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In a prospective cohort study, we compared a 2-swabs-per-nostril 5% iodophor regimen with a 1-swab-per-nostril 10% iodophor regimen on methicillin-resistant Staphylococcus aureus carriage in nursing-home residents. Compared with baseline, both single-swab and double-swab regimens resulted in an identical 40% reduction in nasal carriage and 60% reduction in any carriage, skin or nasal.
Past findings on the connection between class position and political preferences are overwhelmingly derived from cross-sectional studies, which provided a limited basis for inferring causality. This study uses long-term panel data on thousands of British respondents to measure the impact of intra-generational class mobility across a range of political identities and preferences. Upward class mobility leads to small increases in economic conservatism, but party choice, class identity and attitudes to non-economic issues do not change. This updating of economic values is much smaller than cross-sectional differences between classes. These results are consistent with the short-run effects of class mobility operating primarily through a limited economic self-interest mechanism. Beliefs that are plausibly unconnected to economics are unaffected. The overall association between class and a range of identities, opinions and preferences is therefore more likely to be caused by early life experiences and longer-term socialization than by the immediate material interests associated with jobs.
The authors report on 7Li, 19F, and 1H pulsed field gradient NMR measurements of 26 organosilyl nitrile solvent-based electrolytes of either lithium bis(trifluorosulfonyl)imide (LiTFSI) or lithium hexafluorophosphate. Lithium transport numbers (as high as 0.50) were measured and are highest in the LiTFSI electrolytes. The authors also report on solvent blend electrolytes of fluoroorganosilyl (FOS) nitrile solvent mixed with ethylene carbonate (EC) and diethyl carbonate. Solvent diffusion measurements on an electrolyte with 6% FOS suggest both the FOS and EC solvate the lithium cation. By comparing lithium transport and transference numbers, the authors find less ion pairing in FOS nitrile carbonate blend electrolytes and difluoroorganosilyl nitrile electrolytes.
Courtney Ruge, graduate of Monash University, Australia, holding a Master of Business Information Systems with a specialization in Information Management.,
Tom Denison, PhD is a Lecturer and Research Associate with the Centre for Organizational and Social Informatics (COSI) in the Faculty of Information Technology at Monash University, Australia.,
Steve Wright, PhD works in the Faculty of Information Technology, Monash University, Australia.,
Graham Willett, PhD is President of the Australian Lesbian and Gay Archives.,
Joanne Evans, PhD works in the Faculty of Information Technology, Monash University, Australia.
THE TWO RESEARCH projects reported on in this chapter explored issues of resourcing and sustaining the practice of sharing materials online, and had the goal of producing findings that can prove useful to community heritage organizations as well as those who seek to work with them. The purpose of the projects was to look not so much at the management of those collections but, rather, how they were to be accessed and how they could be used to engage their audiences. In the event, this resulted in a strong focus on social media. Social media use has been widely implemented by institutions within the GLAM (galleries, libraries, archives, and museums) sector over the past decade, and is valued as a vehicle for engaging audiences and contributing to an online presence or institutional brand. It is used by cultural institutions for a variety of purposes, particularly the promotion and marketing of services, events and collections. Social media also provides a platform through which cultural institutions can provide online access to their visual-based digital assets, such as digital reproductions of collections of photographs, illustrations, works of arts, objects, posters, ephemera and more.
It is evident, however, that approaches to the management of social media and the provision of online access to digital collections vary considerably across GLAM institutions. Although such institutions have many similarities, there are distinctions amongst them in terms of their organizational goals, audiences and access to resources. The benefits for GLAM institutions of providing online access to digital collections include raising their public profile, relevance and reach; yet, achieving the desired impact demands considerable commitments in terms of resources such as expertise, time and funding. Such resources tend to be constrained within the GLAM sector, supplemented only sporadically by small grants and fundraising. This is particularly the case for smaller heritage organizations such as local historical societies and community archives, within which there is a strong reliance on voluntary labour, and which are faced with ongoing concerns over their organizational sustainability. For example, they are often stretched to seek and maintain the necessary resources for collection development and the management of their holdings while simultaneously building their engagement with the broader community they aim to serve. In such circumstances, the provision of online access to digitized holdings may represent a key means of developing community engagement and relevance.
Patients who experience Transient Ischaemic Attack (TIA) should be assessed and treated in a specialist clinic to reduce risk of further TIA or stroke. But referrals are often delayed. We aimed to identify published studies describing pathways for emergency assessment and referral of patients with suspected TIA at first medical contact: primary care; ambulance services; and emergency department.
We conducted a scoping literature review. We searched four databases (PubMed, CINAHL, Web of Science, Scopus). We screened studies for eligibility. We extracted and analysed data to describe setting, assessment and referral processes reported in primary research on referral of suspected TIA patients directly to specialist outpatient services.
