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Introduction: Community paramedic programs are being implemented to leverage existing resources and contribute to a sustainable patient-centered healthcare system. Expanding the role of paramedics into home care requires new collaborative relationships with healthcare providers such as nurses and physicians. Developing effective and productive collaborative relationships will enhance and support the integration of community paramedic programs. Our objective was to describe the barriers and facilitators to effective collaboration between nurses, physicians, and paramedics within home-based community paramedicine. Methods: We conducted semi-structured interviews with nurses, physicians, paramedics, and faculty who teach in paramedic programs. We explored the attitudes, perceptions, barriers, and enablers to collaboration in home-based community paramedic programs. Participants were recruited utilizing the professional networks of the researchers as well as snowball sampling. Recruitment in each group stopped when saturation was achieved. We conducted a thematic analysis of the interviews to generate findings related to our objectives. Results: We interviewed 33 participants with a typical cross-section of age, years of experience, and education. Overall, participants felt that collaboration was important for effective integration of community paramedics into home care and for ensuring a patient-centered approach to care. Currently, collaboration mostly occurs between physicians and paramedics and community paramedicine appears to be a siloed rather than integrated service. Few collaborative relationships exist between paramedics and nurses, despite the fact that nurses are highly involved in home care. We identified several barriers to effective collaboration including lack of understanding of the contributions of the different health providers, and regulatory and funding constraints. Inter-professional education that supports collaboration and facilitates dismantling of professional and service silos can support the effective integration of paramedics into home care. Conclusion: Strengthening networks of collaboration between nurses, physicians, and paramedics can help dismantle silos and enhance inter-professional collaboration to support appropriate integration of paramedics into home care. The willingness and positive attitudes for collaboration are assets that provide an excellent foundation upon which to move forward. Continuing education to support inter-professional collaboration is needed.
This study examined adolescents with anorexia nervosa admitted to a tertiary referral unit in Dublin over a 3 year period.The aims of the study were to assess changes if any in patient clinical and laboratory parameters specifically weight change, body mass index (BMI), cardiovascular, haematological and biochemical measurements over the course of in-patient stay.
Hospital computerized databases and clinical case notes were examined for each patient.Results were compared with Royal College of Psychiatrists (RCP) and National Institute for Clinical Evidence (NICE) guidelines for treatment of in-patients with anorexia nervosa.
There were at total of 42 admissions over the 3 years.7 males and 35 females were admitted.Median length of admission was 88 days. Female patients gained on average 7.2 kilograms during their admission.The average female BMI on admission was 14.9 on admission and 17.6 on discharge. 82.3% of female admissions had blood abnormalities, the most common being anaemia and hypokalaemia.45.7% of female patients had an abnormal electrocariograph.25% of female patients required transfer out during their admission for medical review.
The eating disorder unit fulfilled the RCP and NICE guidelines for 97.6% of patients in terms of blood results performed and 92.8% in terms of electrocardiographs performed.The average BMI on discharge for both males and females was above 17.5 which is regarded as the normal cut off point for anorexia nervosa.The importance of this study despite its limited sample size is that it is the first study of investigations and outcomes in an Irish in-patient adolescent eating disorder sample.
Research evidence suggests that the prevalence rate of postpartum depression in Western countries is 10–25% (Beck, 2001; O’ Hara & Swain, 1996). Many women diagnosed with postnatal depression(PND) are reluctant to take antidepressant medication (Whitton,1996). Coupled with the limited availability of psychological therapies, the consideration of adjunctive interventions for managing PND would appear worthwhile. Physical activity(PA) has been demonstrated to both mediate and improve outcomes for depression (Dimeo, 2001; Nabkasorn et al., 2006) in the general population, and in moderating the impact of PND (Daley, 2009).
To describe physical activity participation in a cohort of postpartum women in Western Australia
To investigate the factors associated with physical activity participation in postpartum women Examine the differences between women reporting PND and those without on physical activity
Study 1 was the distribution of a postpartum physical activity questionnaire through child health clinics to mothers within the 6 weeks to12 months postpartum period.
Cohort design was used to recruit mothers within postpartum period
The results from the study showed that mothers who were at the risk of PND had the same level of physical activity in compare to normal mothers. The T-test showed there was not any significant correlation. Analysis revealed that there was a significant correlation between the effect of PND on parental self-confidence and partner support.
Findings suggest that further exploration needs to be considered to explore mothers’ experience of physical activity, its barriers and the interaction of their partners in order to exercise after child birth.
