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Morbidity and mortality from coronavirus disease 2019 (COVID-19) have been significant among elderly residents of residential aged-care services (RACS). To prevent incursions of COVID-19 in RACS in Australia, visitors were banned and aged-care workers were encouraged to work at a single site. We conducted a review of case notes and a social network analysis to understand how workplace and social networks enabled the spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) among RACS.
Retrospective outbreak review.
Setting and participants:
Staff involved in COVID-19 outbreaks in RACS in Victoria, Australia, May–October 2020.
The Victorian Department of Health COVID-19 case and contact data were reviewed to construct 2 social networks: (1) a work network connecting RACS through workers and (2) a household network connecting to RACS through households. Probable index cases were reviewed to estimate the number and size (number of resident cases and deaths) of outbreaks likely initiated by multisite work versus transmission via households.
Among 2,033 cases linked to an outbreak as staff, 91 (4.5%) were multisite staff cases. Forty-three outbreaks were attributed to multisite work and 35 were deemed potentially preventable had staff worked at a single site. In addition, 99 staff cases were linked to another RACS outbreak through their household contacts, and 21 outbreaks were attributed to staff–household transmission.
Limiting worker mobility through single-site policies could reduce the chances of SARS-CoV-2 spreading from one RACS to another. However, initiatives that reduce the chance of transmission via household networks would also be needed.
Understanding the cognitive determinants of healthcare worker (HCW) behavior is important for improving the use of infection prevention and control (IPC) practices. Given a patient requiring only standard precautions, we examined the dimensions along which different populations of HCWs cognitively organize patient care tasks (ie, their mental models).
HCWs read a description of a patient and then rated the similarities of 25 patient care tasks from an infection prevention perspective. Using multidimensional scaling, we identified the dimensions (ie, characteristics of tasks) underlying these ratings and the salience of each dimension to HCWs.
Adult inpatient hospitals across an academic hospital network.
In total, 40 HCWs, comprising infection preventionists and nurses from intensive care units, emergency departments, and medical-surgical floors rated the similarity of tasks. To identify the meaning of each dimension, another 6 nurses rated each task in terms of specific characteristics of tasks.
Each HCW population perceived patient care tasks to vary along 3 common dimensions; most salient was the perceived magnitude of infection risk to the patient in a task, followed by the perceived dirtiness and risk of HCW exposure to body fluids, and lastly, the relative importance of a task for preventing versus controlling an infection in a patient.
For a patient requiring only standard precautions, different populations of HCWs have similar mental models of how various patient care tasks relate to IPC. Techniques for eliciting mental models open new avenues for understanding and ultimately modifying the cognitive determinants of IPC behaviors.
Creativity appears to be an important part of cognitive capacities and problem solving. Creativity is one’s ability to generate ideas that are novel, surprising, and compelling (Kaufman and Sternberg, 2010). This chapter will focus on the creative-cognitive approach, which seeks to further understand how human minds produce creative ideas.
In an empirical study on the classification of the psychoses, 302 patients were rated using the Longitudinal Psychopathology Schedule. The data were condensed by factor analysis, which yielded 10 factors - mania and schizomania, depression and suicidal activity, and 6 factors concerned with psychotic symptoms (verbal hallucinosis/passivity, delusion formation, defect symptoms, social decline, cycloid symptomatology and a factor loading depressive auditory hallucinations and visual hallucinations). Provisional diagnostic groups were obtained using DSM III. Discriminant function analyses showed that the only clearly distinct diagnostic group was bipolar disorder, and this was true for various definitions. Canonical variate analyses were performed using 3- and 4-criterion groups. These showed that a group corresponding approximately to cycloid psychosis also met criteria for being a distinct group. The most detailed examination pf the data, using 4-criterion groups and serial reclassification, suggested that the psychoses might fall into 5 groups - bipolar disorder, cycloid psychosis, depression, defect states and schizoaffective depression.
