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Powered equipment for patient handling was designed to alleviate Emergency Medical Service (EMS) clinician injuries while lifting patients. This project evaluated the organizational rationale for purchasing powered equipment and the outcomes from equipment use.
Methods:
This project analyzed secondary data obtained via an insurance Safety Intervention Grant (SIG) program in Ohio USA. These data were primarily in reports from EMS organizations. Investigators applied a mixed-methods approach, analyzing quantitative data from 297 grants and qualitative data from a sample of 64 grants. Analysts abstracted data related to: work-related injuries or risk of musculoskeletal-disorders (MSD), employee feedback regarding acceptance or rejection, and impact on quality, productivity, staffing, and cost.
Results:
A total of $16.67 million (2018 adjusted USD) was spent from 2005 through 2018 for powered cots, powered loading systems, powered stair chairs, and non-patient handling equipment (eg, chest compression system, powered roller). Organizations purchased equipment to accommodate staff demographics (height, age, sex) and patient characteristics (weight, impairments). Grantees were fire departments (n = 254) and public (n = 19) and private (n = 24) EMS organizations consisting of career (45%), volunteer (20%), and a combination of career and volunteer (35%) staff. Powered equipment reduced reported musculoskeletal injuries, and organizations reported it improved EMS clinicians’ safety. Organization feedback was mostly positive, and no organization indicated outright rejection of the purchased equipment. Analyst-identified design advantages for powered cots included increased patient weight capacity and hydraulic features, but the greater weight of the powered cot was a disadvantage. The locking mechanism to hold the cot during transportation was reported as an advantage, but it was a disadvantage for older cots without a compatibility conversion kit. Around one-half of organizations described a positive impact on quality of care and patient safety resulting from the new equipment.
Conclusion:
Overall, organizations reported improved EMS clinicians’ safety but noted that not all safety concerns were addressed by the new equipment.
Sexual unwellness (SU) has been linked to a lack of sexual satisfaction and to an incapacity to maintain sexual relations.
Objectives
The objective of this cross-cultural study is to shed light on older adults’ perspectives on SU across cultures.
Methods
Eighty-three older participants (65 to 98 years of age) took part in this qualitative study. Participants lived in the community and were of two different nationalities (Portuguese and Mexican). Semi-structured interviews were conducted, and content analysis was then carried out.
Results
SU emerged in the findings of the content analysis through six themes: Dissatisfying Sexual Experiences; Feelings of Isolation; Spirituality; Medication; Unattractiveness and Pain. The most common theme among older Portuguese participants was ‘Dissatisfying Sexual Experiences’ (25.5%). ‘Feelings of Isolation’ was most common among older Mexican participants (13.7%).
Conclusions
A diversity of experiences of older adults in relation to SU was highlighted in this study. Moreover, cross-cultural research on the construct of SU is essential for understanding the cultural differences in the conceptualization of the construct and how these themes may influence the quality of sexual life in old age.
Heats of compression of glass bead-water and clay-water mixtures were determined from the peak heights of the thermograms produced when these mixtures were subjected to pressure in a Calvet differential microcalorimeter. It is known that the heat of compression is directly proportional to the peak height. When the latter quantity was plotted against the pressure applied to any mixture, two intersecting straight lines were obtained. The change in slope at the point of intersection was interpreted as being the result of a pressure-induced higher-order phase transition in the water.
The differential peak height, ε, was defined as the rate of change of peak height with pressure/g of water present in the mixture. Hence, it is directly proportional to the rate of change of the heat of compression with pressure/g of water. Values of ε were determined for both glass bead-water and clay-water mixtures containing different proportions of solids. It was found that ε remained nearly constant with increasing proportions of glass beads, whereas, it varied in a non-uniform way with increasing proportions of clay. Also, its values in the clay-water mixtures were relatively high. Calculations showed that the difference in ε values for the two mixtures could not be ascribed to the exchangeable cations associated with the clay particles. Consequently, it was ascribed to the effect of the particle surfaces on the structure of the vicinal water.
The specific surface area, S, of a clay is commonly measured by the adsorption of ethylene glycol monoethyl ether (EGME); however, this method can be tedious and time consuming, especially if the clay is saturated with a monovalent, highly hydrated cation. An alternative method for measuring S was developed involving infrared internal reflectance spectroscopy. This method is based on the discovery that the ratio of R1, the reflectance of a clay-HOD mixture at the frequency of O-D stretching, to R2, the reflectance of the mixture at the frequency of H-O-D bending, is linearly related to S. The correlation coefficient between R1/R2 and S, as measured by the adsorption of EGME, was 0.995. Consequently, a calibration curve of R1/R2 versus S was constructed, and the measured values of R1/R2 for any clay-HOD mixture were referred to it for the determination of S. Results were obtained in triplicate in about an hour; hence, this method of determining S is more rapid and convenient than that involving the adsorption of EGME. Moreover, it applies to clays in a natural condition, i.e., swollen in water.
