To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes.
Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments.
Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30).
Significance of results
Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.
Optical tracking systems typically trade off between astrometric precision and field of view. In this work, we showcase a networked approach to optical tracking using very wide field-of-view imagers that have relatively low astrometric precision on the scheduled OSIRIS-REx slingshot manoeuvre around Earth on 22 Sep 2017. As part of a trajectory designed to get OSIRIS-REx to NEO 101955 Bennu, this flyby event was viewed from 13 remote sensors spread across Australia and New Zealand to promote triangulatable observations. Each observatory in this portable network was constructed to be as lightweight and portable as possible, with hardware based off the successful design of the Desert Fireball Network. Over a 4-h collection window, we gathered 15 439 images of the night sky in the predicted direction of the OSIRIS-REx spacecraft. Using a specially developed streak detection and orbit determination data pipeline, we detected 2 090 line-of-sight observations. Our fitted orbit was determined to be within about 10 km of orbital telemetry along the observed 109 262 km length of OSIRIS-REx trajectory, and thus demonstrating the impressive capability of a networked approach to Space Surveillance and Tracking.
Increasing evidence suggests that circulating factors and immune dysfunction may contribute to the pathogenesis of schizophrenia. In particular, proinflammatory cytokines, complement and autoantibodies against CNS epitopes have recently been associated with psychosis. Related concepts in previous decades led to several clinical trials of dialysis and plasmapheresis as treatments for schizophrenia. These trials may have relevance for the current understanding of schizophrenia. We aimed to identify whether dialysis or plasmapheresis are beneficial interventions in schizophrenia. We conducted a systematic search in major electronic databases for high-quality studies (double-blinded randomised trials with sham controls) applying either haemodialysis or plasmapheresis as an intervention in patients with schizophrenia, published in English from the start of records until September 2018. We found nine studies meeting inclusion criteria, reporting on 105 patients in total who received either sham or active intervention. One out of eight studies reported a beneficial effect of haemodialysis on schizophrenia, one a detrimental effect and six no effect. The sole trial of plasmapheresis found it to be ineffective. Adverse events were reported in 23% of patients. Studies were at unclear or high risk of bias. It is unlikely that haemodialysis is a beneficial treatment in schizophrenia, although the studies were of small size and could not consider potential subgroups. Plasmapheresis was only addressed by one study and warrants further exploration as a treatment modality in schizophrenia.
Macroscale “continuum” level predictions are made by a new way to construct computationally efficient “wrappers” around fine-scale, microscopic, detailed descriptions of dynamical systems, such as molecular dynamics. It is often significantly easier to code a microscale simulator with periodicity: so the challenge addressed here is to develop a scheme that uses only a given periodic microscale simulator; specifically, one for atomistic dynamics. Numerical simulations show that applying a suitable proportional controller within “action regions” of a patch of atomistic simulation effectively predicts the macroscale transport of heat. Theoretical analysis establishes that such an approach will generally be effective and efficient, and also determines good values for the strength of the proportional controller. This work has the potential to empower systematic analysis and understanding at a macroscopic system level when only a given microscale simulator is available.
We argue that concerted efforts by Tea Party leaders, Republican politicians, and leading Christian Right figures to establish and promote a connection between Christian faith and the free-market system has helped shift the economic attitudes of white evangelical Protestants in a more conservative direction. Our analysis of Public Religion Research Institute survey data finds that white evangelical Protestants express greater skepticism about an active role of government in society and believe economic growth is more likely to be spurred by a reduction in taxes rather than in public investments. Moreover, we find that identifying with the Tea Party has a conservatizing influence on their economic issue positions. While we find that partisanship, class, and in some cases, age, serve to modify the views of some evangelicals, by and large, evangelicals have come to embrace the conservative fiscal message promoted by both the Republican Party and the Tea Party movement.
