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Functional family therapy (FFT) is an integrated model that combines family systems and cognitive behavioural theories into a coherent relationship-based approach for working with young persons with externalizing problems and their families. FFT is an evidence-based model that has been supported in numerous controlled research studies and community-based evaluations. In-session process research has also shed light on the clinical interior of treatment, and findings from this research have helped shape the articulation of the core principles and techniques of the model. FFT proceeds through five distinct phases of treatment: engagement, motivation, relational assessment, behaviour change and generalization. Each phase has specific goals, focus, activities and skills. The principles of FFT are consistent with many of the features of core competencies approaches in cognitive behavioural therapy. In this chapter, we describe research on FFT that has led to the inclusion of elements that are considered core competencies. A detailed overview of the FFT clinical model is provided, as are specific examples of techniques or clinical focus that are consistent with a core competencies framework.
Trends in utilization of Emergency Medical Services (EMS) systems can be used to extrapolate future use of an EMS system, which will be valuable for the budgeting and planning of finances and resources. The best model for incorporation of seasonal and regional fluctuations in utilization to predict future utilization is unknown.
Problem:
Authors aimed to trend patterns of utilization in a regional EMS system to identify the needs of a growing population and to allow for a better understanding of how the EMS system is used on a basis of call volume and frequency of EMS transportation. The authors then used a best-fitting prediction model approach to show how the studied EMS system will be used in future years.
Methods:
Systems data were retrospectively extracted by using the electronic medical records of the studied EMS system and its computer-assisted dispatch (CAD) database from 2010 through 2017. All EMS dispatches entering the system’s 9-1-1 public service access point were captured. Annual utilization data were available from 2010 through 2017, while quarterly data were available only from 2013 through 2017. The 9-1-1 utilization per capita, Advanced Life Support (ALS) utilization per capita, and ALS cancel rates were calculated and trended over the study period. The methods of prediction were assessed through a best-fitting model approach, which statistically suggested that Additive Winter’s approach (SAS) was the best fit to determine future utilization and ALS cancel rates.
Results:
Total 9-1-1 call volume per capita increased by 32.46% between 2010 and 2017, with an average quarterly increase of 0.78% between 2013 and 2017. Total ALS call volume per capita increased by 1.93% between 2010 and 2017. Percent ALS cancellations (cancelled en route to scene) increased by eight percent between 2010 and 2017, with an average quarterly increase of 0.42% (2013–2017). Predictions to end of 2019 using Additive Winter’s approach demonstrated increasing trends in 9-1-1 call volume per capita (R2 = 0.47), increasing trends of ALS utilization per capita (R2 = 0.71), and increasing percent ALS cancellation (R2 = 0.93). Each prediction showed increasing future trends with a 95% confidence interval.
Conclusions:
The authors demonstrate paramount per capita increases of 9-1-1 call volume in the studied ALS system. There are concomitant increases of ALS cancellations prior to arrival, which suggests a potential burden on this regional ALS response system.
Data quality in survey research remains a paramount concern for those studying mass political behavior. Because surveys are conducted in increasingly diverse contexts around the world, ensuring that best practices are followed becomes ever more important to the field of political science. Bringing together insights from surveys conducted in more than 80 countries worldwide, this article highlights common challenges faced in survey research and outlines steps that researchers can take to improve the quality of survey data. Importantly, the article demonstrates that with the investment of the necessary time and resources, it is possible to carry out high-quality survey research even in challenging environments in which survey research is not well established.
