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A survey of instruction delivery and reinforcement methods in recent laboratory experiments reveals a wide and inconsistently reported variety of practices and limited research evaluating their effectiveness. Thus, we experimentally compare how methods of delivering and reinforcing experiment instructions impact subjects’ comprehension and retention of payoff-relevant information. We report a one-shot individual decision task in which non-money-maximizing behavior can be unambiguously identified and find that such behavior is prevalent in our baseline treatment which uses plain, but relatively standard experimental instructions. We find combinations of reinforcement methods that can eliminate half of non-money-maximizing behavior, and we find that we can induce a similar reduction via enhancements to the content of instructions. Residual non-money-maximizing behavior suggests that this may be an important source of noise in experimental studies.
This document introduces and explains common implementation concepts and frameworks relevant to healthcare epidemiology and infection prevention and control and can serve as a stand-alone guide or be paired with the “SHEA/IDSA/APIC Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2022 Updates,” which contain technical implementation guidance for specific healthcare-associated infections. This Compendium article focuses on broad behavioral and socio-adaptive concepts and suggests ways that infection prevention and control teams, healthcare epidemiologists, infection preventionists, and specialty groups may utilize them to deliver high-quality care. Implementation concepts, frameworks, and models can help bridge the “knowing-doing” gap, a term used to describe why practices in healthcare may diverge from those recommended according to evidence. It aims to guide the reader to think about implementation and to find resources suited for a specific setting and circumstances by describing strategies for implementation, including determinants and measurement, as well as the conceptual models and frameworks: 4Es, Behavior Change Wheel, CUSP, European and Mixed Methods, Getting to Outcomes, Model for Improvement, RE-AIM, REP, and Theoretical Domains.
The combination of advances in knowledge, technology, changes in consumer preference and low cost of manufacturing is accelerating the next technology revolution in crop, livestock and fish production systems. This will have major implications for how, where and by whom food will be produced in the future. This next technology revolution could benefit the producer through substantial improvements in resource use and profitability, but also the environment through reduced externalities. The consumer will ultimately benefit through more nutritious, safe and affordable food diversity, which in turn will also contribute to the acceleration of the next technology. It will create new opportunities in achieving progress towards many of the Sustainable Development Goals, but it will require early recognition of trends and impact, public research and policy guidance to avoid negative trade-offs. Unfortunately, the quantitative predictability of future impacts will remain low and uncertain, while new chocks with unexpected consequences will continue to interrupt current and future outcomes. However, there is a continuing need for improving the predictability of shocks to future food systems especially for ex-ante assessment for policy and planning.
The impact of Idiopathic Parkinson Disease (IPD) in patient’s sexual health is still a matter of debate. Clinicians should have a concern about the sexual function of their patients with IPD.
Aims
To evaluate sexual health of patients with IPD.
Methods
We randomly select a group of IPD patients and a group of healthy controls. We used the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) to assess sexual function. To evaluate depression and anxiety we used Brief Symptom Inventory (BSI) and Beck Depression Index (BDI).
Results
We had 83 IPD patients, and 69 controls. Male patients had lower total IIEF scores than controls (p< 0,001). The analysis of linear regression shows a relationship between the IIFE and the duration of the disease, the patient age and the BDI score (R=0,72; Adjusted R square=0,49, p< 0,001) when adjusted to the variables: realization of deep brain cirurgy of subthalamic nucleus (DBS-STN) stage of the disease, BSI score, dopaminergic treatment, treatment with antidepressives and antipsychotics. The IFSF didn’t show differences between the cases and the controls. Patients had higher BSI and BDI scores than controls (p< 0,001).
Conclusions
Male IPD patients had an impairment of sexual function predicted by disease duration, patient age and BDI scores. Sexual function should be assessed in these patients
The changes in sexual health of patients with Parkinson's disease must be a concern to the clinicians. The effects in sexual health of patients submitted to functional cirurgy is still a matter of debate.
Objectives:
To describe and evaluate the sexual health of patients with Parkinson's disease following deep brain stimulation (DBS) of the subthalamic nucleus (STN).
Methods:
Patients with Parkinson's disease bilaterally implanted for DBS of STN and those only pharmacologically treated, will be evaluated. Sexual functioning will be assessed using the international erectile function indices (IEFI) and the female sexual function indices (FSFI). Depression and anxiety will be evaluated using the Beck depression inventory and the brief symptom indices. Relations between sexual functioning and modifications in the severity of disease (Hoehn and Yahr stage), reduction in levodopa equivalent daily dosage (LEDD), age, and duration of disease will be analyzed.
Results and conlusions:
We expect to find positive changes in the sexual health of these patients, given the fact of the procedure improve the overall burden of the disease by reduction of medication and motor symptoms.
