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There is limited documentation of cross-tenure collaborative weed management programs, and no consistent set of metrics for evaluating their performance. In this study, twelve weed management practitioners in south-east Australia participated in a qualitative social research project to discuss and document examples of cross-tenure collaborative weed management, and critically reflect on whether existing metrics are suitable for evaluating the performance of their programs. Analysis of focus group discussions, project documentation, subsequent reflections and review of the literature, reveal that weed management practitioners, in Australia and elsewhere, mostly rely on metrics that measure weed management inputs, such as herbicides, labour and costs. Metrics used to evaluate social outcomes focus on benefits for individuals rather than social relationships or achievement of equitable outcomes. Social research on collaborative governance and social science methods more broadly, such as social network analysis and collective narratives, could be used by weed management practitioners to better evaluate and explain social-ecological outcomes over time.
If people with episodic mental-health conditions lose their job due to an episode of their mental illness, they often experience personal negative consequences. Therefore, reintegration after sick leave is critical to avoid unfavorable courses of disease, longer inability to work, long payment of sickness benefits, and unemployment. Existing return-to-work (RTW) programs have mainly focused on “common mental disorders” and often used very elaborate and costly interventions without yielding convincing effects. It was the aim of the RETURN study to evaluate an easy-to-implement RTW intervention specifically addressing persons with mental illnesses being so severe that they require inpatient treatment.
Methods
The RETURN study was a multi-center, cluster-randomized controlled trial in acute psychiatric wards addressing inpatients suffering from a psychiatric disorder. In intervention wards, case managers (RTW experts) were introduced who supported patients in their RTW process, while in control wards treatment, as usual, was continued.
Results
A total of 268 patients were recruited for the trial. Patients in the intervention group had more often returned to their workplace at 6 and 12 months, which was also mirrored in more days at work. These group differences were statistically significant at 6 months. However, for the main outcome (days at work at 12 months), differences were no longer statistically significant (p = 0.14). Intervention patients returned to their workplace earlier than patients in the control group (p = 0.040).
Conclusions
The RETURN intervention has shown the potential of case-management interventions when addressing RTW. Further analyses, especially the qualitative ones, may help to better understand limitations and potential areas for improvement.
Exertional syncope has been suggested to correlate with a cardiac aetiology, particularly when occurring in mid-stride. The aim of the study is to evaluate the incidence of cardiac disease among children presenting with exertional syncope, determine the influence of timing within activity, and determine the utility of genetic testing and implantable event monitors in the evaluation of cardiac syncope. The patients ≤18 years old with exertional syncope who underwent exercise stress testing between 2008 and 2019 were retrospectively included. Patients were assessed to be in one of three groups: mid-exertion (mid-stride syncope), peri-exertion (syncope during activity but not moving), and post-exertion (within minutes of the activity). A total of 334 patients were included; 46 % were mid-exertion, 18 % were peri-exertion, and 36 % were post-exertion. Thirteen patients (3.8 %) were diagnosed with cardiac syncope; n = 9 (69 %) mid-exertion. Only mid-exertional syncope was significantly associated with a cardiac diagnosis (OR: 2.6). Cardiac diagnoses included inherited arrhythmia syndromes (n = 9), abnormal coronary origins (n = 2), and supraventricular tachycardia (n = 2). Only catecholaminergic polymorphic ventricular tachycardia (n = 5) was associated with mid-exertional syncope (OR: 1.4). The definitive diagnostic test was exercise testing (n = 8), echocardiogram (n = 2), genetic testing (n = 1), ambulatory monitor (n = 1), and EKG (n = 1). Mid-stride syncope was more likely to result in a cardiac diagnosis, and exercise testing is the most common definitive test as catecholaminergic polymorphic ventricular tachycardia was the primary aetiology of exertional syncope in our cohort. Implantable event monitors and genetic testing could be helpful in ruling out cardiac disease.
There have been a number of federal policies and guidance’s impacting diversity, equity, inclusion, and accessibility (DEI) in clinical research. While these are needed, they have not diminished the gaps related to clinical trial recruitment, research professional’s capacity for cultural competence, and clinical research professional role development. Mentoring and co-mentoring circles have traditionally been used in Medicine, but until now had not been used for workforce development of clinical research professionals (CRPs).
Materials/Methods:
We designed a six-session, monthly co-mentoring circle to take place at two academic medical centers to pilot an interinstitutional co-mentoring circle centered on storytelling videos of Black Voices in Clinical Research. This provided a DEI framework for discussions on role experiences, cultural competence, and role progression.
