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The study was conducted in 17 hospitals in Pennsylvania.
Clostridioides difficile tests that are not collected within 24 hours are automatically canceled (“autocancel”) through the electronic health record. The intervention took place at 2 facilities (intervention period November 2021–July 2022) and subsequently at 15 additional facilities (April 2022–July 2022). Quality measures included percentage of orders canceled, C. difficile HAI rate, percent positivity of completed tests, and potential adverse outcomes of canceled or delayed testing.
Of 6,101 orders, 1,090 (17.9%) were automatically canceled after not being collected for 24 hours during the intervention periods. The reported C. difficile HAI rates per 10,000 patient days did not significantly change. These rates were 8.07 in the 6-month preintervention period and 8.77 in the intervention period for facilities A and B combined (incidence rate ratio [IRR], 1.09; 95% CI, 0.88–1.34; P = .43), and were 5.23 HAIs per 10,000 patient days in the 6-month preintervention period and 5.33 in the intervention period for facilities C–Q combined (IRR, 1.02; 95% CI, 0.79–1.32; P = .87). From the preintervention to the intervention periods, the percent positivity rates of completed C. difficile tests increased by 1.1% for facilities A and B and by 1.4% for facilities C–Q. No adverse outcomes were observed.
The 24-hour autocancellation of uncollected C. difficile orders reduced testing but did not result in reported HAI reduction.
Despite evidence of gender differences in bipolar disorder characteristics and comorbidity, there is little research on the differences in treatment and service use between men and women with bipolar disorder.
To use routine data to describe specialist mental health service contact for bipolar disorder, including in-patient, community and support service contacts; to compare clinical characteristics and mental health service use between men and women in contact with secondary services for bipolar disorder.
Cross-sectional analysis of mental health patients with bipolar disorder in New Zealand, based on complete national routine health data.
A total of 3639 individuals were in contact with specialist mental health services with a current diagnosis of bipolar disorder in 2015. Of these 58% were women and 46% were aged 45 and over. The 1-year prevalence rate of bipolar disorder leading to contact with specialist mental health services was 1.56 (95% CI 1.50–1.63) per 100 000 women and 1.20 (95% CI 1.14–1.26) per 100 000 men. Rates of bipolar disorder leading to service contact were 30% higher in women than men (rate ratio 1.30, 95% CI 1.22–1.39). The majority (68%) had a diagnosis of bipolar I disorder. Women were more likely to receive only out-patient treatment and have comorbid anxiety whereas more men had substance use disorder, were convicted for crimes when unwell, received compulsory treatment orders and received in-patient treatment.
Although the prevalence of bipolar disorder is equal between men and women in the population, women were more likely to have contact with specialist services for bipolar disorder but had a lower intensity of service interaction.
International studies have shown that patients want their spiritual needs attended to at the end of life. The present authors developed a project to investigate people's understanding of spirituality and spiritual care practices in New Zealand (NZ) hospices.
A mixed-methods approach included 52 semistructured interviews and a survey of 642 patients, family members, and staff from 25 (78%) of NZ's hospices. We employed a generic qualitative design and analysis to capture the experiences and understandings of participants' spirituality and spiritual care, while a cross-sectional survey yielded population level information.
Our findings suggest that spirituality is broadly understood and considered important for all three of the populations studied. The patient and family populations had high spiritual needs that included a search for (1) meaning, (2) peace of mind, and (3) a degree of certainty in an uncertain world. The healthcare professionals in the hospices surveyed seldom explicitly met the needs of patients and families. Staff had spiritual needs, but organizational support was sometimes lacking in attending to these needs.
Significance of results:
As a result of our study, which was the first nationwide study in NZ to examine spirituality in hospice care, Hospice New Zealand has developed a spirituality professional development program. Given that spirituality was found to be important to the majority of our participants, it is hoped that the adoption of such an approach will impact on spiritual care for patients and families in NZ hospices.
For the child in residential care who, for whatever reason will not be returning to the natural family, long term foster placement is often seen as a means of providing a suitable alternative family environment. The formation of mutually satisfying emotional ties within a family setting is recognised as being an important ingredient is the healthy psychological development of a child. However, the high rate of foster placement breakdown attests to the fact that these ties are not easily formed.
