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Capacity development is critical to long-term conservation success, yet we lack a robust and rigorous understanding of how well its effects are being evaluated. A comprehensive summary of who is monitoring and evaluating capacity development interventions, what is being evaluated and how, would help in the development of evidence-based guidance to inform design and implementation decisions for future capacity development interventions and evaluations of their effectiveness. We built an evidence map by reviewing peer-reviewed and grey literature published since 2000, to identify case studies evaluating capacity development interventions in biodiversity conservation and natural resource management. We used inductive and deductive approaches to develop a coding strategy for studies that met our criteria, extracting data on the type of capacity development intervention, evaluation methods, data and analysis types, categories of outputs and outcomes assessed, and whether the study had a clear causal model and/or used a systems approach. We found that almost all studies assessed multiple outcome types: most frequent was change in knowledge, followed by behaviour, then attitude. Few studies evaluated conservation outcomes. Less than half included an explicit causal model linking interventions to expected outcomes. Half of the studies considered external factors that could influence the efficacy of the capacity development intervention, and few used an explicit systems approach. We used framework synthesis to situate our evidence map within the broader literature on capacity development evaluation. Our evidence map (including a visual heat map) highlights areas of low and high representation in investment in research on the evaluation of capacity development.
Number and procedures of involuntary hospital admissions vary in Europe according to the different socio-cultural contexts. The European Commission has funded the EUNOMIA study in 12 European countries in order to develop European recommendations for good clinical practice in involuntary hospital admissions. The recommendations have been developed with the direct and active involvement of national leaders and key professionals, who worked out national recommendations, subsequently summarized into a European document, through the use of specific categories. The need for standardizing the involuntary hospital admission has been highlighted by all centers. In the final recommendations, it has been stressed the need to: providing information to patients about the reasons for hospitalization and its presumable duration; protecting patients’ rights during hospitalization; encouraging the involvement of family members; improving the communication between community and hospital teams; organizing meetings, seminars and focus-groups with users; developing training courses for involved professionals on the management of aggressive behaviors, clinical aspects of major mental disorders, the legal and administrative aspects of involuntary hospital admissions, on communication skills. The results showed the huge variation of involuntary hospital admissions in Europe and the importance of developing guidelines on this procedure.
Aquarium release is a vector for introducing nonnative species that threatens the ecological integrity of aquatic systems. Following coastal invasions by released aquarium strains of Caulerpa taxifolia, aquarists began using the macroalgal genus Chaetomorpha. Use of Chaetomorpha now exceeds 50% of U.S. aquarium hobbyists we surveyed. Aquarium strains of this macroalgal genus possess broad environmental tolerances, demonstrate high nutrient uptake and growth rates, and reproduce by fragmentation. Although these characteristics make Chaetomorpha a desirable aquarium inhabitant, they may also promote invasive tendencies if the alga is introduced into a natural ecosystem. We sought to proactively mitigate this potential invasion risk by testing algal disposal techniques that serve as responsible alternatives to releasing viable individuals. We tested methods used by aquarium hobbyists—boiling, microwaving, freezing, desiccation, and exposure to freshwater. We determined the minimum durations that these techniques must be used in order to induce mortality in three aquarium purchases of Chaetomorpha. We found that boiling for at least 1 min, microwaving for at least 15 s, or freezing for at least 24 h were sufficient to induce 100% mortality in 1-cm-long fragments and clumps up to 1.5 g. Desiccation required more than 24 h when exposed to air and 6 d for samples kept in closed containers. Freshwater exposure was effective at 6 d. These results indicate that disposal of excess or unwanted Chaetomorpha via garbage (if destined for a landfill) or indoor plumbing (e.g., sinks and toilets) represent safe alternatives to release. Disposal of algal tissue, shipping water, or tank water containing small algal fragments down stormwater drains, however, could introduce this hardy species into favorable conditions that could result in detrimental biological invasions.