Three montmorillonites and a nontronite were reduced by sodium dithionite to obtain different amounts of Fe2+ in their octahedral sites. The mass ratio of water to clay, mw/mc was determined as a function of Fe2+ at several values of the swelling pressure, π. The value mwmc decreased markedly with increasing Fe2+ at each value of π for each clay. Moreover, curves of π vs. mwmc for the different clays were displaced downwards as Fe2+ increased. A straight line was obtained when In(π + 1) was plotted against 1/(mw/mc) however, at some oxidation states of three of the samples this line exhibited a sharp break at a specific value of 1/(w/mc. The slope of the line decreased for each clay as Fe2+ increased, and an increase in Fe2+ was accompanied by an increase in the cation exchange capacity. These observations are thought to be due to a collapse or partial collapse of the superimposed clay layers resulting from the increase in cation-exchange capacity.
Screen time in infancy is linked to changes in social-emotional development but the pathway underlying this association remains unknown. We aim to provide mechanistic insights into this association using brain network topology and to examine the potential role of parent–child reading in mitigating the effects of screen time.
Methods
We examined the association of screen time on brain network topology using linear regression analysis and tested if the network topology mediated the association between screen time and later socio-emotional competence. Lastly, we tested if parent–child reading time was a moderator of the link between screen time and brain network topology.
Results
Infant screen time was significantly associated with the emotion processing-cognitive control network integration (p = 0.005). This network integration also significantly mediated the association between screen time and both measures of socio-emotional competence (BRIEF-2 Emotion Regulation Index, p = 0.04; SEARS total score, p = 0.04). Parent–child reading time significantly moderated the association between screen time and emotion processing-cognitive control network integration (β = −0.640, p = 0.005).
Conclusion
Our study identified emotion processing-cognitive control network integration as a plausible biological pathway linking screen time in infancy and later socio-emotional competence. We also provided novel evidence for the role of parent–child reading in moderating the association between screen time and topological brain restructuring in early childhood.
Meta-analyses demonstrate that the quality of early attachment is modestly associated with peer social competence (r = .19) and externalizing behavior (r = −.15), but weakly associated with internalizing symptoms (r = −.07) across early development (Groh et al., Child Development Perspectives, 11(1), 70–76, 2017). Nonetheless, these reviews suffer from limitations that undermine confidence in reported estimates, including evidence for publication bias and the lack of comprehensive assessments of outcome measures from longitudinal studies in the literature. Moreover, theoretical claims regarding the specificity of the predictive significance of early attachment variation for socioemotional versus academic outcomes had not been evaluated when the analyses for this report were registered (but see Dagan et al., Child Development, 1–20, 2023; Deneault et al., Developmental Review, 70, 101093, 2023). To address these limitations, we conducted a set of registered analyses to evaluate the predictive validity of infant attachment in two landmark studies of the Strange Situation: the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) and the NICHD Study of Early Child Care and Youth Development (SECCYD). Across-time composite assessments reflecting teacher report, mother report, and self-reports of each outcome measure were created. Bivariate associations between infant attachment security and socioemotional outcomes in the MLSRA were comparable to, or slightly weaker than, those reported in the recent meta-analyses, whereas those in the SECCYD were weaker for these outcomes. Controlling for four demographic covariates, partial correlation coefficients between infant attachment and all socioemotional outcomes were r ≤ .10 to .15 in both samples. Compositing Strange Situations at ages 12 and 18 months did not substantively alter the predictive validity of the measure in the MLSRA, though a composite measure of three different early attachment measures in the SECCYD did increase predictive validity coefficients. Associations between infant attachment security and academic skills were unexpectedly comparable to (SECCYD) or larger than (MLSRA) those observed with respect to socioemotional outcomes.
To compare visual estimation versus ImageJ calculation of tympanic membrane perforation size in the paediatric population between clinicians of different experience.
Methods
Five images of tympanic membrane perforations in children, captured using an otoendoscope, were selected. The gold standard was the ImageJ results by one consultant otologist. Consultants, registrars and Senior House Officers or equivalent were asked to visually estimate and calculate the perforation size using ImageJ software.
Results
The mean difference in variation from gold standard between visual estimation and ImageJ calculation was 12.16 per cent, 95 per cent CI (10.55, 13.78) p < 0.05, with ImageJ providing a more accurate estimation of perforation. Registrars were significantly more accurate at visual estimation than senior house officers. There was no statistically significant difference in ImageJ results between the different grades.
Conclusion
Using ImageJ software is more accurate at estimating tympanic membrane perforation size than visual assessment for all ENT clinicians regardless of experience.