Results:
Seven CRPs completed the DRC pilot. The participants positively evaluated the experience and made recommendations for future iterations. Discussion: Co-mentoring circles can be useful tools to connect CRPs across complex research medical centers and provide support that may have a positive impact on role satisfaction and retention.
Conclusion:
This framework for developing co-mentoring circles can serve as a toolkit for future CRP co-mentoring circles within and across institutions for workforce development. The Black Voices in Clinical Research storytelling videos provide a rich foundation for future discussion on DEI issues for CRPs and collaborating with participants.
During Cook's 1772–75 Antarctic circumnavigation on the HMS Resolution, he recorded the positions of hundreds of icebergs. This paper compares Cook's observations and those of Halley in 1700, Bouvet in 1739 and Riou in 1789, with the Brigham Young University/National Ice Center (BYU/NIC) and the Alfred Wegener Institute datasets. Cook's description of the iceberg plume east of the Amery Ice Shelf and the iceberg distributions in the Weddell, Ross and Amundsen Seas agree with modern data. In January 1774, Cook reached his farthest south on the shelf of the Amundsen Sea Embayment, the site of the current International Thwaites Glacier Collaboration field study. Cook's largest iceberg had a 2.5 km diameter, where power-law models show that icebergs of this size or smaller comprise 92% of their total number. In the eastern Weddell, Cook's observation of a sea-ice tongue with a much greater extent than in satellite imagery remains unexplained. Although Riou's icebergs lie 1000 km east of the BYU/NIC trajectories, application of the England and others (2020) fracture and drift model to the trajectories removes the discrepancy and means that all the ship observations are consistent with modern observations and theory.
Monitoring parrot populations is of high importance because there is a general lack of quantified population trends for one of the most threatened avian orders. We surveyed parrots in Nicaragua in 1995, 1999, 2004, and 2013 at a minimum of 227 points within 56 sites stratified among the Pacific, Central Highlands, and Caribbean biogeographical regions to assess population trends. From point-count data we calculated encounter rate, flock rate, and flock size metrics and we used presence/absence data to generate species-specific occupancy estimates. Encounter rate, flock rate, and flock size data suggested family-level declines from 1995 to 2004 with some recovery between 2004 and 2013. Patterns of parrot occupancy varied among species with four decreasing, five increasing, and two with no detectable change. Six species of conservation concern are identified, including the Critically Endangered Great Green Macaw and Yellow-naped Parrot, additionally Olive-throated Parakeet, Scarlet Macaw, Brown-hooded Parrot, and White-crowned Parrot, only listed as Least Concern. All six are likely suffering from deforestation and potential unchecked trade activity in the Caribbean. Differing population trends of the regionally disjunct Yellow-naped Parrot subspecies suggest a link to variable deforestation and trade pressure experienced between the Pacific and Caribbean. Our results highlight the importance of actively monitoring changing parrot populations, even when considered Least Concern, so that directed conservation actions can be taken if needed.
Biologists have replaced the metaphor of “genetic transmission” with a detailed account of the molecular mechanisms underlying the phenomenon which Darwin referred to as “like produces like.” Cultural evolution theorists, in contrast, continue to appeal to “imitation” or “copying.” The notion of ritual and instrumental stances does not resolve this issue, and ignores the institutions in which people live.
This report provides the first confirmed identifications of wahoo (Acanthocybium solandri) and striped marlin (Kajikia audax) in the Red Sea, expanding the known ranges of these species into the basin. Potential mechanisms responsible for the lack of regional documentation of the two species are further discussed. These findings illustrate the need for systematic biodiversity surveys of pelagic fish assemblages in the Red Sea.
We characterize the noncommutative Aleksandrov–Clark measures and the minimal realization formulas of contractive and, in particular, isometric noncommutative rational multipliers of the Fock space. Here, the full Fock space over
$\mathbb {C} ^d$
is defined as the Hilbert space of square-summable power series in several noncommuting (NC) formal variables, and we interpret this space as the noncommutative and multivariable analogue of the Hardy space of square-summable Taylor series in the complex unit disk. We further obtain analogues of several classical results in Aleksandrov–Clark measure theory for noncommutative and contractive rational multipliers.