Objectives: Prior studies have found associations between visual acuity (VA) and cognitive function. However, these studies used a limited range of cognitive measures and did not control for cardiovascular disease risk factors (CVD-RFs) and baseline function. The primary objective of this study was to analyze the associations of VA and cognitive performance using a thorough neuropsychological test battery. Methods: This study used community-dwelling sample data across the sixth (2001–2006) and seventh (2006–2010) waves of the Maine-Syracuse Longitudinal Study (n=655). Wave 6 VA as measured by the Snellen Eye Test was the primary predictor of wave 6 and wave 7 Global cognitive performance, Visual-Spatial Organization and Memory, Verbal Episodic Memory, Working Memory, Scanning and Tracking, and Executive Function. Additionally, VA was used to predict longitudinal changes in wave 7 cognitive performance (wave 6 performance adjusted). We analyzed these relationships with multiple linear and logistic regression models adjusted for age, sex, education, ethnicity, depressive symptoms, physical function deficits in addition to CVD-RFs, chronic kidney disease, homocysteine, continuous systolic blood pressure, and hypertension status. Results: Adjusted for demographic covariates and CVD-RFs, poorer VA was associated with concurrent and approximate 5-year declines in Global cognitive function, Visual-Spatial Organization and Memory, and Verbal Episodic Memory. Discussion: VA may be used in combination with other screening measures to determine risk for cognitive decline. (JINS, 2018, 24, 1–9)
Radioactive waste with widely varying characteristics is generated from the operation and maintenance of nuclear reactors, nuclear fuel cycle facilities, research facilities and medical facilities and the through the use of radioisotopes in industrial applications. The waste needs to be treated and conditioned appropriately to provide wasteforms acceptable for safe storage and disposal. Conditioning of radioactive waste is an important step to prepare waste for long-term storage or disposal and includes the following processes:
▪ Immobilization which may or may not also provide volume reduction, including
a) Low temperature processes and
b) Thermal processes;
▪ Containerization for
a) Transport,
b) Storage, and
c) Disposal;
▪ Overpacking of primary containers
a) Prior to disposal and
b) In a disposal facility as part of disposal process.
Conditioning consists of operations that produce a waste package suitable for handling, transportation, storage and/or disposal and may be performed for a variety of reasons including standardization of practices and/or wasteforms, technical requirements for waste stability in relation to a repository design or safety case, technical requirements related to waste transportation, societal preferences, regulatory preferences, etc. This paper gives an overview of recent advances in conditioning of low- and intermediate-level radioactive waste.
The paper is based on the new IAEA Handbook “Conditioning of Low- and Intermediate-Level Liquid, Solidified and Solid Waste” which is one of eight IAEA handbooks intended to provide guidance for evaluating and implementing various characterisation and radioactive waste processing and storage technologies before final disposal
The Lothagam harpoon site in north-west Kenya's Lake Turkana Basin provides a stratified Holocene sequence capturing changes in African fisher-hunter-gatherer strategies through a series of subtle and dramatic climate shifts (Figure 1). The site rose to archaeological prominence following Robbins's 1965–1966 excavations, which yielded sizeable lithic and ceramic assemblages and one of the largest collections of Early Holocene human remains from Eastern Africa (Robbins 1974; Angel et al. 1980).
Ever more agricultural economics departments are offering appointments for nine rather than twelve months but little if any analysis of the impact of this change has been done. Our research shows that converting to nine-month contracts is an effective way to raise salaries without an initial outlay of new funds and thus meets the retention criterion. Lower ranks do not suffer significantly lower salaries (without supplements) and professors earn more. Because the nine-month alternative costs more, justification for converting all twelve-month faculty members must rest on other factors, such as enhanced grants or comparability.
Research using the Agricultural Resource Management Survey (ARMS) and other data shows that direct government payments to farmers increase rents and the price of land. However, some ARMS data is imputed and does not account for relationships between payments and other variables. We investigate various imputation methods and benefits gained from a method with a wide scope rather than a parsimonious range of variables. Using our method, we estimate that an additional dollar of direct payment increases land value about $2.69 more per acre than ARMS imputation methods and that our imputations (using an exhaustive iterative sequential regression) outperform other methods and/or smaller models.
Arboviruses are pathogens that widely affect the health of people in different communities around the world. Recently, a few successful approaches toward production of effective vaccines against some of these pathogens have been developed, but treatment and prevention of the resulting diseases remain a major health and research concern. The arbovirus infection and replication processes are complex, and many factors are involved in their regulation. Apoptosis, autophagy and the unfolded protein response (UPR) are three mechanisms that are involved in pathogenesis of many viruses. In this review, we focus on the importance of these pathways in the arbovirus replication and infection processes. We provide a brief introduction on how apoptosis, autophagy and the UPR are initiated and regulated, and then discuss the involvement of these pathways in regulation of arbovirus pathogenesis.