We identified eight studies in nine papers from five countries: 1/9 randomized trial; 6/9 before-and-after designs; 2/9 descriptive account. Five pathways were used by family doctors and three by Emergency Department (ED) physicians. None were used by paramedics. Clinicians identified TIA patients using a checklist incorporating the ABCD2 tool to describe risk of further stroke, online decision support tool or clinical judgement. They referred to a specialist clinic, either directly or via a telephone helpline. Anti-platelet medication was often given, usually aspirin unless contraindicated. Some patients underwent neurological and blood tests before referral and discharge. Five studies reported reduced incident of stroke at 90 days, from 6–10 percent predicted rate to 1.2-2.1 percent actual rate. Between 44 percent and 83 percent of suspected TIA cases in these studies were directly referred to stroke clinics through the pathways.
Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalization of TIA patients. No pathways for paramedic use were reported. Since many suspected TIA patients present to ambulance services, effective pre-hospital assessment and referral pathways are needed. We will use review results to develop a paramedic referral pathway to test in a feasibility trial.
Transient Ischaemic Attack (TIA) is a neurologic event with symptom resolution within 24 hours. Early specialist assessment of TIA reduces risk of stroke and death. National United Kingdom (UK) guidelines recommend patients with TIA are seen in specialist clinics within 24 hours (high risk) or seven days (low risk).
We aimed to develop a complex intervention for patients with low risk TIA presenting to the emergency ambulance service. The intervention is being tested in the TIER feasibility trial, in line with Medical Research Council (MRC) guidance on staged development and evaluation of complex interventions.
We conducted three interrelated activities to produce the TIER intervention:
• Survey of UK Ambulance Services (n = 13) to gather information about TIA pathways already in use
• Scoping review of literature describing prehospital care of patients with TIA
• Synthesis of data and definition of intervention by specialist panel of: paramedics; Emergency Department (ED) and stroke consultants; service users; ambulance service managers.
The panel used results to define the TIER intervention, to include:
1. Protocol for paramedics to assess patients presenting with TIA and identify and refer low risk patients for prompt (< 7day) specialist review at TIA clinic
2. Patient Group Directive and information pack to allow paramedic administration of aspirin to patients left at home with referral to TIA clinic
3. Referral process via ambulance control room
4. Training package for paramedics
5. Agreement with TIA clinic service provider including rapid review of referred patients
We followed MRC guidance to develop a clinical intervention for assessment and referral of low risk TIA patients attended by emergency ambulance paramedic. We are testing feasibility of implementing and evaluating this intervention in the TIER feasibility trial which may lead to fully powered multicentre randomized controlled trial (RCT) if predefined progression criteria are met.
More information about the pattern of behavioural and psychological symptoms of dementia (BPSD) in the course of dementia is needed to inform patients and clinicians and to design future interventions.
To determine the persistence and incidence of BPSD and their relation to cognitive function, in individuals with dementia or in cohorts investigated for dementia onset.
A systematic literature review analysed the baseline prevalence, persistence and incidence of 11 symptoms. The review was conducted according to established guidelines with the exception that we could not exclude the possibilities of bias in the studies examined.
The 59 included studies showed considerable heterogeneity in their objectives and methods. The symptoms hyperactivity and apathy showed high persistence and incidence; depression and anxiety low or moderate persistence and moderate incidence; and psychotic symptoms low persistence with moderate or low incidence.
Despite heterogeneity across studies in terms of setting, focus and length of follow-up, there were clinically relevant differences in the longitudinal courses of different BPSD. Apathy was the only symptom with high baseline prevalence, persistence and incidence during the course of dementia.
Nursing home residents are at risk for acquiring and transmitting MDROs. A serial point-prevalence study of 605 residents in 3 facilities using random sampling found MDRO colonization in 45% of residents: methicillin-resistant Staphylococcus aureus (MRSA, 26%); extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL, 17%); vancomycin-resistant Enterococcus spp. (VRE, 16%); carbapenem-resistant Enterobacteriaceae (CRE, 1%). MDRO colonization was associated with history of MDRO, care needs, incontinence, and catheters.
Standard estimates of the impact of Clostridium difficile infections (CDI) on inpatient lengths of stay (LOS) may overstate inpatient care costs attributable to CDI. In this study, we used multistate modeling (MSM) of CDI timing to reduce bias in estimates of excess LOS.
A retrospective cohort study of all hospitalizations at any of 120 acute care facilities within the US Department of Veterans Affairs (VA) between 2005 and 2012 was conducted. We estimated the excess LOS attributable to CDI using an MSM to address time-dependent bias. Bootstrapping was used to generate 95% confidence intervals (CI). These estimates were compared to unadjusted differences in mean LOS for hospitalizations with and without CDI.