Noncommutative measures are defined as positive linear functionals on a certain self-adjoint subspace of the Cuntz–Toeplitz algebra, the unital
$C^*$
-algebra generated by the left creation operators on the full Fock space. Our results demonstrate that there is a fundamental relationship between NC Hardy space theory, representation theory of the Cuntz–Toeplitz and Cuntz algebras, and the emerging field of noncommutative rational functions.
The UK's relationship with the European Union (EU) is now embodied in two principal legal instruments: the EU–UK Trade and Cooperation Agreement, which formally entered into force on 1 May 2021; and the Withdrawal Agreement, with its Protocol on Ireland/Northern Ireland, which continues to apply. Using a ‘building blocks’ framework for analysis of national health systems derived from the World Health Organisation, this article examines the likely impacts in the UK of this legal settlement on the National Health Service (NHS), health and social care. Specifically, we determine the extent to which the trade, cooperation and regulatory aspects of those legal measures support positive impacts for the NHS and social care. We show that, as there is clear support for positive health and care outcomes in only one of the 17 NHS ‘building blocks’, unless mitigating action is taken, the likely outcomes will be detrimental. However, as the legal settlement gives the UK a great deal of regulatory freedom, especially in Great Britain, we argue that it is crucial to track the effects of proposed new health and social care-related policy choices in the months and years ahead.
To describe national trends in testing and detection of carbapenemases
produced by carbapenem-resistant Enterobacterales (CRE) and associate
testing with culture and facility characteristics.
Design:
Retrospective cohort study.
Setting:
Department of Veterans’ Affairs medical centers (VAMCs).
Participants:
Patients seen at VAMCs between 2013 and 2018 with cultures positive for CRE,
defined by national VA guidelines.
Interventions:
Microbiology and clinical data were extracted from national VA data sets.
Carbapenemase testing was summarized using descriptive statistics.
Characteristics associated with carbapenemase testing were assessed with
bivariate analyses.
Results:
Of 5,778 standard cultures that grew CRE, 1,905 (33.0%) had evidence of
molecular or phenotypic carbapenemase testing and 1,603 (84.1%) of these had
carbapenemases detected. Among these cultures confirmed as
carbapenemase-producing CRE, 1,053 (65.7%) had molecular testing for
≥1 gene. Almost all testing included KPC (n = 1,047, 99.4%), with KPC
detected in 914 of 1,047 (87.3%) cultures. Testing and detection of other
enzymes was less frequent. Carbapenemase testing increased over the study
period from 23.5% of CRE cultures in 2013 to 58.9% in 2018. The South US
Census region (38.6%) and the Northeast (37.2%) region had the highest
proportion of CRE cultures with carbapenemase testing. High complexity (vs
low) and urban (vs rural) facilities were significantly associated with
carbapenemase testing (P < .0001).
Conclusions:
Between 2013 and 2018, carbapenemase testing and detection increased in the
VA, largely reflecting increased testing and detection of KPC. Surveillance
of other carbapenemases is important due to global spread and increasing
antibiotic resistance. Efforts supporting the expansion of carbapenemase
testing to low-complexity, rural healthcare facilities and standardization
of reporting of carbapenemase testing are needed.
To determine the impact of various aerosol mitigation interventions and to establish duration of aerosol persistence in a variety of dental clinic configurations.
Methods:
We performed aerosol measurement studies in endodontic, orthodontic, periodontic, pediatric, and general dentistry clinics. We used an optical aerosol spectrometer and wearable particulate matter sensors to measure real-time aerosol concentration from the vantage point of the dentist during routine care in a variety of clinic configurations (eg, open bay, single room, partitioned operatories). We compared the impact of aerosol mitigation strategies (eg, ventilation and high-volume evacuation (HVE), and prevalence of particulate matter) in the dental clinic environment before, during, and after high-speed drilling, slow–speed drilling, and ultrasonic scaling procedures.
Results:
Conical and ISOVAC HVE were superior to standard-tip evacuation for aerosol-generating procedures. When aerosols were detected in the environment, they were rapidly dispersed within minutes of completing the aerosol-generating procedure. Few aerosols were detected in dental clinics, regardless of configuration, when conical and ISOVAC HVE were used.
Conclusions:
Dentists should consider using conical or ISOVAC HVE rather than standard-tip evacuators to reduce aerosols generated during routine clinical practice. Furthermore, when such effective aerosol mitigation strategies are employed, dentists need not leave dental chairs fallow between patients because aerosols are rapidly dispersed.