Sonographic measurement of optic nerve sheath diameter (ONSD) is becoming increasingly accepted as a diagnostic modality to detect elevations in intracranial pressure. As this technique becomes more widespread, methods to address the inherent operator-dependent nature of this modality will need to be developed. We propose a novel low-cost model to accurately simulate sonographic ONSD measurement for purposes of training and assessment.
Methods:
We designed models composed of medical tubing of various diameters readily available from typical hospital supplies and suspended them in gelatin. The models were evaluated by ultrasound by three expert point-of-care sonographers using a standard linear array probe and technique proposed in the literature.
Results:
This model generates faithful simulation of the ONS that closely approximates in vivo images and can be used to produce accurate, reproducible measurements. Materials are low cost and easy to acquire and assemble.
Conclusions:
Our model provides realistic simulated images of the ONS. Through comparison of sonographic measurements to the known tube diameters, this model serves as a promising inexpensive tool to teach the method of ultrasound assessment of ONSD or as a way to determine accuracy of this novel ultrasound technology.
The primary objective of this study was to examine the impact of an electronic medical record (EMR)–driven intensive care unit (ICU) antimicrobial stewardship (AMS) service on clinician compliance with face-to-face AMS recommendations. AMS recommendations were defined by an internally developed “5 Moments of Antimicrobial Prescribing” metric: (1) escalation, (2) de-escalation, (3) discontinuation, (4) switch, and (5) optimization. The secondary objectives included measuring the impact of this service on (1) antibiotic appropriateness, and (2) use of high-priority target antimicrobials.
Methods:
A prospective review was undertaken of the implementation and compliance with a new ICU-AMS service that utilized EMR data coupled with face-to-face recommendations. Additional patient data were collected when an AMS recommendation was made. The impact of the ICU-AMS round on antimicrobial appropriateness was evaluated using point-prevalence survey data.
Results:
For the 202 patients, 412 recommendations were made in accordance with the “5 Moments” metric. The most common recommendation made by the ICU-AMS team was moment 3 (discontinuation), which comprised 173 of 412 recommendations (42.0%), with an acceptance rate of 83.8% (145 of 173). Data collected for point-prevalence surveys showed an increase in prescribing appropriateness from 21 of 45 (46.7%) preintervention (October 2016) to 30 of 39 (76.9%) during the study period (September 2017).
Conclusions:
The integration of EMR with an ICU-AMS program allowed us to implement a new AMS service, which was associated with high clinician compliance with recommendations and improved antibiotic appropriateness. Our “5 Moments of Antimicrobial Prescribing” metric provides a framework for measuring AMS recommendation compliance.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
We describe the investigation of two temporally coincident illness clusters involving salmonella and Staphylococcus aureus in two states. Cases were defined as gastrointestinal illness following two meal events. Investigators interviewed ill persons. Stool, food and environmental samples underwent pathogen testing. Alabama: Eighty cases were identified. Median time from meal to illness was 5·8 h. Salmonella Heidelberg was identified from 27 of 28 stool specimens tested, and coagulase-positive S. aureus was isolated from three of 16 ill persons. Environmental investigation indicated that food handling deficiencies occurred. Colorado: Seven cases were identified. Median time from meal to illness was 4·5 h. Five persons were hospitalised, four of whom were admitted to the intensive care unit. Salmonella Heidelberg was identified in six of seven stool specimens and coagulase-positive S. aureus in three of six tested. No single food item was implicated in either outbreak. These two outbreaks were linked to infection with Salmonella Heidelberg, but additional factors, such as dual aetiology that included S. aureus or the dose of salmonella ingested may have contributed to the short incubation periods and high illness severity. The outbreaks underscore the importance of measures to prevent foodborne illness through appropriate washing, handling, preparation and storage of food.
Medieval English Theatre is the premier journal in early theatre studies. Its name belies its wide range of interest: it publishes articles on theatre and pageantry from across the British Isles up to the opening of the London playhouses and the suppression of the civic mystery cycles, and also includes contributions on European and Latin drama, together with analyses of modern survivals or equivalents, and of research productions of medieval plays. This volume includes essays on spectatorship, audience reception and records of early drama, especially in Scotland, besides engaging with the current interest in the Towneley Plays and the history of its manuscript.Editors: Sarah Carpenter, Pamela M. King, Meg Twycross, Greg Walker.
Woven composite specimens with embedded fibre Bragg grating (FBG) sensor networks were impacted at low velocities, while global measurements of contact forces and dissipated energies were obtained from drop tower measurements, and local residual, post-impact strain values were obtained from the FBG sensors. Critical damage events were identified in the global data for these specimens and damage signatures in the residual strain data corresponding to these critical damage events were correlated. The results indicate that the full spectral scan information from the sensor network, although obtainable at a lower scan rate, provide more reliable residual lifetime information than average residual strains.