During the study period, there were 3.96 million hospitalizations and 43,540 CDIs. A comparison of unadjusted means suggested an excess LOS of 14.0 days (19.4 vs 5.4 days). In contrast, the MSM estimated an attributable LOS of only 2.27 days (95% CI, 2.14–2.40). The excess LOS for mild-to-moderate CDI was 0.75 days (95% CI, 0.59–0.89), and for severe CDI, it was 4.11 days (95% CI, 3.90–4.32). Substantial variation across the Veteran Integrated Services Networks (VISN) was observed.
CDI significantly contributes to LOS, but the magnitude of its estimated impact is smaller when methods are used that account for the time-varying nature of infection. The greatest impact on LOS occurred among patients with severe CDI. Significant geographic variability was observed. MSM is a useful tool for obtaining more accurate estimates of the inpatient care costs of CDI.
Infect. Control Hosp. Epidemiol. 2015;36(9):1024–1030
To determine values for reliable change and clinically significant change for the Leeds Dependence Questionnaire (LDQ) and Social Satisfaction Questionnaire (SSQ). The performance of these two measures with the Clinical Outcomes in Routine Evaluation (CORE-10) as three dimension measures of addiction was then explored.
The reliable change statistic for both LDQ and SSQ was ≥4; the cut-offs for clinically significant change were LDQ 410 males, ≤5 females, and SSQ ≥16. There was no overlap of 95% CIs for means by gender between ‘well-functioning’ and pre- and post-treatment populations.
These data enable the measurement of clinically significant change using the LDQ and SSQ and add to the evidence for the performance of the LDQ, CORE-10 and SSQ as dimension measures of addiction. The CORE-10 and SSQ can be used as treatment outcome measures for mental health problems other than addiction.
Research efforts have combined land-use and land-cover change (LUCC) and carbon (C) dynamics to estimate the flux and storage of C under different land-use and land-management regimes (e.g., see Chapters 10 and 11). Ultimately, this research arena seeks to understand the C sequestration implications of different land-use change processes or futures. However, despite the need for simulation tools to produce robust predictions of C dynamics under different land-use and land-cover scenarios, there are relatively few models that integrate LUCC and C cycle dynamics. To be clear, many publications document the C balance of specific land-cover scenarios; however, there is an important distinction between modeling land-use change endogenously (such that it changes dynamically as a result of the modeled processes) and incorporating an exogenous land-cover scenario (with a prespecified set of land-cover data) in a C model.
The integration of land-use and C-cycle modeling is necessary for several reasons, most notably for the development and implementation of climate change policy (see Chapter 8). National and international science communities have emphasized the need for integrating land-use and C dynamics (e.g., the International Geosphere-Biosphere Programme [IGBP], Global Land Project [GLP], International Human Dimensions Programme on Global Environmental Change [IHDP]; see Chapter 1); however, the C and LUCC modeling communities often operate as somewhat disparate fields of research. Development of international climate negotiations and treaties, such as the Kyoto Protocol and the United Nations Framework Convention on Climate Change Good Practice Guidance for Land Use, Land-Use Change, and Forestry (UNFCCC GPG-LULUCF), relies on current estimates of C pools and fluxes, as well as our expectations for how land-use change will influence C dynamics in the future.
Galactic post-AGB stars show a large diversity in chemical compositions as well as in the kinematical and geometrical properties of their circumstellar material. The theoretical interpretation is hampered by the lack of good distances to almost all Galactic objects. We therefore initiated a large project to study systematically post-AGB stars in the Large and Small Magellanic Cloud (LMC, SMC respectively). Here we report on our preliminary results.
Background: Suicide rates are higher in the over 65s than in younger adults and there is a strong link between deliberate self harm (DSH) and suicide in older people. The association between personality disorder (PD) and DSH in older adults remains uncertain. Our objective was to describe this association.
Methods: A case control study was conducted in which participants were: (i) those who had undertaken an act of DSH and (ii) a hospital-based control group drawn from a geographical contiguous population. PD was assessed using the Standardised Assessment of Personality (SAP)
Results: Seventy-seven cases of DSH were identified; 61 (79.2%) of these participants were interviewed. There were 171 potential controls identified of whom 140 (81.9%) were included. An SAP was completed in 45/61 (73.8%) of cases and 100/140 (71.4%) of controls. The mean age was 79.8 years (SD = 9, range 65–103). The crude odds ratio for the association between PD and DSH was 5.91 [(95% CI 2.3, 14.9) p<0.0001]. There was a strong interaction with age stratified at 80 years. There was no association between PD and DSH after age 80. The adjusted odds ratio for PD in the group <80 years was 20.5 [(95% CI 3, 141) p = 0.002]. Borderline and impulsive PD traits tended to be associated with an episode of DSH more than other personality types.