We present a Newtonian, one-dimensional, differential analysis for capillary breakup rheometry (CBR) to determine the surface tension to viscosity ratio $\unicode[STIX]{x1D6FC}$. Our local differential analysis does not require specific assumptions for the axial force to preclude its measurement. Our analysis indicates that measuring gradients in filament curvature is necessary to accurately determine $\unicode[STIX]{x1D6FC}$ when axial force is not measured. CBR experiments were performed on five silicone oils ($0.35~\text{Pa}~\text{s}<\unicode[STIX]{x1D707}<10~\text{ Pa}~\text{s}$), three sample volumes, and three strains to evaluate the operating range of the differential analysis and compare its performance to that of a standard integral method from literature. We investigate the role of filament asymmetry, caused mainly by gravity, on the performance of the differential method for the range of conditions studied. Experimental and analytical details for resolving gradients of curvature are also given.
We report two patients with dyskinesia responding to antidepressants. The first is a 70-year-old man with depression, Parkinsonism and neuroleptic-induced tardive dyskinesia who presented with hysterical mutism. After recovery from the mutism, he was started on desipramine for depression. One week later the dyskinesia improved markedly. The second patient is a 61-year-old man with Parkinson's disease, dementia, depression and L-dopa-induced oro-lingual-facial dyskinesias. He was taking levodopa, trihexyphenydil and bromocriptine. The depression was treated first with desipramine and later with trazodone. The dyskinesia improved significantly on both drugs. The response of the dyskinesias to antidepressant medication may be due to the fact that antidepressants decrease beta-adrenoreceptor sensitivity and density which in turn may result in a diminished release of dopamine since beta-adrenoceptors mediate the noradrenaline-stimulated release of dopamine.
Renewable energy can provide a host of benefits to society. In addition to the reduction of carbon dioxide (CO2) emissions, governments have enacted renewable energy (RE) policies to meet a number of objectives including the creation of local environmental and health benefits; facilitation of energy access, particularly for rural areas; advancement of energy security goals by diversifying the portfolio of energy technologies and resources; and improving social and economic development through potential employment opportunities. Energy access and social and economic development have been the primary drivers in developing countries whereas ensuring a secure energy supply and environmental concerns have been most important in developed countries.
An increasing number and variety of RE policies–motivated by a variety of factors–have driven substantial growth of RE technologies in recent years. Government policies have played a crucial role in accelerating the deployment of RE technologies. At the same time, not all RE policies have proven effective and efficient in rapidly or substantially increasing RE deployment. The focus of policies is broadening from a concentration almost entirely on RE electricity to include RE heating and cooling and transportation.
RE policies have promoted an increase in RE capacity installations by helping to overcome various barriers. Barriers specific to RE policymaking (e.g., a lack of information and awareness), to implementation (e.g., a lack of an educated and trained workforce to match developing RE technologies) and to financing (e.g., market failures) may further impede deployment of RE.
Polymer drag reduction, diffusion and degradation in a high-Reynolds-number turbulent boundary layer (TBL) flow were investigated. The TBL developed on a flat plate at free-stream speeds up to 20ms−1. Measurements were acquired up to 10.7m downstream of the leading edge, yielding downstream-distance-based Reynolds numbers up to 220 million. The test model surface was hydraulically smooth or fully rough. Flow diagnostics included local skin friction, near-wall polymer concentration, boundary layer sampling and rheological analysis of polymer solution samples. Skin-friction data revealed that the presence of surface roughness can produce a local increase in drag reduction near the injection location (compared with the flow over a smooth surface) because of enhanced mixing. However, the roughness ultimately led to a significant decrease in drag reduction with increasing speed and downstream distance. At the highest speed tested (20ms−1) no drag reduction was discernible at the first measurement location (0.56m downstream of injection), even at the highest polymer injection flux (10 times the flux of fluid in the near-wall region). Increased polymer degradation rates and polymer mixing were shown to be the contributing factors to the loss of drag reduction. Rheological analysis of liquid drawn from the TBL revealed that flow-induced polymer degradation by chain scission was often substantial. The inferred polymer molecular weight was successfully scaled with the local wall shear rate and residence time in the TBL. This scaling revealed an exponential decay that asymptotes to a finite (steady-state) molecular weight. The importance of the residence time to the scaling indicates that while individual polymer chains are stretched and ruptured on a relatively short time scale (~10−3s), because of the low percentage of individual chains stretched at any instant in time, a relatively long time period (~0.1s) is required to observe changes in the mean molecular weight. This scaling also indicates that most previous TBL studies would have observed minimal influence from degradation due to insufficient residence times.