Cholla infestations can be problematic on rangelands in North America, Australia, Africa, and Europe, and treatment options for this plant are limited because of its ability to resprout from broken stem fragments. We investigated dragged-rail treatments, where iron rails are dragged across the rangeland by tractor and knock plants over while uprooting them, as a treatment option for tree cholla in southeast New Mexico. Railing effectively controlled tree cholla plants over 0.5 m tall, but did not effectively control plants smaller than 0.5 m. Nevertheless, treatment did effectively reduce overall cholla density: Treated areas averaged 40 to 50 plants ha−1, whereas nontreated areas averaged over 350 plants ha−1. Railing can be an effective means of cholla control, especially if followed by another treatment, such as prescribed fire, that is known to be effective against the smaller sizes of cholla.
‘I don't understand some of the decisions that are made in this place.’
‘How can I get the support I need to carry on my research?’
‘How can I ensure my project has impact?’
This book is an introduction to research, evaluation and audit techniques for library and information service practitioners. You may well have an interest in pure research for its own sake but it is more likely that you are interested in using research to prompt a change in policy or to improve service delivery. The reality is that much research never does get into practice. If you do not want this neglect to befall your own work, this chapter will give you some pointers about how to design your project with impact in mind and how to plan to influence organizations and wider communities to make use of your project findings.
In most organizations research, evaluation or audit does not take place in a vacuum. This chapter explores the important question of how you can make your project findings count, to help bring about the changes that will make your organization stronger and more responsive. Equally you may want to influence a whole sector or community of organizations. The techniques explored in this chapter can be summarized under four headings:
Understanding the organization
Establishing your credibility
Designing projects to make change happen
Understanding your organization
Large organizations are complex entities and they have many different ways of making decisions. These are not always totally rational; you cannot assume that because your project has identified what you believe is the most appropriate course of action that this will be recognized immediately and the necessary changes made as a matter of course. Changing a service can take time, and may involve challenging longheld beliefs and assumptions. If you are not sensitive to your organization's values and culture, and fail to tailor your strategy accordingly, you are likely to be disappointed when others fail to share your enthusiasm. Change will always meet some resistance because it involves effort, and there will always be rival priorities and competition for resources.
Long-term care (LTC) patients are often sent to emergency departments (EDs) by ambulance. In this novel extended care paramedic (ECP) program, specially trained paramedics manage LTC patients on site. The objective of this pilot study was to describe the dispatch and disposition of LTC patients treated by ECPs and emergency paramedics.
Data were collected from consecutive calls to 15 participating LTC facilities for 3 months. Dispatch determinants, transport rates, and relapse rates were described for LTC patients attended by ECPs or emergency paramedics. ECP involvement in end-of-life care was identified.
Of 238 eligible calls, 140 (59%) were attended by an ECP and 98 (41%) by emergency paramedics. Although the top three determinants were the same in each group, the overall distribution of dispatch determinants and acuity differed. In the ECP cohort, 98 of 140 (70%) were treated and released, 33 of 140 (24%) had “facilitated transfer” arranged by an ECP, and 9 of 140 (6%) were immediately transported to the ED by ambulance. In the emergency paramedic cohort, 77 of 98 (79%) were immediately transported to the ED and 21 of 98 (21%) were not transported. In the ECP group, 6 of 98 (6%) patients not transported triggered a 911 call within 48 hours for a related clinical reason, although none of the patients not transported by emergency paramedics relapsed.
ECP involvement in LTC calls was found to reduce transports to the ED with a low rate of relapse. These pilot data generated hypotheses for future study, including determination of appropriate populations for ECP care and analysis of appropriate and safe nontransport.
Background and purpose: Research is increasingly important in radiation therapy, but radiation therapists (or therapy radiographers) (RTs) are relatively new to research and may have difficulty defining research topics. Our aim was to identify the group interests and focus research priorities of Australian RTs. Although not measured, an additional aim was to make RTs more aware of the relevance of RT research.
Materials and methods: An Australia-wide Delphi process was used, examining the problems related to patient care, working with colleagues, and radiotherapy in general, that RTs experienced in their daily work. In an initial study, 374 problems were identified. These were translated into 53 research areas which were prioritised in the second stage of the study. Agreement between groups was analysed using a hierarchical cluster procedure and post hoc Scheffe multiple comparisons.
