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To evaluate different prospective audit-and-feedback models on antimicrobial prescribing at a rehabilitation hospital.
Retrospective interrupted time series (ITS) and qualitative methods.
A 178-bed rehabilitation hospital within an academic health sciences center.
ITS analysis was used to analyze monthly days of therapy (DOT) per 1,000 patient days (PD) and monthly urine cultures ordered per 1,000 PD. We compared 2 sequential intervention periods to the baseline: (1) a period when a dedicated antimicrobial stewardship (AMS) pharmacist performed prospective audit and feedback and provided urine culture education followed by (2) a period when ward pharmacists performing audit and feedback. We conducted an electronic survey with physicians and semistructured interviews with pharmacists, respectively.
Audit and feedback conducted by an AMS pharmacist resulted in a 24.3% relative reduction in total DOT per 1,000 PD (incidence rate ratio [IRR], 0.76; 95% confidence interval [CI], 0.58–0.99; P = .04), whereas we detected no difference between ward pharmacist audit and feedback and the baseline (IRR, 1.20; 95% CI, 0.53–2.70; P = .65). We detected no statistically significant change in monthly urine-culture orders between the AMS pharmacist period and the baseline (level coefficient, 0.81; 95% CI, 0.65–1.01; P = .07). Compared to baseline, the ward pharmacist period showed a statistically significant increase in urine-culture ordering over time (slope coefficient, 1.04; 95% CI, 1.01–1.08; P = .02). The barrier most identified by pharmacists was insufficient time.
Audit and feedback conducted by an AMS pharmacist in a rehabilitation hospital was associated with decreased antimicrobial use.
A policy mandating the completion of an online learning module for healthcare workers intending to decline influenza immunization was associated with a nearly 25% relative increase in immunization and significant reduction in healthcare-associated influenza. In the absence of mandatory vaccination, this model may help to augment severe acute respiratory coronavirus virus 2 (SARS-CoV-2) vaccine efforts.
We examined demographic, clinical, and psychological characteristics of a large cohort (n = 368) of adults with dissociative seizures (DS) recruited to the CODES randomised controlled trial (RCT) and explored differences associated with age at onset of DS, gender, and DS semiology.
Prior to randomisation within the CODES RCT, we collected demographic and clinical data on 368 participants. We assessed psychiatric comorbidity using the Mini-International Neuropsychiatric Interview (M.I.N.I.) and a screening measure of personality disorder and measured anxiety, depression, psychological distress, somatic symptom burden, emotional expression, functional impact of DS, avoidance behaviour, and quality of life. We undertook comparisons based on reported age at DS onset (<40 v. ⩾40), gender (male v. female), and DS semiology (predominantly hyperkinetic v. hypokinetic).
Our cohort was predominantly female (72%) and characterised by high levels of socio-economic deprivation. Two-thirds had predominantly hyperkinetic DS. Of the total, 69% had ⩾1 comorbid M.I.N.I. diagnosis (median number = 2), with agoraphobia being the most common concurrent diagnosis. Clinical levels of distress were reported by 86% and characteristics associated with maladaptive personality traits by 60%. Moderate-to-severe functional impairment, high levels of somatic symptoms, and impaired quality of life were also reported. Women had a younger age at DS onset than men.
Our study highlights the burden of psychopathology and socio-economic deprivation in a large, heterogeneous cohort of patients with DS. The lack of clear differences based on gender, DS semiology and age at onset suggests these factors do not add substantially to the heterogeneity of the cohort.
The Indian Supreme Court sits in panels and can have up to 31 judges. This chapter explores how the Indian Supreme Court developed its current structure and the impact of this structure on its functioning. It argues that the Supreme Court’s structure has a range of inter-related effects that includes increasing access to the Court, producing a “polyvocal” jurisprudence that destabilizes stare decisis, spurring experimentation among judges, fostering a “Chief Justice dominant” Court, and reducing the perceived partisanship of judges. Mapping the structure of the Court, as well as the Court’s relationship with the rest of the judiciary, helps us appreciate how judges ultimately interpret the law and the Constitution not in isolation, but within a larger judicial architecture.