Defining the causal relationship between a microbe and encephalitis is complex. Over 100 different infectious agents may cause encephalitis, often as one of the rarer manifestations of infection. The gold-standard techniques to detect causative infectious agents in encephalitis in life depend on the study of brain biopsy material; however, in most cases this is not possible. We present the UK perspective on aetiological case definitions for acute encephalitis and extend them to include immune-mediated causes. Expert opinion was primarily used and was supplemented by literature-based methods. Wide usage of these definitions will facilitate comparison between studies and result in a better understanding of the causes of this devastating condition. They provide a framework for regular review and updating as the knowledge base increases both clinically and through improvements in diagnostic methods. The importance of new and emerging pathogens as causes of encephalitis can be assessed against the principles laid out here.
The authors used results from a 20-year, high-intensity follow-up to measure the influence of ageing, and of age at onset, on the long-term persistence of symptoms in major depressive disorder (MDD).
Method
Subjects who completed a 20-year series of semi-annual and then annual assessments with a stable diagnosis of MDD or schizo-affective disorder other than mainly schizophrenic (n=220) were divided according to their ages at intake into youngest (18–29 years), middle (30–44 years) and oldest (>45 years) groups. Depressive morbidity was quantified as the proportion of weeks spent in major depressive or schizo-affective episodes. General linear models then tested for effects of time and time×group interactions on these measures. Regression analyses compared the influence of age of onset and of current age.
Results
Analyses revealed no significant time or group×time effects on the proportions of weeks in major depressive episodes in any of the three age groups. Earlier ages of onset were associated with greater symptom persistence, particularly in the youngest group. The proportions of weeks ill showed intra-individual stability over time that was most evident in the oldest group.
Conclusions
These results indicate that the persistence of depressive symptoms in MDD does not change as individuals move from their third to their fifth decade, from their fourth to their sixth decade, or from their sixth to their eighth decade. An early age of onset, rather than youth per se, is associated with greater morbidity over two decades.
A set of controlled high-Reynolds-number experiments has been conducted at the William B. Morgan Large Cavitation Channel (LCC) in Memphis, Tennessee to investigate the friction drag reduction achieved by injecting aqueous poly(ethylene oxide) (PEO) solutions at three different mean molecular weights into the near-zero-pressure-gradient turbulent boundary layer that forms on a smooth flat test surface having a length of nearly 11m. The test model spanned the 3.05m width of the LCC test section and had an overall length of 12.9m. Skin-friction drag was measured with six floating-plate force balances at downstream-distance-based Reynolds numbers as high as 220 million and free stream speeds up to 20ms−1. For a given polymer type, the level of drag reduction was measured for a range of free stream speeds, polymer injection rates and concentrations of the injected solution. Polymer concentration fields in the near-wall region (0 < y+ < ~103) were examined at three locations downstream of the injector using near-wall planar laser-induced-fluorescence imaging. The development and extent of drag reduction and polymer mixing are compared to previously reported results using the traditional K-factor scaling. Unlike smaller scale and lower speed experiments, speed dependence is observed in the K-scaled results for the higher molecular weight polymers and it is postulated that this dependence is caused by molecular aggregation and/or flow-induced polymer degradation (chain scission). The evolution of near-wall polymer concentration is divided into three regimes: (i) the development region near the injector where drag reduction increases with downstream distance and the polymer is highly inhomogeneous forming filaments near the wall, (ii) the transitional mixing region where drag reduction starts to decrease as the polymer mixes across the boundary layer and where filaments are less pronounced and (iii) the final region where the polymer mixing and dilution is set by the rate of boundary layer growth. Unlike pipe-flow friction-drag reduction, the asymptotic maximum drag reduction (MDR) either was not reached or did not persist in these experiments. Instead, the nearest approach to MDR was transitory and occurred between the development and transitional regions. The length of the development region was observed to increase monotonically with increasing polymer molecular weight, injection rate, concentration and decreasing free stream speed. And finally, the near-wall polymer concentration is correlated to the measured drag reduction for the three polymer molecular weights in the form of a proposed empirical drag-reduction curve.