Results: There were three groups of responders with varying degrees of research interest. There was agreed high importance (p > 0.01) for the technical aspects of radiation therapy, such as image guidance, intensity-modulated radiation therapy (IMRT) and patient positioning. There was significant disagreement (p < 0.001 to p = 0.023) between groups on the importance of patient care research.
Conclusions: The strong interest in technical research is consistent with the rapid influx of technology, particularly in imaging. The disagreement on patient-related research may be of concern. The list of potential research areas specific to radiation therapy will be useful for new RT researchers to consider.
Aim: To describe the recruitment, ophthalmic examination methods and distribution of ocular biometry of participants in the Norfolk Island Eye Study, who were individuals descended from the English Bounty mutineers and their Polynesian wives. Methods: All 1,275 permanent residents of Norfolk Island aged over 15 years were invited to participate, including 602 individuals involved in a 2001 cardiovascular disease study. Participants completed a detailed questionnaire and underwent a comprehensive eye assessment including stereo disc and retinal photography, ocular coherence topography and conjunctival autofluorescence assessment. Additionally, blood or saliva was taken for DNA testing. Results: 781 participants aged over 15 years were seen (54% female), comprising 61% of the permanent Island population. 343 people (43.9%) could trace their family history to the Pitcairn Islanders (Norfolk Island Pitcairn Pedigree). Mean anterior chamber depth was 3.32mm, mean axial length (AL) was 23.5mm, and mean central corneal thickness was 546 microns. There were no statistically significant differences in these characteristics between persons with and without Pitcairn Island ancestry. Mean intra-ocular pressure was lower in people with Pitcairn Island ancestry: 15.89mmHg compared to those without Pitcairn Island ancestry 16.49mmHg (P = .007). The mean keratometry value was lower in people with Pitcairn Island ancestry (43.22 vs. 43.52, P = .007). The corneas were flatter in people of Pitcairn ancestry but there was no corresponding difference in AL or refraction. Conclusion: Our study population is highly representative of the permanent population of Norfolk Island. Ocular biometry was similar to that of other white populations. Heritability estimates, linkage analysis and genome-wide studies will further elucidate the genetic determinants of chronic ocular diseases in this genetic isolate.
The seventh annual Teaching and Learning Conference (TLC) was held in Philadelphia, Pennsylvania, from February 5 to 7, 2010, with 224 attendees onsite. The theme for the meeting was “Advancing Excellence in Teaching Political Science.” Using the working-group model, the TLC track format encourages in-depth discussion and debate on research dealing with the scholarship of teaching and learning.
In this article we present the protocol of the Birmingham Registry for Twin Heritability Studies (BiRTHS), which aims to establish a long-term prospective twin registry with twins identified from the antenatal period and subjected to detailed follow-up. We plan to investigate the concordance in anthropo-metrics and early childhood phenotypes between 66 monozygotic and 154 dizygotic twin pairs in the first 2 years of recruitment. In this project we plan to determine the relative contributions of heritability and environment to fetal growth, birth size, growth in infancy and development up to 2 years of age in an ethnically mixed population. Twins will be assessed with the Griffitth's Mental Development Scales, which will enable us to obtain detailed information on development. As maternal depression may have an effect on the twins' neurodevelopment, the Edinburgh Postnatal Depression Scale will be used at various stages during pregnancy and after delivery to assess maternal depressive symptoms. The increasing prevalence of obesity in both adults and children has raised concerns about the effect of maternal obesity in pregnancy on fetal growth. The prospective study design gives us the opportunity to obtain data on maternal nutrition (reflected by body mass index) and ante- and postnatal growth and development of twins.
