NASA and the U.S. Army to perform modelling and analysis for the assessment of the handling qualities of rotorcraft conceptual designs. Illustrative scenarios of a tiltrotor in forward flight and a single-main rotor helicopter at hover are analysed using a combined process of SIMPLI-FLYD integrated with the conceptual design sizing tool NDARC. The effects of variations of input parameters such as horizontal tail and tail rotor geometry were evaluated in the form of margins to fixed- and rotary-wing handling qualities metrics and the computed vehicle empty weight. The handling qualities Design Margins are shown to vary across the flight envelope due to both changing flight dynamics and control characteristics and changing handling qualities specification requirements. The current SIMPLI-FLYD capability, lessons learned from its use and future developments are discussed.
The Flint Community Resilience Group (Flint, Michigan USA) and the Centers for Disease Control and Prevention (CDC; Atlanta, Georgia USA) assessed behavioral health concerns among community members to determine the impact of lead contamination of the Flint, Michigan water supply.
A Community Assessment for Public Health Emergency Response (CASPER) was conducted from May 17 through May 19, 2016 using a multi-stage cluster sampling design to select households and individuals to interview.
One-half of households felt overlooked by decision makers. The majority of households self-reported that at least one member experienced more behavioral health concerns than usual. The prevalence of negative quality of life indicators and financial concerns in Flint was higher than previously reported in the Michigan 2012 and 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey.
The following can be considered to guide recovery efforts in Flint: identifying additional resources for behavioral health interventions and conducting follow-up behavioral health assessments to evaluate changes in behavioral health concerns over time; considering the impact of household economic factors when implementing behavioral health interventions; and ensuring community involvement and engagement in recovery efforts to ease community stress and anxiety.
FortenberryGZ, ReynoldsP, BurrerSL, Johnson-LawrenceV, WangA, SchnallA, PullinsP, KieszakS, BayleyegnT, WolkinA. Assessment of Behavioral Health Concerns in the Community Affected by the Flint Water Crisis — Michigan (USA) 2016. Prehosp Disaster Med. 2018;33(3):256–265.
A field study was conducted for the 2014 and 2015 growing season in Arkansas, Indiana, Illinois, Missouri, Ohio, and Tennessee to determine the effect of cereal rye and either oats, radish, or annual ryegrass on the control of Amaranthus spp. when integrated with comprehensive herbicide programs in glyphosate-resistant and glufosinate-resistant soybean. Amaranthus species included redroot pigweed, waterhemp, and Palmer amaranth. The two herbicide programs included were: a PRE residual herbicide followed by POST application of foliar and residual herbicide (PRE/POST); or PRE residual herbicide followed by POST application of foliar and residual herbicide, followed by another POST application of residual herbicide (PRE/POST/POST). Control was not affected by type of soybean resistance trait. At the end of the season, herbicides controlled 100 and 96% of the redroot pigweed and Palmer amaranth, respectively, versus 49 and 29% in the absence of herbicides, averaged over sites and other factors. The PRE/POST and PRE/POST/POST herbicide treatments controlled 83 and 90% of waterhemp at the end of the season, respectively, versus 14% without herbicide. Cover crop treatments affected control of waterhemp and Palmer amaranth and soybean yield, only in the absence of herbicides. The rye cover crop consistently reduced Amaranthus spp. density in the absence of herbicides compared to no cover treatment.
The American Heart Association (AHA; Dallas, Texas USA) and European Resuscitation Council (Niel, Belgium) cardiac arrest (CA) guidelines recommend the intraosseous (IO) route when intravenous (IV) access cannot be obtained. Vasopressin has been used as an alternative to epinephrine to treat ventricular fibrillation (VF).
Limited data exist on the pharmacokinetics and resuscitative effects of vasopressin administered by the humeral IO (HIO) route for treatment of VF. The purpose of this study was to evaluate the effects of HIO and IV vasopressin, on the occurrence, odds, and time of return of spontaneous circulation (ROSC) and pharmacokinetic measures in a swine model of VF.
Twenty-seven Yorkshire-cross swine (60 to 80 kg) were assigned randomly to three groups: HIO (n=9), IV (n=9), and a control group (n=9). Ventricular fibrillation was induced and untreated for two minutes. Chest compressions began at two minutes post-arrest and vasopressin (40 U) administered at four minutes post-arrest. Serial blood specimens were collected for four minutes, then the swine were resuscitated until ROSC or 29 post-arrest minutes elapsed.