In South Australia, at any one time, approximately 2,300 children are known to be living apart from their parents. Some 1,500 of these children are in foster care. A 1982 Department for Community Welfare survey of a 50% sample of children who had been in continuous foster care for more than three years revealed that, while 60%of the sample had experienced only one foster placement, 24% had experienced three or more foster placements. Figures are similar In the United States where analysis of eleven foster care studies revealed that some 23% of children had three or more placements. (Westman, 1979).
Education and related proxies for cognitive reserve (CR) are confounded by associations with environmental factors that correlate with cerebrovascular disease possibly explaining discrepancies between studies examining their relationships to cognitive aging and dementia. In contrast, sex-related memory differences may be a better proxy. Since they arise developmentally, they are less likely to reflect environmental confounds. Women outperform men on verbal and men generally outperform women on visuospatial memory tasks. Furthermore, memory declines during the preclinical stage of AD, when it is clinically indistinguishable from normal aging. To determine whether CR mitigates age-related memory decline, we examined the effects of gender and APOE genotype on longitudinal memory performances. Memory decline was assessed in a cohort of healthy men and women enriched for APOE ɛ4 who completed two verbal [Rey Auditory Verbal Learning Test (AVLT), Buschke Selective Reminding Test (SRT)] and two visuospatial [Rey-Osterrieth Complex Figure Test (CFT), and Benton Visual Retention Test (VRT)] memory tests, as well as in a separate larger and older cohort [National Alzheimer’s Coordinating Center (NACC)] who completed a verbal memory test (Logical Memory). Age-related memory decline was accelerated in APOE ɛ4 carriers on all verbal memory measures (AVLT, p=.03; SRT p<.001; logical memory p<.001) and on the VRT p=.006. Baseline sex associated differences were retained over time, but no sex differences in rate of decline were found for any measure in either cohort. Sex-based memory advantage does not mitigate age-related memory decline in either APOE ɛ4 carriers or non-carriers. (JINS, 2015, 21, 95–104)
Trudgill (2004) proposed that the emergence of New Zealand English, and of isolated new dialects generally, is purely deterministic. It can be explained solely in terms of the frequency of occurrence of particular variants and the frequency of interactions between different speakers in the society. Trudgill's theory is closely related to usage-based models of language, in which frequency plays a role in the representation of linguistic knowledge and in language change. Trudgill's theory also corresponds to a neutral evolution model of language change. We use a mathematical model based on Croft's usage-based evolutionary framework for language change (Baxter, Blythe, Croft, & McKane, 2006), and investigate whether Trudgill's theory is a plausible model of the emergence of new dialects. The results of our modeling indicate that determinism cannot be a sufficient mechanism for the emergence of a new dialect. Our approach illustrates the utility of mathematical modeling of theories and of empirical data for the study of language change.
The millennium of Edward the Confessor's birth presents an appropriate occasion for a full-scale, up-to-date reassessment of his life, reign and cult, a reappraisal which is provided in the essays here. After an introduction to the many views of Edward's life, and a reinterpretation of the development of his cult, the volume considers his childhood in England and its influence upon his later life; the time he spent in Normandy and the relationships that developed there; and his later life, including an examination of the role played by Edith, his queen. There is also a particular focus upon Westminster Abbey, and the major new discoveries which have recently been made there. Incorporating both broad surveys and the fruits of detailed new work, this book is essential reading for all those interested in late Saxon and Norman England.
CONTRIBUTORS: RICHARD MORTIMER, SIMON KEYNES, ELISABETH VAN HOUTS, STEPHEN BAXTER, PAULINE STAFFORD, ERIC FERNIE, WARWICK RODWELL, RICHARD GEM, EDINA BOZOKY
The perceptions and expectations by referrers of assessments performed by a medium secure unit were examined in order to ascertain areas for possible improvement. All referrals to two teams at the North West Thames Regional Secure Unit were monitored over a 6-month period. A self-report questionnaire was sent to each referrer, in cases where an assessment and forensic report had been completed.
Assessments and forensic reports were completed (and questionnaires sent to referrers) in 63% of total referrals (32 out of 51). The response rate to the questionnaire was 81% (26 out of 32). Many referrers wanted the assessments and report to be completed in 2 weeks. Most referrers were satisfied with the quality of the report received and the majority were happy with the risk assessment.
Referrers want forensic assessments to be of a high quality and to be performed quickly. Recommendations for service development are suggested.
