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There are limited data documenting sources of medical information that families use to learn about paediatric cardiac conditions. Our study aims to characterise these resources and to identify any disparities in resource utilisation. We hypothesise there are significant variations in the resources utilised by families from different educational and socio-economic backgrounds.
A survey evaluating what resources families use (websites, healthcare professionals, social media, etc.) to better understand paediatric cardiac conditions was administered to caretakers and paediatric patients at Morgan Stanley Children’s Hospital. Patients with a prior diagnosis of CHD, cardiac arrhythmia, and/or heart failure were included. Caretakers’ levels of education (fewer than 16 years vs. 16 years or more) and patients’ medical insurance types (public vs. private) were compared with regard to the utilisation of resources.
Surveys completed by 137 (91%) caretakers and 27 (90%) patients were analysed. Websites were utilised by 72% of caretakers and 56% of patients. Both private insurance and higher education were associated with greater reported utilisation of websites, healthcare professionals, and personal networks (by insurance p = 0.009, p = 0.001, p = 0.006; by education p = 0.022, p < 0.001, p = 0.018). They were also more likely to report use of electronic devices (such as a computer) compared to those with public medical insurance and fewer than 16 years of education (p < 0.001, p < 0.001, respectively).
Both levels of education and insurance status are associated with the utilisation of informative resources and digital devices by families seeking to learn more about cardiac conditions in children.
The events following the collapse of Ansett Airlines in September 2001 provide an opportunity to explore the impact of internal labour markets on post-retrenchment labour market outcomes. This paper traces the labour market experiences of a sample of 649 former Ansett Airlines employees in the first eleven months after the airline’s initial closure. It reveals that many workers spent long periods in an employment limbo — officially ‘stood down’ but not retrenched — while waiting for their Ansett jobs to be resurrected under new ownership. During that time, many accepted fragmented, short-term placements in ‘bad’ jobs. After this initial period of uncertainty, however, many former Ansett employees found their way back to ‘good’ jobs — either in the aviation sector or in firms offering secure primary segment employment conditions. The uneven outcomes experienced by different groups of workers reflect the interconnections between workers’ perceptions of their options, their attachments to Ansett, their age and household circumstances in the context of weak demand for their skills. The paper illuminates the ways in which the personal loyalties, social networks and work expectations developed within Ansett’s rigid internal labour market shaped retrenched workers’ job search, recruitment and re-employment outcomes.
The 1988 sector-based industry plan for restructuring of the Australian Textiles Clothing and Footwear industries accelerated the decline of employment in the TCF sector. Many of those thrown out of work by TCF plant closures were women, older workers, and workers from non-English speaking backgrounds who would find it difficult to re-establish themselves in the labour market. The Hawke government provided a package of labour adjustment assistance designed to help the retrenched TCF workers find jobs in other industries. This paper examines the rates of participation by retrenched TCF workers in the TCF Labour Adjustment Package. Drawing on both statistical and case study evidence it explores the different take-up rates by different subgroups of retrenched TCF workers. The paper concludes by exploring the implications for labour market interventions more generally.
To explore, from the perspectives of adolescents and caregivers, and using qualitative methods, influences on adolescent diet and physical activity in rural Gambia.
Six focus group discussions (FGD) with adolescents and caregivers were conducted. Thematic analysis was employed across the data set.
Rural region of The Gambia, West Africa.
Participants were selected using purposive sampling. Four FGD, conducted with forty adolescents, comprised: girls aged 10–12 years; boys aged 10–12 years; girls aged 15–17 years, boys aged 15–17 years. Twenty caregivers also participated in two FGD (mothers and fathers).
All participants expressed an understanding of the association between salt and hypertension, sugary foods and diabetes, and dental health. Adolescents and caregivers suggested that adolescent nutrition and health were shaped by economic, social and cultural factors and the local environment. Adolescent diet was thought to be influenced by: affordability, seasonality and the receipt of remittances; gender norms, including differences in opportunities afforded to girls, and mother-led decision-making; cultural ceremonies and school holidays. Adolescent physical activity included walking or cycling to school, playing football and farming. Participants felt adolescent engagement in physical activity was influenced by gender, seasonality, cultural ceremonies and, to some extent, the availability of digital media.
These novel insights into local understanding should be considered when formulating future interventions. Interventions need to address these interrelated factors, including misconceptions regarding diet and physical activity that may be harmful to health.