Conclusions: PD appears to be a strong and independent risk for an act of DSH in people aged between 65 and 80 years and should be looked for as part of any risk assessment in this population. Access to specialist services may be required to optimally manage this problem and reduce the subsequent risk of suicide.
The Bengal Florican is a ‘Critically Endangered’ bustard (Otididae) restricted to India, Nepal and southern Indochina. Fewer than 500 birds are estimated to remain in the Indian subcontinent, whilst the Indochinese breeding population is primarily restricted to grasslands surrounding the Tonle Sap lake, Cambodia. We conducted the first comprehensive breeding season survey of Bengal Florican within the Tonle Sap region (19,500 km2). During 2005/06 and 2006/07 we systematically sampled 1-km squares for territorial males. Bengal Florican were detected within 90 1-km squares at a mean density of 0.34 males km−2 which, accounting for unequal survey effort across grassland blocks, provides a mean estimate of 0.2 males km−2. Based on 2005 habitat extent, the estimated Tonle Sap population is 416 adult males (333–502 ± 95% CI), more than half of them in Kompong Thom province. Tonle Sap grasslands are rapidly being lost due to intensification of rice cultivation and, based on satellite images, we document declines of 28% grassland cover within 10 grassland blocks between January 2005 and March 2007. Based on mean 2005 population densities the remaining grassland may support as few as 294 adult male florican, a decline of 30% since 2005. In response to these habitat declines almost 350 km2 of grassland have been designated as protected areas, set aside for biodiversity and local livelihoods. Conservation activities in these areas include participatory land-use zoning, patrols reporting new developments to government officials, awareness-raising and incentive-led nest protection schemes.
The detected variety in chemistry and circumstellar shell morphology of the limited sample of Galactic post-AGB stars is so large, that there is no consensus yet on how individual objects are linked by evolutionary channels. The evaluation is complicated by the fact that the distances and hence luminosities of these objects are poorly known. In this contribution we report on our project to overcome this problem by focusing on a significant sample of post-AGB stars with known distances: those in the LMC. Via cross-correlation of the infrared SAGE-SPITZER catalogue with optical catalogues we selected a sample of 322 LMC post-AGB candidates based on their position in the various colour-colour diagrams. We determined the fundamental properties of 82 of them, using low resolution optical spectra that we obtained at Siding Spring and SAAO. We selected a subsample to be studied at high spectral resolution in order to obtain accurate abundances of a wide range of species. This will allow us to connect the theoretical predictions with the obtained surface chemistry at a given luminosity and metallicity. By this, we want to constrain important structure parameters of the evolutionary models. Preliminary results of the selection process are presented.
Magnetic thin films of Co80Cr16Ta4 were sputtered onto identical CrMo seed-layers at −200 V bias and 3 different substrate temperatures (150, 200, and 250°C). Energy-filtered transmission electron microscopy (EFTEM) was performed to analyze Cr levels at the grain boundaries as well as inside the grains. These quantitative Cr measurements were used to estimate the local values of magnetocrystalline anisotropy (Ku) and, together with grain size distributions, calculate the product of Ku and the grain volume (KuV), a quantity which is a measure of thermal stability. The results show that the coercivity as well as the percentage of stable grains increased with increasing substrate temperature. The increase in the number of stable grains is produced by the enhancement in the Ku value from Cr depletion of the grain interiors and the magnetic decoupling between the grains from Cr grain boundary segregation.
This report, like its predecessors, focuses on areas which have been especially active since the last General Assembly. Two major developments have been the unification of the T-dwarf standards and the new general catalogue of stellar spectral classifications.
Abstract. A vote-maximizing incumbent government is expected
to adjust discretionary spending and taxation in ways that increase its
probability for re-election. Unequal voters per electoral district in
Canada distort this calculation in favour of small electoral districts.
Using two measures of federal expenditures, and one of income taxes,
between the years 1961–2000, empirical estimates indicate that
greater representation per capita (lower relative electoral district
populations) results in higher federal spending, and lower income taxes,
per capita, even after controlling for income and unemployment.
Résumé. Un gouvernement en place tentant de
maximiser les votes en sa faveur est censé ajuster les
dépenses discrétionnaires et les impôts de
manière à augmenter la probabilité de sa
réélection. L'inégalité du nombre
d'électeurs des districts électoraux au Canada
crée une distorsion en faveur des districts de petite taille. En
utilisant deux mesures des dépenses fédérales et une
mesure des impôts sur le revenu entre 1961 et 2000, nos
résultats empiriques montrent qu'une plus forte
représentation par habitant (plus petits districts
électoraux) entraîne des dépenses
fédérales plus importantes et des impôts sur le revenu
moins élevés par personne, même en contrôlant
pour le revenu et le taux de chômage.