Fisher’s Exact test determined ROSC was significantly higher in the HIO 5/7 (71.5%) and IV 8/11 (72.7%) groups compared to the control 0/9 (0.0%; P=.001). Odds ratios of ROSC indicated no significant difference between the treatment groups (P=.68) but significant differences between the HIO and control, and the IV and control groups (P=.03 and .01, respectively). Analysis of Variance (ANOVA) indicated the mean time to ROSC for HIO and IV was 621.20 seconds (SD=204.21 seconds) and 554.50 seconds (SD=213.96 seconds), respectively, with no significant difference between the groups (U=11; P=.22). Multivariate Analysis of Variance (MANOVA) revealed the maximum plasma concentration (Cmax) and time to maximum concentration (Tmax) of vasopressin in the HIO and IV groups was 71753.9 pg/mL (SD=26744.58 pg/mL) and 61853.7 pg/mL (SD=22745.04 pg/mL); 111.42 seconds (SD=51.3 seconds) and 114.55 seconds (SD=55.02 seconds), respectively. Repeated measures ANOVA indicated no significant difference in plasma vasopressin concentrations between the treatment groups over four minutes (P=.48).
The HIO route delivered vasopressin effectively in a swine model of VF. Occurrence, time, and odds of ROSC, as well as pharmacokinetic measurements of HIO vasopressin, were comparable to IV.
BurgertJM, JohnsonAD, Garcia-BlancoJ, FultonLV, LoughrenMJ. The Resuscitative and Pharmacokinetic Effects of Humeral Intraosseous Vasopressin in a Swine Model of Ventricular Fibrillation. Prehosp Disaster Med. 2017;32(3):305–310.
A field study was conducted in 2014 and 2015 in Arkansas, Illinois, Indiana, Ohio, Tennessee, Wisconsin, and Missouri to determine the effects of tillage system and herbicide program on season-long emergence of Amaranthus species in glufosinate-resistant soybean. The tillage systems evaluated were deep tillage (fall moldboard plow followed by (fb) one pass with a field cultivator in the spring), conventional tillage (fall chisel plow fb one pass with a field cultivator in the spring), minimum tillage (one pass of a vertical tillage tool in the spring), and no-tillage (PRE application of paraquat). Each tillage system also received one of two herbicide programs; PRE application of flumioxazin (0.09 kg ai ha–1) fb a POST application of glufosinate (0.59 kg ai ha−1) plus S-metolachlor (1.39 kg ai ha–1), or POST-only applications of glufosinate (0.59 kg ha−1). The deep tillage system resulted in a 62, 67, and 73% reduction in Amaranthus emergence when compared to the conventional, minimum, and no-tillage systems, respectively. The residual herbicide program also resulted in an 87% reduction in Amaranthus species emergence compared to the POST-only program. The deep tillage system, combined with the residual program, resulted in a 97% reduction in Amaranthus species emergence when compared to the minimum tillage system combined with the POST-only program, which had the highest Amaranthus emergence. Soil cores taken prior to planting and herbicide application revealed that only 28% of the Amaranthus seed in the deep tillage system was placed within the top 5-cm of the soil profile compared to 79, 81, and 77% in the conventional, minimum, and no-tillage systems. Overall, the use of deep tillage with a residual herbicide program provided the greatest reduction in Amaranthus species emergence, thus providing a useful tool in managing herbicide-resistant Amaranthus species where appropriate.
The objective of this research was to describe proportional differences across time and region in management practices among southern cotton farmers who experienced glyphosate-resistant (GR) weeds on their farms earlier than those who experienced them later and among farmers who were closest to one of four historical outbreak epicenters: Lauderdale County, TN; Macon County, GA; Edgecombe County, NC; and Terry County, TX. A mail survey was conducted with cotton farmers in 2012 from 13 southern, cotton-producing states. Survey responses on practices used by farmers were classified into three broad categories of labor, mechanical/tillage/chemical (MTC), and cultural. Proportions of respondents using practices from each category were identified by time and region; across which, proportional-difference tests were conducted. Results indicated respondents encountering GR weeds earlier were more likely than farmers who experienced them later to use the three broad-category practices (labor, 98 vs. 92%; MTC, 95 vs. 89%; and cultural, 86 vs. 76%) and specific practices, including hooded sprayers (76 vs. 58%), in-season herbicide change (83 vs. 60%), and field-border management (60 vs. 35%). Also, respondents closest to Lauderdale County were more likely than farmers closest to Edgecombe County to use broad-labor practices (99 vs. 91%) and specific practices, including hand hoeing (96 vs. 84%), hand spraying (49 vs. 31%), spot spraying (76 vs. 59%), wick applicator (13 vs. 11%), and field-border management (58 vs. 39%). Education programs on weed management can be developed and tailored according to the time and regional differences to provide effective information and communication channels to farmers.