The formation and characterization of composite films of copper/boron nitride (Cu/BN) and nickel/boron nitride (Ni/BN) are described. Composite Cu/BN and Ni/BN films were synthesized by a metal electrodeposition from suspensions of boron nitride particles on carbon steel substrates. The effects of concentration of boron nitride in the solution, temperature, potential and various additives on the morphology of composite films have been investigated. The morphology of these films was examined using Scanning Electron Microscopy. The elemental analysis for boron, nitrogen, copper and nickel was performed using Energy Dispersive X-ray Spectroscopy (EDS), and a Microprobe X-ray Analyzer. The Vickers hardness of Cu/BN and Ni/BN films prepared under different conditions was also investigated. It has been found that the composite Cu/BN and Ni/BN films have an increased microhardness as compared to the respective pure metal films. The effects of deposition potential, temperature, concentration of BN and presence of various additives on the microhardness of Cu/BN and Ni/BN films have been investigated.
Having spoken of the CONSTITUTION of the Kingdom of God, I shall proceed to speak of the ADMINISTRATION thereof.
Thes. 35. God as the Soveraign Ruler of mankind hath given him the Law of nature, commonly called the Morall Law, to be the Rule of his obedience.
1. The Law of nature in the primary most proper sence, is to be found in natura rerum, in the whole Creation that is objected to our Knowledg, as it is a Glass in which we may see the Lord, and much of his Will; and as it is a Signifler of that Will of God concerning our duty. 2. The Law of nature is sometime taken for that Disposition or Aptitude that there is in mans nature to the actual knowledg of these naturally revealed things, especially some clear and greatest Principles, which almost all the world discern. 3. And it is sometime taken for the Actual knowledge of those plain and common Principles. 4. And sometime for the Actual knowledge of all that meer Nature doth reveal. When I say God hath given man this law of nature, I mean, both that he hath made an Impress of his minde upon the Creation, and set us this Glass to see himself, and much of our Duty in, & also that he hath given to the very nature of man a Capacity of perceiving what is thus revealed, and a disposition especially to the Reception of the more obvious Principles; so that by ordinary helps, they will be quickly known; and the rest may be known if we be not wanting to our selves.
Because it is a matter of so great moment, that you pass not in impenitency to the Barre of God, (where you must all speedily appear) and that the many Thousands of this Nation, that never were actually guilty, may not make your sinnes (sinnes of such a dreadfull nature) to become their own by approbation; I thought it my duty to manifest the fallacy of all those Arguments, which I judged might most probably deceive you. And therefore supporting that thence you are likely to fetch matter of encouragement, I shall briefly discuss the wounding Answer to the Healing Question, so far as may concern your Consciences.
1. He placeth the Cause in two things; 1. p. 3, 4. ‘To have and enjoy the Freedom (by way of dutifull compliance and condescension from all the parts and members of this society,) to set up meet persons in the place of Supream Judicature, and authority amongst them.’ 2. p. 5, 6. ‘Freedom in matters of Religion, or that concern the service and worship of God.’
The former is thus enlarged, p. 10. ‘That the body of the good people in their military capacity and posture, are most properly Soveraign, and possesse their right of naturall Soveraignty.’ And p. 11. ‘Becoming one Civill or Politick Incorporation with the whole Party of honest Men, they do therein keep the Soveraignty, as Originally seated in themselves, and part with it only as by way of Deputation, and Representation of themselves, &c.’
Having spoken of the Universal Kingdom, and next in general of particular subordinate Common-wealths, that God hath by institution made the parts of it; I must First speak of the CONSTITUTION, and next of the ADMINISTRATION of these. And about the Constitution I shall first speak of the MODES (or SPECIES as commonly called) and then of the Individuation.
Thes. 65. God hath not in his Universal Lawes restrained the Nations of the world to any one Mode or Species of Government, but left it as a variable thing to be determined according to the condition of each people, whether one or many shall have the Soveraignty under him.
There is a twofold diversity of Governments: One is in the Persons Ruling; Another is in the Matter of Government: whether the former do deserve the name of Specification or not, it hath by Custome obtained that name: And so Monarchy; Aristocracie, and Democracie are called the distinct Species of Governments or Common-wealths. In the Matter of Government there is difference, in that some have greater power, and some have less: some Soveraigns are limited to certain things, and degrees of power; and some are unlimited: and some limited more, and some less. And one would think this difference were as great as the former.
I know some pretend to a Divine Institution for Monarchy, but they mean onely that it may from Scripture be proved to be best; but not that no other but it, is Lawfull.