Patients with SMI receive long term intervention with psychotropic agents often associated with weight gain. Weight and lifestyle management programmes may prevent, reduce or reverse weight gain, however most data is short-term. Categorical data is not often reported
A group programme (Solutions for Wellness) designed to address weight and other cardiovascular risk factors commenced 2002 in Ireland. Each group provided open-ended access to referred SMI patients. Weekly group sessions consisted weighing, discussion and an 8-week rotational cycle of educational topics on aspects of weight, dietary choices and lifestyle changes. Groups were led by trained healthcare professionals.
Data is reported up to 24 months from 55 patients (27 male; 28 female) from 6 centres. Mean age 49.4 years (range 21-74). Schizophrenia 63%, Affective disorders 26%, other 11%. Patients completing 1 year - 55% and 2 years 22%. Baseline mean weight 98.6 kg (SD 19.2) decreased to final visit weight 96.9kg (SD 18.4).Paired t –test, p = 0.0030; CI Mean 2.53 (0.9-4.159). Weight increased in 11/55, maintained 7/55 and decreased 37/55.
Weight gain in SMI patients is not inevitable and was found in only 20% of patients attending weight clinics in Ireland. Patients may benefit if similar interventions were widely available.
For most women in the postpartum period, six to 52 weeks after childbirth, participation in exercise is very limited. More information is needed to fully understand the specific barriers and enablers to exercise during this period.
Explore the daily experience of physical activity in postpartum women. Investigate the key barriers and enablers to physical activity in the postpartum period
A qualitative approach in the form of a semi-structured interview with thematic analysis was used
This study used a multi-method approach.Postpartum women recruited from child health clinics were sent a package of standardized questionnaires to investigate the barriers that affected their exercise participation. In addition, 14 postpartum women who participated in the survey were contacted for an interview in order to further discuss exercise barriers and enablers.
For the 150 women who responded to the survey lack of confidence and lack of time had the greatest impact on participation in sport and exercise. When daily physical activity participation was assessed lack of information, lack of confidence, lack of knowledge were statistically significant. The qualitative data showed that mothers may be able to participate more in exercise if they had greater social support, particularly partner support. The participants suggested that environmental factors like increased knowledge and access to appropriate exercise programs, either in the home or outside, could potentially enable increased exercise.
New mothers require substantial social support and specifically tailored exercise programs to enable them to access the physiological and psychological benefits of exercise.
Recent literature suggests that over 70% of cases of antibody-mediated encephalitis present to psychiatry services with features of psychosis predominantly.
To investigate the seroprevalence of N-Methyl-D-Aspartate receptor antibodies (NMDAr-Ab) in patients with first episode psychosis (FEP)
Following ethical approval, all cases meeting entry criteria were invited to participate. Participants were interviewed with SCID to obtain a DSM diagnosis. NMDAr-Ab were identified in serum by cell based assay using co-transfected Human Embryonic Kidney (HEK)cells. Positive cases were reviewed by clinical neurology. Decision to treat with immunotherapy was made on a case by case basis.
85/115 (72%) of patients with FEP entered the study. 49 (58%) participants were male, mean age (SD) 37 (15.7) years. 42 (52%) were outpatients at the time of assessment. Four cases (5%) were serum NMDAr-Ab positive. 3 of these cases were male, age 48 (16.3) years. All four were admitted as inpatients with normal brain MRI imaging. One case (female, 55) was confirmed as NMDAr-Ab encephalitis based on case presentation, EEG demonstrating bilateral cerebral dysfunction and NMDAr-Ab in CSF. Immunotherapy treatment lead to clinical improvement. In remaining cases, EEG was normal and CSF negative. All 3 of these cases showed clinical improvement following psychiatric treatment as usual.
Our findings support the current estimates as to NMDAr-Ab prevalence in FEP. Increased awareness has lead to rapid treatment of florid cases of NMDAr-Ab encephalitis in our service. Additional seropositive cases are being followed with neuro-cognitive testing for any evidence of decline.
Over the past decade, the World Health Summit (WHS) has provided a global platform for policy-makers and decision-makers to interact with academics and practitioners on global health. Recently the WHS adopted health security into their agenda for transnational disease risks (eg, Ebola and antimicrobial resistance) that increasingly threaten multiple sectors. Global health engagement (GHE) focuses efforts across interdisciplinary and interorganizational lines to identify critical threats and provide rapid deployment of key resources at the right time for addressing health security risks. As a product of subject matter experts convening at the WHS, a special side-group has organically risen with leadership and coordination from the German Institute for Defense and Strategic Studies in support of GHE activities across governmental, academic, and industry partners. Through novel approaches and targeted methodology that maximize outcomes and streamline global health operational process, the Global Health Security Alliance (GloHSA) was born. This short conference report describes in more detail the GloHSA.