Approximately, 1.7 million individuals in the United States have been infected with SARS-CoV-2, the virus responsible for the novel coronavirus disease-2019 (COVID-19). This has disproportionately impacted adults, but many children have been infected and hospitalised as well. To date, there is not much information published addressing the cardiac workup and monitoring of children with COVID-19. Here, we share the approach to the cardiac workup and monitoring utilised at a large congenital heart centre in New York City, the epicentre of the COVID-19 pandemic in the United States.
Delirium is a common complication in palliative care patients, especially in the terminal phase of the illness. To date, evidence regarding risk factors and prognostic outcomes of delirium in this vulnerable population remains sparse.
In this prospective observational cohort study at a tertiary care center, 410 palliative care patients were included. Simple and multiple logistic regression models were used to identify associations between predisposing and precipitating factors and delirium in palliative care patients.
The prevalence of delirium in this palliative care cohort was 55.9% and reached 93% in the terminally ill. Delirium was associated with prolonged hospitalization (p < 0.001), increased care requirements (p < 0.001) and health care costs (p < 0.001), requirement for institutionalization (OR 0.11; CI 0.069–0.171; p < 0.001), and increased mortality (OR 18.29; CI 8.918–37.530; p < 0.001). Predisposing factors for delirium were male gender (OR 2.19; CI 1.251–3.841; p < 0.01), frailty (OR 15.28; CI 5.885–39.665; p < 0.001), hearing (OR 3.52; CI 1.721–7.210; p < 0.001), visual impairment (OR 3.15; CI 1.765–5.607; p < 0.001), and neoplastic brain disease (OR 3.63; CI 1.033–12.771; p < 0.05). Precipitating factors for delirium were acute renal failure (OR 6.79; CI 1.062–43.405; p < 0.05) and pressure sores (OR 3.66; CI 1.102–12.149; p < 0.05).
Significance of results
Our study identified several predisposing and precipitating risk factors for delirium in palliative care patients, some of which can be targeted early and modified to reduce symptom burden.
Over 175 growers in each of six states (Illinois, Indiana, Iowa, Mississippi, Nebraska, and North Carolina) were surveyed by telephone to assess their perceptions of the benefits of utilizing the glyphosate-resistant (GR) crop trait in corn, cotton, and soybean. The survey was also used to determine the weed management challenges growers were facing after using this trait for a minimum of 4 yr. This survey allowed the development of baseline information on how weed management and crop production practices have changed since the introduction of the trait. It provided useful information on common weed management issues that should be addressed through applied research and extension efforts. The survey also allowed an assessment of the perceived levels of concern among growers about glyphosate resistance in weeds and whether they believed they had experienced glyphosate resistance on their farms. Across the six states surveyed, producers reported 38, 97, and 96% of their corn, cotton, and soybean hectarage planted in a GR cultivar. The most widely adopted GR cropping system was a GR soybean/non-GR crop rotation system; second most common was a GR soybean/GR corn crop rotation system. The non-GR crop component varied widely, with the most common crops being non-GR corn or rice. A large range in farm size for the respondents was observed, with North Carolina having the smallest farms in all three crops. A large majority of corn and soybean growers reported using some type of crop rotation system, whereas very few cotton growers rotated out of cotton. Overall, rotations were much more common in Midwestern states than in Southern states. This is important information as weed scientists assist growers in developing and using best management practices to minimize the development of glyphosate resistance.
A 2010 survey of 1,299 corn, cotton, and soybean growers was conducted to determine their attitudes and awareness regarding glyphosate-resistant (GR) weeds and resultant implications on weed management practices. An additional 350 growers included in the current study participated in a 2005 survey, and these answers were compared across time so that cross-sectional and longitudinal comparisons of responses could be made. Most growers surveyed in 2010 were aware of the potential for weeds to evolve resistance to glyphosate; however, many growers were not aware of glyphosate resistance in specific weeds in their county or state. Growers in the South were different from growers in other geographic regions and were significantly more aware of local cases of GR weeds. Awareness of GR weeds did not increase appreciably from 2005 to 2010, but the percentage who reported GR weeds as problematic was significantly higher. Grower reports of GR weeds on-farm in 2010 were up considerably from 2005, with growers in the South reporting significantly more instances than growers in other regions. Growers in the South were also more likely to consider glyphosate resistance a serious problem. Overall, 30% of growers did not consider GR weeds to be a problem. It appears that most growers received information about glyphosate resistance from farm publications, although in the South this percentage was less than for other geographic regions. Growers in the South received more information from universities and extension sources.