Political scientists are increasingly engaged with the importance of the “visual turn,” asking questions about how we understand what we see and the social and political consequences of that seeing. One of the greatest challenges facing researchers is developing methods that can help us understand visual politics. Much of the literature has fallen into the familiar qualitative versus quantitative methodological binary, with a strong bias in favor of the former, and has consequently been unable to realize the advantages of mixed-methods research. We advance the study of visual politics as well as the literature on bridging the quantitative versus qualitative divide by showing that it is possible to generate quantitative data that is rooted in, and amenable to, qualitative research on visual phenomena. Our approach to conducting mixed-methods research is an alternative to the more common strategy of seeing various research methods as an assortment of tools, as it is directed at developing an organic relationship between qualitative and quantitative methods. We demonstrate the effectiveness of this strategy for research on visual politics by discussing our own efforts to create a dataset for quantifying visual signifiers of militarism.
Dietary intake during adolescence contributes to lifelong eating habits and the development of early risk factors for disease in adulthood. Few studies have examined the dietary patterns of adolescents and the social and environmental factors that may affect them during this life stage. The present study describes dietary patterns in a cohort of adolescents and examines their associations with socio-economic factors, as well as parental and adolescent risk factor behaviours.
A semi-quantitative FFQ was used to assess study adolescents’ usual dietary intake over the previous year. Information was collected on family functioning and various socio-economic and risk factor variables via questionnaire. Adolescents visited the study clinic for anthropometric measurements.
The Western Australian Pregnancy Cohort Study (Raine Study), Perth, Western Australia.
Adolescents (n 1631) aged 14 years from a pregnancy cohort study.
Factor analysis identified two distinct dietary patterns that differed predominantly in fat and sugar intakes. The ‘Western’ pattern consisted of high intakes of take-away foods, soft drinks, confectionery, French fries, refined grains, full-fat dairy products and processed meats. The ‘healthy’ pattern included high intakes of whole grains, fruit, vegetables, legumes and fish. ANOVA showed that the ‘Western’ dietary pattern was positively associated with greater television viewing and having a parent who smoked, and was inversely associated with family income. The ‘healthy’ pattern was positively associated with female gender, greater maternal education, better family functioning and being in a two-parent family, and was inversely associated with television viewing.
The study suggests that both lifestyle factors and family psycho-social environment are related to dietary patterns in Australian adolescents.
The Bugscope project is an educational outreach program for kindergarten to grade 12 (K–12) classrooms. The project provides a resource to classrooms so that they may remotely operate a scanning electron microscope to image insects at high magnification. The microscope is remotely controlled in real time from a classroom computer over the Internet using a Web browser. Bugscope provides a state-of-the-art microscope resource for teachers that can be readily integrated into classroom activities. The Bugscope project provides a low-cost, sustainable model for research groups to support K–12 education outreach projects.
Economic evaluation of quality assurance programs is often called for but rarely reported. A study was designed to estimate the cost-utility of audit of thrombolysis in four U.K. district general hospitals, using the quality-adjusted life year. Although the results obtained were imprecise, the model used could be applied in future evaluations.
Otitis media with effusion is the most common cause of hearing impairment and reason for elective surgery in children. In most cases no specific treatment is required and the important role of the medical practitioner is to identify the small number of cases that warrant treatment or onward referral. This chapter aims to provide background information on the condition and a practical guide to assist medical practitioners in this task.
Otitis media with effusion (OME) is a normal finding in children following an upper respiratory tract infection and the majority of OME resolves spontaneously. Only a small minority of approximately 4.7 per 1000 children come to surgery in Britain. While many have focused their attention on the appearance of the drum or tympanometric tracing, it is the history that is all-important in the management of OME.
Hearing screening attempts to identify children whose hearing loss is sufficient to affect their language and speech development. It is of primary importance to ensure that children with a sensorineural hearing loss are not missed, and every effort should be made to try and find these children as early as possible, although logistically this is difficult. This group has to be differentiated from the large number of children with OME. Many children will need following up as a result of screening. The system varies from district to district depending on the resources available but follow-up may be undertaken by a variety of staff.
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