Combating iron deficiency in toddlers with iron-fortified food has proved difficult in countries with phytate-rich diets. For this purpose, a new haem iron preparation was developed. The study compared changes in iron status after administration of refried beans with beans fortified with a haem iron preparation or ferrous sulphate (FeSO4).
Design
In a masked, stratified-randomised intervention trial, children received five 156-g cans of refried black beans per week for 10 consecutive weeks. The beans-only (control), FeSO4 and haem iron groups were offered a cumulative dose of 155 mg, 1625 mg and 1700 mg of iron from the bean intervention, respectively. Haemoglobin (Hb) and ferritin concentrations were determined at baseline and after 5 and 10 weeks. Compliance was examined weekly.
Setting
A low-income community in Guatemala City.
Subjects
One hundred and ten children aged 12–36 months with initial Hb values between 100 and 115 g l−1.
Results
The cumulative intake of beans was approximately 80% of that offered, signifying an additional ~1300 mg of either haem or inorganic iron in the corresponding treatment groups over 10 weeks. Hb concentrations increased by the order of 7.3–11.4 g l-1 during the intervention, but without significant differences across treatments. Average ferritin concentrations were unaffected by treatment assignment. However, post hoc analysis by subgroups of initial high ferritin and initial low ferritin found the Hb increments after 10 weeks in the haem iron group (13.1±7.7 g l−1) to be significantly greater than the respective increases (6.8±11.2 and 6.4±8.5 g l−1) in the inorganic iron and beans-only groups.
Conclusions
Canned refried beans are a candidate vehicle for fortificant iron. Given the improved colour and organoleptic properties imparted by haem iron added to refried beans, its additional potential for benefiting the iron status of consumers with iron deficiency may recommend it over FeSO4.
Education-based interventions can reduce the incidence of catheter-associated bloodstream infection. The generalizability of findings from single-center studies is limited.
Objective.
To assess the effect of a multicenter intervention to prevent catheter-associated bloodstream infections.
Design.
An observational study with a planned intervention.
Setting.
Twelve intensive care units and 1 bone marrow transplantation unit at 6 academic medical centers.
Patients.
Patients admitted during the study period.
Intervention.
Updates of written policies, distribution of a 9-page self-study module with accompanying pretest and posttest, didactic lectures, and incorporation into practice of evidence-based guidelines regarding central venous catheter (CVC) insertion and care.
Measurements.
Standard data collection tools and definitions were used to measure the process of care (ie, the proportion of non-tunneled catheters inserted into the femoral vein and the condition of the CVC insertion site dressing for both tunneled and nontunneled catheters) and the incidence of catheter-associated bloodstream infection.
Results.
Between the preintervention period and the postintervention period, the percentage of CVCs inserted into the femoral vein decreased from 12.9% to 9.4% (relative ratio, 0.73; 95% confidence interval [CI], 0.61-0.88); the total proportion of catheter insertion site dressings properly dated increased from 26.6% to 34.4% (relative ratio, 1.29; 95% CI, 1.17-1.42), and the overall rate of catheter-associated bloodstream infections decreased from 11.2 to 8.9 infections per 1,000 catheter-days (relative rate, 0.79; 95% CI, 0.67-0.93). The effect of the intervention varied among individual units.
Conclusions.
An education-based intervention that uses evidence-based practices can be successfully implemented in a diverse group of medical and surgical units and reduce catheter-associated bloodstream infection rates.
Education-based interventions can reduce the incidence of catheter-associated bloodstream infection. The generalizability of findings from single-center studies is limited.