This paper describes the evaluation of three diagnostic wind models by direct comparison with wind field data. The models are the California Meteorological Model (CALMET), the Mass Consistent model (MCSCIPUF) associated with the Second Order Closure Integrated Puff (SCIPUFF) transport/dispersion model, and the Stationary Wind Field and Turbulence (SWIFT) model. The evaluation follows previous works by Chang, Franzese & Hanna, who compared the same three models, and by Bradley & Mazzola who evaluated SWIFT coupled with SCIPUFF. As with SWIFT, MCSCIPUF is incorporated in the Hazard Prediction and Assessment Capability (HPAC), while CALMET is linked with the California Puff model (CALPUFF), another transport and dispersion model. The Dipole Pride 26 (DP26) experiments, performed at the US Department of Energy (DOE) Nevada Test Site, are used as the source of the wind data. They provide a comprehensive set of meteorological data with wide-ranging atmospheric stability conditions over a complex terrain. Model calculations were compared with measured data in two phases. The first phase uses complete sets of data from eight locations (the 8M phase) as model inputs, and thus tests the ability of the models to reproduce input conditions. In the second phase, five of the measured wind sites are withheld from input, and instead used for validation of model calculations (the 3M phase). In the first phase, the errors were found (with some exceptions) to be quite small. In the second phase, mean absolute errors were found to be of the order of 1 ms−1 and 30°, with only small differences among models in terms of performance.
Preemption is a powerful strategy used by special interest groups to undermine strong, local public health standards. Currently, 20 states in the U.S. have preemption ordinances in place related to clean indoor air initiatives. These preemption laws are the direct result of an ongoing and aggressive campaign of tobacco companies to thwart clean indoor air initiatives, which ultimately, according to tobacco industry internal documents, cause significant reductions in their annual revenues. Clean indoor air policies have arisen from a greater understanding of the documented health risks associated with exposure to secondhand smoke and action by local government (city councils, county commissions, and boards of health) to protect the public from these hazards. The efforts of the tobacco industry undermine local authority and seek to shift policy action to the state and federal levels, where the industry has greater political influence.
The United States Defense Threat Reduction Agency (DTRA) DIPOLE EAST 169 experiment took place at White Sands Missile Range (WSMR), New Mexico on 23 September 1999. The objective of the experiment was to validate the DTRA Hazard Prediction and Assessment Capability (HPAC) suite of models in a weakly forced, light wind environment. Specifically, DTRA diagnostic and prognostic models were used to produce wind fields that were passed to DTRA's transport model. The resultant transport calculations were compared with the ground truth data. A release of SF6 was tracked by remote sensors to provide ground truth data. Test day weather conditions were gathered. Data from the WSMR Surface Automated Meteorological Site (SAMS) sites, a mobile profiling system, and from rawinsonde were collected and fed into the models.
A presentation of the general weather conditions that existed on the test day is first reviewed, followed by a discussion of the forecast profiles for the test site as well as a discussion of the weather condition that existed in the calculation domain as evidenced by the surface data. This provides the background conditions for the test such as the cloudy conditions that were experienced and the light winds throughout the domain. Included in this discussion is the presentation of the ground truth data collected by the Fourier Transfer Infrared Spectrometers (FTIRs) used to determine the location of the SF6 cloud centroid. The results of the transport model output based on input from the diagnostic and prognostic models are presented. Finally, the results of the actual SF6 cloud centroid are compared with the modelled results. The differences are discussed and potential causes for the differences considered. However, the overall model performance produced results that show that cloud tracking and calculations were within one grid unit of ground truth. Overall, the models produced reliable results for this limited study on a light wind case.
This book tells the story of a dog that did not bark. Since the 1980s, a number of European scholars have advocated a system of income support that would eliminate the stigma attached to most forms of poverty assistance and would be simple, easy, and cheap to implement. Their idea, which has various forms, is to provide all citizens a guaranteed level of support that would have no strings attached. Organized as the Basic Income European Network (BIEN), these scholars have met regularly to discuss the subject of basic income and have endeavored to make their research useful to policymaking by promoting their group's ideas in their home countries. The problem is that after more than a decade of activity, the group cannot claim any major success. To the contrary, many countries have striven to make unemployment and social assistance more conditional by attaching work requirements or lowering thresholds of eligibility.