Approximately 1,300 growers from 22 states were surveyed during 2010 to determine herbicide use. Cropping systems included continuous glyphosate-resistant corn, cotton, and soybean, and various combinations of these crops and rotations with non–glyphosate-resistant crops. The most commonly used herbicide for both fall and spring applications was glyphosate followed by synthetic auxin herbicides. Herbicide application in spring was favored over application in the fall. The percentage of growers in a glyphosate-only system was as high as 69% for some cropping systems. Excluding glyphosate, the most frequently used herbicides included photosystem II, mitotic, and protoporphyrinogen oxidase inhibitors. A higher percentage of growers integrated herbicides other than glyphosate during 2010 compared with 2005. Extensive educational efforts have promoted resistance management by increasing the diversity of herbicides in glyphosate-resistant cropping systems. However, a considerable percentage of growers continued use of only glyphosate from the period of 2005 to 2010, and this practice most likely will continue to exert a high level of selection for evolved glyphosate-resistant weed species.
Introduction, Mandeep K. Dhami, Anne Schlottmann, and Michael R. Waldmann
In conclusion, rather than present a summary of the preceding chapters, we invited nine eminent past presidents of the Society for Judgment and Decision Making (SJDM) to provide personal perspectives on the concept of JDM as a dynamic skill. These scholars were not asked to comment on the chapters in this book, but rather to highlight their personal points of contact with the notion of JDM as a dynamic skill. The following perspectives offer historical accounts, and also point to future lines of research.
Shanteau describes how over the years he has highlighted the importance of training and skill acquisition in JDM, but feels “blue” that this view has not been more popular. Wallsten remembers the benefits of learning for JDM performance found in a study that he conducted 30 years ago, and confesses that he has only recently begun to revisit this important finding. Fischhoff points out that a sound understanding of the normative implications of tasks has laid a better foundation for the study of dynamically changing skills, especially in development. Levin and colleagues provide useful examples of their research on the developmental and neurological bases of JDM skills. Reyna highlights how her fuzzy trace theory taps into JDM processes that develop over time and experience, has neurological correlates, and may be evolutionarily adaptive. Baron reveals how he now finds himself in search of the developmental origins of the types of moral heuristics and biases that he has studied during his career. Hogarth shares three steps he has developed during decades of teaching decision making that can help people make better decisions. Klayman reveals that despite decades of studying learning and development of JDM, he still seeks a greater understanding of how decision makers “get that way.” Finally, Birnbaum points to the methodological factors that have limited our understanding of JDM as a skill, and presents a challenge for future researchers: to explain how and why JDM skills change. Overall, the following perspectives provide a rare glimpse of the personalized views of those who have made significant contributions to the field of human JDM.
New data are emerging on the use of palivizumab as prophylaxis against infection with the respiratory syncytial virus in infants with congenital cardiac disease. Following a 4-year multicentre randomised trial, it was shown that prophylactic injections with palivizumab were effective and safe for such children. Prophylaxis consists of 5, monthly, intramuscular injections of palivizumab, at a dose of 15 mg/kg, given during the season for infection with the respiratory syncytial virus. Timing is at the discretion of the physician, depending on the onset of the season locally. It is suggested that, in the United Kingdom, this should be commenced in mid-September. To help clinicians to identify appropriate candidates for palivizumab, a working group of the British Paediatric Cardiac Association has developed recommendations.
Infants, namely those under 1 year old, with congenital cardiac disease likely to benefit from prophylaxis include those with haemodynamically significant lesions, particularly increased pulmonary blood flow with or without cyanosis; pulmonary venous congestion, pulmonary hypertension or long-term pulmonary complications, residual haemodynamic abnormalities following medical or surgical intervention (patients who have undergone cardiopulmonary bypass should receive an injection as soon as they are medically stable), cardiomyopathy requiring treatment, and congenital cardiac disease likely to need hospital admission for medical or surgical intervention during the season of infection with the virus. Prophylaxis with palivizumab may also be indicated, at the discretion of the physician, in some children with complex cardiac disease over the age of 1 year. Children less likely to benefit from prophylaxis are those with haemodynamically insignificant disease, or those with lesions adequately corrected by medical or surgical intervention.