Objective.
To assess the effect of a multicenter intervention to prevent catheter-associated bloodstream infections.
Design.
An observational study with a planned intervention.
Setting.
Twelve intensive care units and 1 bone marrow transplantation unit at 6 academic medical centers.
Patients.
Patients admitted during the study period.
Intervention.
Updates of written policies, distribution of a 9-page self-study module with accompanying pretest and posttest, didactic lectures, and incorporation into practice of evidence-based guidelines regarding central venous catheter (CVC) insertion and care.
Measurements.
Standard data collection tools and definitions were used to measure the process of care (ie, the proportion of non-tunneled catheters inserted into the femoral vein and the condition of the CVC insertion site dressing for both tunneled and nontunneled catheters) and the incidence of catheter-associated bloodstream infection.
Results.
Between the preintervention period and the postintervention period, the percentage of CVCs inserted into the femoral vein decreased from 12.9% to 9.4% (relative ratio, 0.73; 95% confidence interval [CI], 0.61-0.88); the total proportion of catheter insertion site dressings properly dated increased from 26.6% to 34.4% (relative ratio, 1.29; 95% CI, 1.17-1.42), and the overall rate of catheter-associated bloodstream infections decreased from 11.2 to 8.9 infections per 1,000 catheter-days (relative rate, 0.79; 95% CI, 0.67-0.93). The effect of the intervention varied among individual units.
Conclusions.
An education-based intervention that uses evidence-based practices can be successfully implemented in a diverse group of medical and surgical units and reduce catheter-associated bloodstream infection rates.
To evaluate whether a natural language processing system, SymText, was comparable to human interpretation of chest radiograph reports for identifying the mention of a central venous catheter (CVC), and whether use of SymText could detect patients who had a CVC.
Design:
To identify patients who had a CVC, we performed two surveys of hospitalized patients. Then, we obtained available reports from 104 patients who had a CVC during one of two cross-sectional surveys (ie, case-patients) and 104 randomly selected patients who did not have a CVC (ie, control-patients).
Setting:
A 600-bed public teaching hospital.
Results:
Chest radiograph reports were available from 124 of the 208 participants. Compared with human interpretation, SymText had a sensitivity of 95.8% and a specificity of 98.7%. The use of SymText to identify case- and control-patients resulted in a sensitivity of 43% and a specificity of 98%. Successful application of SymText varied significantly by venous insertion site (eg, a sensitivity of 78% for subclavian and a sensitivity of 3.7% for femoral). Twenty-six percent of the case-patients had a femoral CVC.
Conclusions:
Compared with human interpretation, SymText performed well in interpreting whether a report mentioned a CVC. In patient populations with less frequent CVC placement in femoral veins, the sensitivity for CVC detection likely would be higher. Applying a natural language processing system to chest radiograph reports may be a useful adjunct to other data sources to automate detection of patients who had a CVC.
To examine a comprehensive approach for preventing percutaneous injuries associated with phlebotomy procedures.
Design and Setting:
From 1993 through 1995, personnel at 10 university-affiliated hospitals enhanced surveillance and assessed underreporting of percutaneous injuries; selected, implemented, and evaluated the efficacy of phlebotomy devices with safety features (ie, engineered sharps injury prevention devices [ESIPDs]); and assessed healthcare worker satisfaction with ESIPDs. Investigators also evaluated the preventability of a subset of percutaneous injuries and conducted an audit of sharps disposal containers to quantify activation rates for devices with safety features.
Results:
The three selected phlebotomy devices with safety features reduced percutaneous injury rates compared with conventional devices. Activation rates varied according to ease of use, healthcare worker preference for ESIPDs, perceived “patient adverse events,” and device-specific training.
Conclusions:
Device-specific features and healthcare worker training and involvement in the selection of ESIPDs affect the activation rates for ESIPDs and therefore their efficacy. The implementation of ESIPDs is a useful measure in a comprehensive program to reduce percutaneous injuries associated with phlebotomy procedures.