Addressing the obesity epidemic depends on a holistic understanding of the reasons that people become and maintain excessive fat. Theories about the causes of obesity usually focus proximately or evoke evolutionary mismatches, with minimal clinical value. There is potential for substantial progress by adapting strategic body mass regulation models from evolutionary ecology to human obesity by assessing the role of information.
The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract infection (CAUTI) prevention as an example, we hypothesize that US Department of Veterans Affairs (VA) nursing homes have a more robust infection prevention infrastructure due to integration and centralization compared with non–VA nursing homes.
VA and non-VA nursing homes participating in the AHRQ Safety Program for Long-Term Care collaborative.
Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to CAUTI prevention via a needs assessment questionnaire.
A total of 353 of 494 nursing homes from 41 states (71%; 47 VA and 306 non-VA facilities) responded. VA nursing homes reported more hours per week devoted to infection prevention-related activities (31 vs 12 hours; P<.001) and were more likely to have committees that reviewed healthcare-associated infections. Compared with non-VA facilities, a higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs 66%; P<.001), sharing CAUTI data with leadership (94% vs 70%; P=.014) and with nursing personnel (85% vs 56%, P=.003). However, fewer VA nursing homes reported having policies for appropriate catheter use (64% vs 81%; P=.004) and catheter insertion (83% vs 94%; P=.004).
Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems.
To assess knowledge about infection prevention among nursing home personnel and identify gaps potentially addressable through a quality improvement collaborative.
Baseline knowledge assessment of catheter-associated urinary tract infection, asymptomatic bacteriuria, antimicrobial stewardship, and general infection prevention practices for healthcare-associated infections.
Nursing homes across 14 states participating in the national “Agency for Healthcare Research and Quality Safety Program for Long-Term Care: Healthcare-Associated Infections/Catheter-Associated Urinary Tract Infection.”
Each facility aimed to obtain responses from at least 10 employees (5 licensed and 5 unlicensed). We assessed the percentage of correct responses.
A total of 184 (78%) of 236 participating facilities provided 1 response or more. Of the 1,626 respondents, 822 (50.6%) were licensed; 117 facilities (63.6%) were for-profit. While 99.1% of licensed personnel recognized the definition of asymptomatic bacteriuria, only 36.1% knew that pyuria could not distinguish a urinary tract infection from asymptomatic bacteriuria. Among unlicensed personnel, 99.6% knew to notify a nurse if a resident developed fever or confusion, but only 27.7% knew that cloudy, smelly urine should not routinely be cultured. Although 100% of respondents reported receiving training in hand hygiene, less than 30% knew how long to rub hands (28.5% licensed, 25.2% unlicensed) or the most effective agent to use (11.7% licensed, 10.6% unlicensed).
This national assessment demonstrates an important need to enhance infection prevention knowledge among healthcare personnel working in nursing homes to improve resident safety and quality of care.
In our response to the 27 commentaries, we refine the theoretical claims, clarify several misconceptions of our framework, and explore substantial disagreements. In doing so, we (1) show that our framework accommodates multiple historical scenarios; (2) debate the historical evidence, particularly about “pre-Axial” religions; (3) offer important details about cultural evolutionary theory; (4) clarify the term prosociality; and (4) discuss proximal mechanisms. We review many interesting extensions, amplifications, and qualifications of our approach made by the commentators.
The ITRACK study explored the process and predictors of transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) in the Republic of Ireland.
Following ethical approval, clinicians in each of Ireland’s four Health Service Executive (HSE) areas were contacted, informed about the study and were invited to participate. Clinicians identified all cases who had reached the transition boundary (i.e. upper age limit for that CAMHS team) between January and December 2010. Data were collected on clinical and socio-demographic details and factors that informed the decision to refer or not refer to the AMHS, and case notes were scrutinised to ascertain the extent of information exchanged between services during transition.
A total of 62 service users were identified as having crossed the transition boundary from nine CAMHS [HSE Dublin Mid-Leinster (n=40, 66%), HSE South (n=18, 30%), HSE West (n=2, 3%), HSE Dublin North (n=1, 2%)]. The most common diagnoses were attention deficit hyperactivity disorder (ADHD; n=19, 32%), mood disorders (n=16, 27%), psychosis (n=6, 10%) and eating disorders (n=5, 8%). Forty-seven (76%) of those identified were perceived by the CAMHS clinician to have an ‘on-going mental health service need’, and of these 15 (32%) were referred, 11 (23%) young people refused and 21 (45%) were not referred, with the majority (12, 57%) continuing with the CAMHS for more than a year beyond the transition boundary. Young people with psychosis were more likely to be referred [χ2 (2, 46)=8.96, p=0.02], and those with ADHD were less likely to be referred [χ2 (2, 45)=8.89, p=0.01]. Being prescribed medication was not associated with referral [χ2 (2, 45)=4.515, p=0.11]. In referred cases (n=15), there was documented evidence of consent in two cases (13.3%), inferred in another four (26.7%) and documented preparation for transition in eight (53.3%). Excellent written communication (100%) was not supported by face-to-face planning meetings (n=2, 13.3%), joint appointments (n=1, 6.7%) or telephone conversations (n=1, 6.7%) between corresponding clinicians.