Objectives: To compare the cost-effectiveness of generic psychological therapy (counseling) with routinely prescribed antidepressant drugs in a naturalistic general practice setting for a follow-up period of 12 months.
Methods: Economic analysis alongside a randomized clinical trial with patient preference arm. Comparison of depression-related health service costs at 12 months. Cost-effectiveness analysis of bootstrapped trial data using net monetary benefits and acceptability curves.
Results: No significant difference between the mean observed costs of patients randomized to antidepressants or to counseling (£342 vs £302, p = .56 [t test]). If decision makers are not willing to pay more for additional benefits (value placed on extra patient with good outcome, denoted by K, is zero), then we find little difference between the treatment modalities in terms of cost-effectiveness. If decision makers do place value on additional benefit (K > £0), then the antidepressant group becomes more likely to be cost-effective. This likelihood is in excess of 90% where decision makers are prepared to pay an additional £2,000 or more per additional patient with a good global outcome. The mean values for incremental net monetary benefits (INMB) from antidepressants are substantial for higher values of K (INMB = £406 when K = £2,500).
Conclusions: For a small proportion of patients, the counseling intervention (as specified in this trial) is a dominant cost-effective strategy. For a larger proportion of patients, the antidepressant intervention (as specified in this trial) is the dominant cost-effective strategy. For the remaining group of patients, cost-effectiveness depends on the value of K. Since we cannot observe K, acceptability curves are a useful way to inform decision makers.
Our objective was to establish a mechanism for monitoring indicators of the state of health of inner London's mental illness services. Data were collected for a census week around 15 June 1994. Local data collection was coordinated by consultant pyschiatrists working in inner London services. Twelve services participated with a combined catchment population of 2.6 m. They included ten London services which were among the 17 most socially deprived areas of England. Main indicators were admission bed occupancy levels (including an estimate of the total requirement), proportion of patients detained under the Mental Health Act, number of assaults committed by inpatients, number of emergency assessments and CPN caseloads. The mean true bed occupancy (which reflects the number of patients who were receiving, or required, in-patient care on census day) was 130%. To meet all need for acute psychiatric care, including for patients who should have been admitted and those discharged prematurely because beds were full, a further 426 beds would have been required. Fifty per cent of patients were legally detained. Physical assaults were virtually a daily occurrence on the admission units. Average community pyschiatric nurse caseloads were 37, suggesting that the majority were not working intensively with limited caseloads of patients with severe mental illness. These indicators, although imperfect, will allow for some measurement of the impact of local and central initiatives on the poor state of London's mental illness services.
A sample of 26 HIV seronegative, 59 HIV seropositive asymptomatic and 7 HIV seropositive symptomatic homosexual and bisexual men were assessed over two visits, a mean of 11 months apart, using the BDI, STAI, and CIS. Significant differences emerged between the symptomatic group and the other two groups. Past psychiatric history and the somatic items in the assessments accounted for some of these differences. The seropositive asymptomatic and the seronegative groups did not differ on any of the mood or psychiatric assessments, suggesting minimal effect on psychological well-being of seroconversion in the absence of symptoms.
Nine out of 4044 patients admitted to our institution between 1987 and 1990 suffered an episode of NMS. Neuroleptic rechallenge using clozapine for persisting psychiatric illness was tolerated by eight patients. Clozapine was discontinued in one older, high-risk patient because recurrence of NMS was anticipated. Clozapine should be considered a drug of choice for psychotic patients with a history of NMS.
The Sextans dwarf Spheroidal (dSph) galaxy was discovered recently by Irwin, et al. (1990, M. N. R. A. S., 244, 16p). We report results concerning a number of the global properties of the stellar population of this system. Based on deep CCD photometry obtained with the prime-focus CCD camera on the CTIO 4m telescope, we find that the galaxy is dominated by an old stellar population, similar to that observed in the Draco, Sculptor, and Ursa Minor dwarfs. Some blue stragglers are also present; if these are associated with an intermediate age component, they indicate that only a tiny fraction of the stellar population of Sextans is younger than about 10 Gyr. Based on the apparent magnitude of the predominately red horizontal branch, we conclude that the true distance modulus of Sextans is 19.7 ± 0.3, and the total luminosity of the galaxy is 5.2 × 105L⊙. A complete description of these results is given in Mateo, et al. (1991, A. J., 101, 892).
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