Background: Some sleep-promoting medications are associated with cognitive impairment, making treatment of comorbid obstructive-sleep-apnea (OSA) and insomnia (COMISA) challenging. Lemborexant is a dual-orexin-receptor-antagonist approved for insomnia treatment. This post-hoc analysis evaluated cognition in the subgroup of subjects with mild-OSA (apnea-hypopnea-index ≥5–<15 events/h-of-sleep). Methods: Study E2006-G000-304 was a 1-month, randomized, double-blind, placebo (PBO)- and active-comparator (zolpidem-ER 6.25mg [ZOL])-controlled study of lemborexant 5/10mg (LEM5/LEM10). Subjects ≥55y with insomnia disorder/sleep maintenance problems were enrolled (N=1006). A cognitive-performance assessment battery (CPAB) was performed at morning waketime of Days(D)2/3 and D30/31. Change-from-baseline (CFB) for mean power-of-attention (PoA), continuity-of-attention (CoA), quality-of-memory (QoM), and speed-of-memory-retrieval (SoMR) for CPAB tasks was analyzed. Results: The mild-OSA subgroup comprised 410 (40.8%) subjects. On D2/3 and D30/31, CFB for PoA, CoA, QoM, and SoMR for LEM5/LEM10 were not significantly different than PBO. On D2/3, PoA and QoM were significantly worse with ZOL vs PBO; QoM was significantly better with LEM5/LEM10 vs ZOL. On D30/31, SoMR was significantly worse with ZOL vs PBO and significantly better with LEM5/LEM10 vs ZOL. LEM safety in the subgroup was consistent with the overall study population. Conclusions: Memory and attention domains in subjects with COMISA characterized by mild-OSA were not impacted by LEM, unlike ZOL.
Optimum nutrition plays a major role in the achievement and maintenance of good health. The Nutrition Society of the UK and Ireland and the Sabri Ülker Foundation, a charity based in Türkiye and focused on improving public health, combined forces to highlight this important subject. A hybrid conference was held in Istanbul, with over 4000 delegates from sixty-two countries joining the proceedings live online in addition to those attending in person. The primary purpose was to inspire healthcare professionals and nutrition policy makers to better consider the role of nutrition in their interactions with patients and the public at large to reduce the prevalence of non-communicable diseases such as obesity and type 2 diabetes. The event provided an opportunity to share and learn from different approaches in the UK, Türkiye and Finland, highlighting initiatives to strengthen research in the nutritional sciences and translation of that research into nutrition policy. The presenters provided evidence of the links between nutrition and disease risk and emphasised the importance of minimising risk and implementing early treatment of diet-related disease. Suggestions were made including improving health literacy and strengthening policies to improve the quality of food production and dietary behaviour. A multidisciplinary approach is needed whereby Governments, the food industry, non-governmental groups and consumer groups collaborate to develop evidence-based recommendations and appropriate joined-up policies that do not widen inequalities. This summary of the proceedings will serve as a gateway for those seeking to access additional information on nutrition and health across the globe.
We provide an overview of diagnostic stewardship with key concepts that include the diagnostic pathway and the multiple points where interventions can be implemented, strategies for interventions, the importance of multidisciplinary collaboration, and key microbiologic diagnostic tests that should be considered for diagnostic stewardship. The document focuses on microbiologic laboratory testing for adult and pediatric patients and is intended for a target audience of healthcare workers involved in diagnostic stewardship interventions and all workers affected by any step of the diagnostic pathway (ie, ordering, collecting, processing, reporting, and interpreting results of a diagnostic test). This document was developed by the Society for Healthcare Epidemiology of America Diagnostic Stewardship Taskforce.
Six pairs of steers were allowed to choose between two types of floors in a paired choice test. The four floors tested were a fully slatted floor, a fully slatted floor covered with rubber mats, a solid floor with sawdust bedding, and a solid floor with straw bedding. All combinations of floor types were tested and the choices were repeated eight times, using naïve animals. The animals were allowed 17 days to habituate, and on days 18-21 their behaviour was recorded by video for 72 hours. Straw was the most preferred floor type, followed by sawdust, then mats, and finally slats. During a second test period, rubber mats were compared with rubber strips, and no significant preferences were found.
Two of the pathways by which evolutionary processes can influence disease risk are evolutionary mismatch, where the individual’s evolved coping mechanisms are overwhelmed by a novel or severe cue, and developmental mismatch, where the individual is exposed to an environment that is not matched to its adaptively developed phenotype. Both pathways draw on the evolutionary principle that selection operates to sustain and promote Darwinian fitness, irrespective of the impact on health during the post-reproductive age. In this chapter we will frame DOHaD phenomena within an evolutionary context, showing that human health and disease risk are dependent on our both evolutionary and developmental histories. We also discuss the contributory role of a unique human activity to not only construct a niche but also continually modify it. Using nutrition as the exemplar, we demonstrate how the DOHaD phenomenon is underpinned by both evolutionary and developmental mismatches, and discuss the evidence for how developmental anticipatory responses may confer adaptive advantage in humans.