Palmer amaranth and waterhemp have become increasingly troublesome weeds throughout the United States. Both species are highly adaptable and emerge continuously throughout the summer months, presenting the need for a residual PRE application in soybean. To improve season-long control of Amaranthus spp., 19 PRE treatments were evaluated on glyphosate-resistant Palmer amaranth in 2013 and 2014 at locations in Arkansas, Indiana, Nebraska, Illinois, and Tennessee; and on glyphosate-resistant waterhemp at locations in Illinois, Missouri, and Nebraska. The two Amaranthus species were analyzed separately; data for each species were pooled across site-years, and site-year was included as a random variable in the analyses. The dissipation of weed control throughout the course of the experiments was compared among treatments with the use of regression analysis where percent weed control was described as a function of time (the number of weeks after treatment [WAT]). At the mean (i.e., average) WAT (4.3 and 3.2 WAT for Palmer amaranth and waterhemp, respectively) isoxaflutole + S-metolachlor + metribuzin had the highest predicted control of Palmer amaranth (98%) and waterhemp (99%). Isoxaflutole + S-metolachlor + metribuzin, S-metolachlor + mesotrione, and flumioxazin + pyroxasulfone had a predicted control ≥ 97% and similar model parameter estimates, indicating control declined at similar rates for these treatments. Dicamba and 2,4-D provided some, short-lived residual control of Amaranthus spp. When dicamba was added to metribuzin or S-metolachlor, control increased compared to dicamba alone. Flumioxazin + pyroxasulfone, a currently labeled PRE, performed similarly to treatments containing isoxaflutole or mesotrione. Additional sites of action will provide soybean growers more opportunities to control these weeds and reduce the potential for herbicide resistance.
Herbicide-resistant Amaranthus spp. continue to cause management difficulties in soybean. New soybean technologies under development, including resistance to various combinations of glyphosate, glufosinate, dicamba, 2,4-D, isoxaflutole, and mesotrione, will make possible the use of additional herbicide sites of action in soybean than is currently available. When this research was conducted, these soybean traits were still regulated and testing herbicide programs with the appropriate soybean genetics in a single experiment was not feasible. Therefore, the effectiveness of various herbicide programs (PRE herbicides followed by POST herbicides) was evaluated in bare-ground experiments on glyphosate-resistant Palmer amaranth and glyphosate-resistant waterhemp (both tall and common) at locations in Arkansas, Illinois, Indiana, Missouri, Nebraska, and Tennessee. Twenty-five herbicide programs were evaluated; 5 of which were PRE herbicides only, 10 were PRE herbicides followed by POST herbicides 3 to 4 wks after (WA) the PRE application (EPOST), and 10 were PRE herbicides followed by POST herbicides 6 to 7 WA the PRE application (LPOST). Programs with EPOST herbicides provided 94% or greater control of Palmer amaranth and waterhemp at 3 to 4 WA the EPOST. Overall, programs with LPOST herbicides resulted in a period of weed emergence in which weeds would typically compete with a crop. Weeds were not completely controlled with the LPOST herbicides because weed sizes were larger (≥ 15 cm) compared with their sizes at the EPOST application (≤ 7 cm). Most programs with LPOST herbicides provided 80 to 95% control at 3 to 4 WA applied LPOST. Based on an orthogonal contrast, using a synthetic-auxin herbicide LPOST improves control of Palmer amaranth and waterhemp over programs not containing a synthetic-auxin LPOST. These results show herbicides that can be used in soybean and that contain auxinic- or HPPD-resistant traits will provide growers with an opportunity for better control of glyphosate-resistant Palmer amaranth and waterhemp over a wide range of geographies and environments.
Cannabis use has been reported to be associated with an earlier onset of symptoms in patients with first-episode psychosis, and a worse outcome in those who continue to take cannabis. In general, studies have concentrated on symptoms of psychosis rather than mania. In this study, using a longitudinal design in a large naturalistic cohort of patients with first-episode psychosis, we investigated the relationship between cannabis use, age of presentation to services, daily functioning, and positive, negative and manic symptoms.
Clinical data on 502 patients with first-episode psychosis were collected using the MiData audit database from seven London-based Early Intervention in psychosis teams. Individuals were assessed at two time points – at entry to the service and after 1 year. On each occasion, the Positive and Negative Syndrome Scale, Young Mania Rating Scale and Global Assessment of Functioning Scale disability subscale were rated. At both time points, the use of cannabis and other drugs of abuse in the 6 months preceding each assessment was recorded.
Level of cannabis use was associated with a younger age at presentation, and manic symptoms and conceptual disorganization, but not with delusions, hallucinations, negative symptoms or daily functioning. Cannabis users who reduced or stopped their use following contact with services had the greatest improvement in symptoms at 1 year compared with continued users and non-users. Continued users remained more symptomatic than non-users at follow-up.
Effective interventions for reducing cannabis use may yield significant health benefits for patients with first-episode psychosis.
Ethnic variations have previously been identified in the duration of untreated psychosis (DUP) and pathways into psychiatric services. These have not been examined in the context of early intervention services, which may alter these trajectories.
To explore ethnic differences in the nature and duration of pathways into early intervention services.
In a naturalistic cohort study, data were collected for 1024 individuals with psychotic disorders accepted for case management by eight London early intervention services.
Duration of untreated psychosis was prolonged in the White British group compared with most other ethnic groups. White British individuals were more likely to make contact with their general practitioner and less likely to be seen within emergency medical services. All Black patient groups were more likely than their White British counterparts to experience involvement of criminal justice agencies.
Variations continue to exist in how and when individuals from different ethnic groups access early intervention services. These may account for disparities in DUP.
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).