Despite perceived on-going mental health (MH) service need, many young people are not being referred or are refusing referral to the AMHS, with those with ADHD being the most affected. CAMHS continue to offer on-going care past the transition boundary, which has resource implications. Further qualitative research is warranted to understand, in spite of perceived MH service need, the reason for non-referral by the CAMHS clinicians and refusal by the young person.
We have studied photoluminescence (PL) from undoped GaN films grown by HVPE technique on sapphire. Several defect-related PL bands are observed in the low-temperature PL spectrum. The concentrations of the defects responsible for these PL bands are determined from the dependence of PL intensity on excitation intensity. The RL band with a maximum at 1.8 eV is often the dominant PL band in HVPE GaN. It is caused by an unknown defect with the concentration of up to ∼1017 cm-3. The concentrations of defects responsible for other defect-related PL bands rarely exceed 1015 cm-3.
We develop a cultural evolutionary theory of the origins of prosocial religions and apply it to resolve two puzzles in human psychology and cultural history: (1) the rise of large-scale cooperation among strangers and, simultaneously, (2) the spread of prosocial religions in the last 10–12 millennia. We argue that these two developments were importantly linked and mutually energizing. We explain how a package of culturally evolved religious beliefs and practices characterized by increasingly potent, moralizing, supernatural agents, credible displays of faith, and other psychologically active elements conducive to social solidarity promoted high fertility rates and large-scale cooperation with co-religionists, often contributing to success in intergroup competition and conflict. In turn, prosocial religious beliefs and practices spread and aggregated as these successful groups expanded, or were copied by less successful groups. This synthesis is grounded in the idea that although religious beliefs and practices originally arose as nonadaptive by-products of innate cognitive functions, particular cultural variants were then selected for their prosocial effects in a long-term, cultural evolutionary process. This framework (1) reconciles key aspects of the adaptationist and by-product approaches to the origins of religion, (2) explains a variety of empirical observations that have not received adequate attention, and (3) generates novel predictions. Converging lines of evidence drawn from diverse disciplines provide empirical support while at the same time encouraging new research directions and opening up new questions for exploration and debate.
We describe two cases of infant botulism due to Clostridium butyricum producing botulinum type E neurotoxin (BoNT/E) and a previously unreported environmental source. The infants presented at age 11 days with poor feeding and lethargy, hypotonia, dilated pupils and absent reflexes. Faecal samples were positive for C. butyricum BoNT/E. The infants recovered after treatment including botulism immune globulin intravenous (BIG-IV). C. butyricum BoNT/E was isolated from water from tanks housing pet ‘yellow-bellied’ terrapins (Trachemys scripta scripta): in case A the terrapins were in the infant's home; in case B a relative fed the terrapin prior to holding and feeding the infant when both visited another relative. C. butyricum isolates from the infants and the respective terrapin tank waters were indistinguishable by molecular typing. Review of a case of C. butyricum BoNT/E botulism in the UK found that there was a pet terrapin where the infant was living. It is concluded that the C. butyricum-producing BoNT type E in these cases of infant botulism most likely originated from pet terrapins. These findings reinforce public health advice that reptiles, including terrapins, are not suitable pets for children aged <5 years, and highlight the importance of hand washing after handling these pets.
Feedback provided by relativistic jets may be effective in shaping the galaxy luminosity function. The quenching mode (quasar mode) at redshifts ~2-3 potentially disperses gas in star-forming galaxies. The maintenance mode (radio mode) heats the gas in galaxy clusters counteracting cooling flows. A number of authors have examined the effect of relativistic jets in dispersing clouds in the kpc-scale inhomogeneous interstellar medium of evolving galaxies. We have also investigated a particular case of maintenance-mode feedback in our simulation of the iconic radio galaxy / cooling flow cluster Hydra A. Modelling of the knots produced by the jets in the inner 10 kpc provides an estimate of 0.8 – 0.9 c for the velocities of the jets in agreement with other velocity estimates for FR1 jets. The addition of jet precession provides realistic simulations of the morphology of the Hydra A radio source and raises interesting questions as to the role of black hole and disk precession, in general, in galaxy formation.