Mental illness is the single largest cause of disability in the UK, with one in four individuals suffering from a mental health problem. Despite this, only 13% of the NHS budget goes towards treatment of mental illness. It is thus unsurprising that addressing the parity of esteem of mental health has been highlighted as a major priority for the healthcare system, with the NHS Five Year Forward plan aiming to achieve this by 2020.
Objectives
To explore the barriers to achieving parity of esteem of mental healthcare in the UK and develop recommendations for implementation.
Methods
Narrative review of literature and synthesis of findings
Results
Three key barriers to achieving parity of esteem of mental health were identified: the current mental health investment standard (MHIS), medical sub-specialisation, and access to acute day units (ADU). The following recommendations were thus synthesised: to increase the time-period to measure MHIS increments, integrating mental health teaching into specialty training programmes, and increasing the availbility of ADUs to crisis referral teams.
Conclusions
Addressing the disparity between mental and physical health is a major priority for the NHS. This research provides an overview of current barriers and suggests recommendations for improvement. By prioritizing improvement in the MHIS, integrating mental health teaching into specialty training, and increasing access to ADUs, the NHS formulates an excellent founding to achieving the ultimate goal, parity of esteem of mental health.
In response to the 2014–2016 West Africa Ebola virus disease (EVD) epidemic, the Centers for Disease Control and Prevention (CDC) designated 56 US hospitals as Ebola treatment centers (ETCs) with high-level isolation capabilities. We sought to determine the ongoing sustainability of ETCs and to identify how ETC capabilities have affected hospital, local, and regional coronavirus disease 2019 (COVID-19) readiness and response.
Design:
An electronic survey included both qualitative and quantitative questions and was structured into 2 sections: operational sustainability and role in the COVID-19 response.
Setting and participants:
The survey was distributed to site representatives from the 56 originally designated ETCs, and 37 (66%) responded.
Methods:
Data were coded and analyzed using descriptive statistics.
Results:
Of the 37 responding ETCs, 33 (89%) reported that they were still operating, and 4 had decommissioned. ETCs that maintain high-level isolation capabilities incurred a mean of $234,367 in expenses per year. All but 1 ETC reported that existing capabilities (eg, trained staff, infrastructure) before COVID-19 positively affected their hospital, local, and regional COVID-19 readiness and response (eg, ETC trained staff, donated supplies, and shared developed protocols).
Conclusions:
Existing high-level isolation capabilities and expertise developed following the 2014–2016 EVD epidemic were leveraged by ETCs to assist hospital-wide readiness for COVID-19 and to support responses by other local and regional hospitals However, ETCs face continued challenges in sustaining those capabilities for high-consequence infectious diseases.
The NIH Center for Accelerated Innovations at Cleveland Clinic (NCAI-CC) was funded by the National Heart Lung and Blood Institute (NHLBI) to support academic investigators in technology development and commercialization. NCAI-CC was one of three multi-institutional Centers established in the fall of 2013. The goal of each Center was to catalyze the growth of an ecosystem of commercialization within their affiliated institutions and regions by managing a program of funding and guiding translational project development and by delivering commercialization education programs to participating investigators. NCAI-CC created and managed such a funding program, ultimately supporting 75 different projects across seven separate academic institutions and developed tailored educational content following the National Science Foundation I-Corps™ curriculum and delivered the program to 79 teams from 12 institutions. We determined early on that in establishment and implementation of projects, it is important to support the teams and principal investigators throughout the program. The support includes a change in principal investigator mindset from specific aims orientation to goals and deliverables on projects. Our skills development efforts emphasized commercialization and a deep understanding of customer needs for new technology adoption. Here, we review our experiences, outcomes, and insights, including the challenges identified in program implementation.
Moral disengagement is a social cognition people use to engage in wrongdoings even when they know it is wrong. However, little is known about the antecedents that predict moral disengagement. The current study focuses on the development of self-control and cooperation during middle childhood as two antecedents of moral disengagement among 1,103 children (50% female; 77% White, 12% Black, 6% Hispanic, and 5% other). Children's self-control at age 8 and growth in self-control from age 8 to 11 were positively linked to adolescents seeing themselves as having self-control at age 15, which then predicted less moral disengagement at age 18. Children's cooperation at age 8 also was positively linked to adolescents’ self-views of cooperation at age 15, which in turn, was associated with less moral disengagement at age 18. These findings demonstrate the potential of self-control and cooperation as intrapersonal and interpersonal strengths during middle childhood for mitigating moral disengagement 10 years later.