Medieval English Theatre Meeting 2015 Change of publication details
The 2015 METh meeting was held at the University of Southampton, hosted by John McGavin. His carefully timetabled proceedings were interrupted by the unscheduled (by him) presentation of a Festschrift in his honour. He holds the unique composite volume, but the articles it contains will be divided between this volume of METh (Part One), and Volume 38 (Part Two).
The rest of the day lived up to its festive beginning. A range of papers on the topic of ‘Paradigms Lost’ highlighted those once entrenched scholarly positions about which we have changed our minds. Pamela M. King, in ‘Medieval Drama Criticism before METh’, introduced the late nineteenth-century work of Adolphus William Ward; Garrett Epp, on ‘Things we can no longer say about the Towneley Plays’, gave an impressive PowerPoint show of deletions of accepted ‘facts’; while Meg Twycross summarised new evidence on the provenance of the manuscript (see this volume). Other speakers introduced new material which extends or changes our approach to well-worn topics: Lindsey Cox showed us the visual evidence for the portrait miniature in Wit and Science, and how the different parts of the audience might have perceived it, and Jason Burg sketched the changing patterns of performance in Lincoln Cathedral between 1309 and 1642. Nadia van Pelt reminded us of the necessity of looking at original manuscript sources rather than their calendared summaries by discussing the enigmatic detail of a letter from Chapuys which reports Henry VIII's visit to a St John's Day pageant showing him ‘cutting off the heads of the clergy’; while Greg Walker rounded off the day with a masterly summation of recent critical approaches to spectatorship, and where they fell short.
Elisabeth Dutton gave us our own spectatorly experience. Before lunch, James McBain and Stephanie Allen of the EDOX (Early Drama at Oxford University) project spoke about ‘Rehabilitating Academic Drama’, and just after lunch this was put to the test by an enthusiastic reading of the play of Narcissus originally mounted by the undergraduates of St John's College, Oxford, as a Christmas entertainment in 1602.
Volumes 37 and 38 of Medieval English Theatre offer a collection of essays to honour John McGavin. Written by his friends and colleagues, students and admirers, these all testify to the deep affection as well as the academic esteem in which John himself and his work across the discipline of early theatre are held. Many reflect his own particular interests in the early drama of England and, especially, of Scotland: its records and narratives, its spectators, its intellectual and affective strategies, and its cultural work. There are papers on many aspects of Scottish theatrical culture, from ceremonial (Williamson) to Sir David Lyndsay (Hadley Williams, Happé, and Walker); from foolery (Carpenter) to Dunbar's dramatic voice (Jack). John's abiding interest in spectatorship and audience reception is approached from different angles, in morality drama (Steenbrugge), dialogue (Bose), in the York Play (King), academic drama (Dutton), and theory (van Pelt). His authoritative work in the creative interpretation of records and narratives, of both dramatic and para-dramatic performance, is reflected in essays on coronation ceremony (Hunt), libel (Egan), and monastic crucifixion games (Klausner). His steering role in the project on Early Modern London Theatres is commemorated in the online Bear Hunt (MacLean and Hagen). Three essays engage with one of the central current concerns of early theatre study, the Towneley manuscript and its plays (Epp, Johnston, and Twycross), while two more address uniquely revealing single plays: the Digby Mary Magdalen (Godfrey), and the Welsh Troelus a Chresyd (Niebrzydowski).
John's work has indeed come to epitomise ‘the best pairt of our play’. The number of essays contributed to the collection, by scholars young and old across the whole field of early drama studies, shows the range of his influence on the discipline itself and on generations of those working within it. This collection is offered as a tribute both to his creative scholarship and his collegiality. There is no space here for all the many friends and colleagues who would like to salute him on this occasion; but we hope that the recollections of three voices, offering memories and appreciation from John's student days to the present, may speak for us all.
The high cost of single-crystal III–V substrates limits the use of gallium arsenide (GaAs) and related sphalerite III–V materials in many applications, especially photovoltaics. However, by making devices from epitaxially grown III–V layers that are separated from a growth substrate, one can recycle the growth substrate to reduce costs. Here, we show damage-free removal of an epitaxial single-crystal GaAs film from its GaAs growth substrate using a laser that is absorbed by a smaller band gap, pseudomorphic indium gallium arsenide nitride layer grown between the substrate and the GaAs film. The liftoff process transfers the GaAs film to a flexible polymer substrate, and the transferred GaAs layer is indistinguishable in structural quality from its growth substrate.