Imagination – the ability to mentally simulate situations and ideas not perceived by the physical senses – lays the foundation for creativity. Yet imagination alone is insufficient to produce creativity. We define two types of imagination important for creativity: social-emotional and temporal. Social-emotional imagination is the ability to conceive of and reflect on multiple social perspectives and scenarios and the implications of these for one’s own and others’ lives. It promotes creativity by helping individuals understand multiplicities of identity and experience within themselves and others, reason ethically, and appreciate human diversity and potential. Temporal imagination is the ability to engage in mental time travel, counterfactual thinking, and mind-wandering. It can lead to creativity by allowing individuals to engage in the kind of nonliteral, divergent, and future-oriented thought creativity necessitates. For creativity to happen, imaginative thought is infused into mental simulations that are regulated, evaluated, and integrated to conjure new ideas and concepts. As such, in the brain, creativity relies heavily on the default mode network, which is known to be involved in mental simulations across time and especially about social content. Creativity also relies on organized interactions between the default mode network and the executive attention and salience networks, in order for imaginings to be strategically organized into coherent, meaningful plans and actionable ideas. To harness the potential of imagination, individuals need conducive personal qualities, including openness to experience and intrinsic motivation, as well as a supportive context. To better support individuals in developing their creative potential, for example in schools and in the workplace, we must continue to explore the mechanisms by which imagination leads to creativity and the biological, mental, and cultural constraints and affordances.
In this chapter, we discuss the relations between creativity, on the one hand, and intelligence and wisdom, on the other. First, we discuss what is to be learned from studies of implicit (folk) theories of these constructs. Then, we review five explicit theories: Structure of Intellect (SOI) Theory, Cattell–Horn–Carroll (CHC) Theory, Planning Attention Simultaneous Sequential (PASS) Model, Multiple Intelligences, and Wisdom, Intelligence, and Creativity Synthesized (WICS).
Laboratory and field experiments were conducted to determine whether manipulation of radiation environment during the period of winter wheat establishment can be used to improve wheat yields in Italian ryegrass-infested fields. Percentage of total irradiation and ratio of red (R) light (around 660 ηm) to far-red (FR) light (around 730 ηm) reaching the soil surface were important factors in regulating Italian ryegrass germination, growth, and competitive interactions with wheat. Reducing total irradiation to about 10% of full sunlight while maintaining the normal R/FR ratio of about 1.0 reduced wheat grain production in the presence of Italian ryegrass by about 40% compared with weed-free wheat in full sunlight. Further, reducing total irradiation to 3% of full sunlight plus reducing the R/FR ratio to about 0.2 reduced wheat grain production competing with Italian ryegrass by about 35% compared with production in the control conditions. Wheat production of dry matter, spikes, and seeds in the presence of Italian ryegrass increased more than threefold under both shading treatments compared with production in full sunlight.
Triazine-resistant giant foxtail was identified in 1984 near Delta, PA. In field studies conducted from 1985 to 1987, preemergence applications of atrazine with cyanazine or simazine provided poor (≤60%) season-long control of this annual grass in no-tillage corn. Best season-long preemergence control was obtained with metolachlor or microencapsulated formulations of alachlor or EPTC. Postemergence applications of cyanazine or tridiphane + atrazine + crop oil provided poor giant foxtail control. Postdirected applications of paraquat resulted in fair (≥70%) control of giant foxtail through midseason. In greenhouse studies, triazineresistant (R) giant foxtail tolerated preemergence applications of atrazine or simazine at dosages to 9.0 kg ai/ha. Triazine-sensitive (S) giant foxtail was injured by 2.2 kg/ha and higher rates of atrazine and simazine. In laboratory studies, the I50 for inhibition by atrazine of photoinduced electron transport in thylakoids isolated from S and R biotypes was determined to be 0.24 and 205 μM, respectively. The differential sensitivity was paralleled by simazine. However, the limited solubility of simazine prevented determination of an I50 value with thylakoids from the R biotype.
We compared the cost-effectiveness (CE) of an active case-finding (ACF) programme for household contacts of tuberculosis (TB) cases enrolled in first-line treatment to routine passive case-finding (PCF) within an established national TB programme in Peru. Decision analysis was used to model detection of TB in household contacts through: (1) self-report of symptomatic cases for evaluation (PCF), (2) a provider-initiated ACF programme, (3) addition of an Xpert MTB/RIF diagnostic test for a single sputum sample from household contacts, and (4) all strategies combined. CE was calculated as the incremental cost-effectiveness ratio (ICER) in terms of US dollars per disability-adjusted life years (DALYs) averted. Compared to PCF alone, ACF for household contacts resulted in an ICER of $2155 per DALY averted. The addition of the Xpert MTB/RIF diagnostic test resulted in an ICER of $3275 per DALY averted within a PCF programme and $3399 per DALY averted when an ACF programme was included. Provider-initiated ACF of household contacts in an urban setting of Lima, Peru can be highly cost-effective, even including costs to seek out contacts and perform an Xpert/MTB RIF test. ACF including Xpert MTB/RIF was not cost-effective if TB cases detected had high rates of default from treatment or poor outcomes.
A Curriculum Task Force proposed problem-based learning as one important educational strategy and recommended changes to a traditional medical curriculum.
This paper describes how a problem-based learning course in neurosciences was developed and has evolved since its inception in the Dalhousie University Faculty of Medicine. The curriculum planning and design phases are outlined, followed by a description of how the course has been implemented and evaluated.
Program evaluation results are presented, describing student performance on examinations and their feedback about the course.
The authors summarize lessons learned and identify future issues to continue the ongoing development of the course.
Individuals with anxiety disorders often remain symptomatic despite treatment with a first-line pharmacologic agent. More research examining pharmacotherapy augmentation strategies to improve outcomes is needed.
In an 8-week, open-label, prospective augmentation study, we examined the efficacy and tolerability of the novel antipsychotic agent aripiprazole for adult outpatients with generalized anxiety disorder (n=13) or panic disorder (n=10) who remained symptomatic despite treatment for at least 8 weeks with an adequate (or maximally tolerated) dose of typical pharmacotherapy.
Aripiprazole augmentation was associated with a significant reduction in Clinical Global Impressions-Severity scores (paired t=4.41, df=22, P<.001) in the intent-to-treat sample of 23 individuals. Three subjects (13%) discontinued due to sedation, chest discomfort, and restlessness, respectively.
These data provide preliminary evidence that aripiprazole may be a useful augmentation strategy for individuals with generalized anxiety disorder or panic disorder who show a limited response to initial pharmacotherapy.
Background: Children with myocarditis have multiple risk factors for thrombotic events, yet the role of antithrombotic therapy is unclear in this population. We hypothesised that thrombotic events in critically ill children with myocarditis are common and that children with myocarditis are at higher risk for thrombotic events than children with non-inflammatory dilated cardiomyopathy. Methods: This is a retrospective chart review of all children presenting to a single centre cardiac intensive care unit with myocarditis from 1995 to 2008. A comparison group of children with dilated cardiomyopathy was also examined. Antithrombotic regimens were recorded. The primary outcome of thrombotic events included intracardiac clots and any thromboembolic events. Results: Out of 45 cases with myocarditis, 40% were biopsy-proven, 24% viral polymerase chain reaction-supported, and 36% diagnosed based on high clinical suspicion. There were two (4.4%) thrombotic events in the myocarditis group and three (6.7%) in the dilated cardiomyopathy group (p = 1.0). Neither the use of any antiplatelet or anticoagulation therapy, use of intravenous immune globulin, presence of any arrhythmia, nor need for mechanical circulatory support were predictive of thrombotic events in the myocarditis, dilated cardiomyopathy, or combined groups. Conclusions: Thrombotic events in critically ill children with myocarditis and dilated cardiomyopathy occurred in 6% of the combined cohort. There was no difference in thrombotic events between inflammatory and non-inflammatory cardiomyopathy groups, suggesting that the decision to use antithrombotic prophylaxis should be based on factors other than the underlying aetiology of a child's acute decompensated heart failure.
Although widely used, the term repellency needs to be employed with care when applied to ticks and other periodic or permanent ectoparasites. Repellency has classically been used to describe the effects of a substance that causes a flying arthropod to make oriented movements away from its source. However, for crawling arthropods such as ticks, the term commonly subsumes a range of effects that include arthropod irritation and consequent avoiding or leaving the host, failing to attach, to bite, or to feed. The objective of the present article is to highlight the need for clarity, to propose consensus descriptions and methods for the evaluation of various effects on ticks caused by chemical substances.
The draft paper sets out the authors' views of what good practice for the actuarial aspects of internal models will look like in 2012, the year Solvency II is expected to be implemented. Actuaries working on internal models can expect to have to follow such practices if their internal models are to be approved for use in calculating regulatory capital. The paper is therefore relevant for actuaries who plan to work on internal model implementation for Solvency II.
Moreover, the risk quantification techniques discussed in the paper can also be used in the Own Risk Solvency Assessment (ORSA) process also required by Solvency II. The paper is therefore relevant to actuaries working in companies that are not planning to apply to use an internal model.
The paper covers both life and non-life insurance and reinsurance, and reviews current practice as well as setting out possible future practice. This leads to identification of areas for research by the Profession to prepare for 2012 and an indication of the directions this work might take.
The paper is effectively a work in progress, and readers should ask themselves what they should do in response to the ideas discussed.