Vitreous materials are the overwhelming world-wide choice for the immobilisation
of HLW resulting from nuclear fuel reprocessing due to glass tolerance for the
chemical elements found in the waste as well as its inherent stability and
durability. Vitrification is a mature technology and has been used for
high-level nuclear waste immobilization for more than 50 years. Borosilicate
glass is the formulation of choice in most applications although other
formulations are also used e.g. phosphate glasses are used to immobilize high
level wastes in Russia. The excellent durability of vitrified radioactive waste
ensures a high degree of environment protection. Waste vitrification gives high
waste volume reduction along with simple and cheap disposal facilities. Although
vitrification requires a high initial investment and then operational costs, the
overall cost of vitrified radioactive waste is usually lower than alternative
options when account is taken of transportation and disposal expenses. Glass has
proven to be also a suitable matrix for intermediate and low-level radioactive
wastes and is currently used to treat legacy waste in USA, and NPP operational
waste in Russia and South Korea. This report is also outlining IAEA activities
aiming to support utilisation of vitreous materials for nuclear waste
immobilisation.
This study develops a theoretical model of the multiproduct firm which allows for imperfect competition in the output market. Hypotheses are tested for retail meat prices concerning the degree and speed of price transmission, the effects of interfirm competition, and the interrelationship between prices within the store. Empirical results indicated that meat prices within a store were highly interrelated. Further, the firm was found to be very responsive to prices of competitors in the short run, but more responsive to wholesale price changes in the long run.
To identify factors that may explain hospital-level differences in outcomes of programs to prevent central line–associated bloodstream infections.
DESIGN
Extensive qualitative case study comparing higher- and lower-performing hospitals on the basis of reduction in the rate of central line–associated bloodstream infections. In-depth interviews were transcribed verbatim and analyzed to determine whether emergent themes differentiated higher- from lower-performing hospitals.
SETTING
Eight US hospitals that had participated in the federally funded On the CUSP—Stop BSI initiative.
PARTICIPANTS
One hundred ninety-four interviewees including administrative leaders, clinical leaders, professional staff, and frontline physicians and nurses.
RESULTS
A main theme that differentiated higher- from lower-performing hospitals was a distinctive framing of the goal of “getting to zero” infections. Although all sites reported this goal, at the higher-performing sites the goal was explicitly stated, widely embraced, and aggressively pursued; in contrast, at the lower-performing hospitals the goal was more of an aspiration and not embraced as part of the strategy to prevent infections. Five additional management practices were nearly exclusively present in the higher-performing hospitals: (1) top-level commitment, (2) physician-nurse alignment, (3) systematic education, (4) meaningful use of data, and (5) rewards and recognition. We present these strategies for prevention of healthcare-associated infection as a management “bundle” with corresponding suggestions for implementation.
CONCLUSIONS
Some of the variance associated with CLABSI prevention program outcomes may relate to specific management practices. Adding a management practice bundle may provide critical guidance to physicians, clinical managers, and hospital leaders as they work to prevent healthcare-associated infections.
Few studies have examined associations between different subcategories of cholesterol and cognitive function. We examined relationships between total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglyceride levels and cognitive performance in the Maine-Syracuse Longitudinal Study, a community-based study of cardiovascular risk factors. Cross-sectional analyses were undertaken on data from 540 participants, aged 60 to 98 years, free of dementia and stroke. TC, HDL, LDL, and triglyceride levels were obtained. Cognitive function was assessed using a thorough neuropsychological test battery, including domains of cognitive function indexed by multiple cognitive tests. The cognitive outcomes studied were as follows: Visual-Spatial Memory and Organization, Verbal and Working Memory, Scanning and Tracking, Abstract Reasoning, a Global Composite score, and the Mini-Mental State Examination (MMSE). Significant positive associations were observed between HDL-cholesterol and the Global Composite score, Working Memory, and the MMSE after adjustment for demographic and cardiovascular risk factors. Participants with desirable levels of HDL (≥60 mg/dL) had the highest scores on all cognitive outcomes. There were no significant associations observed between TC, LDL, or triglyceride concentrations and cognition. In older individuals, HDL-cholesterol was related to a composite of Working Memory tests and for general measures of cognitive ability when adjusted for cardiovascular variables. We speculate that persons over 60 are survivors and thus less likely to show cognitive deficit in relation to TC, LDL-cholesterol, and triglycerides. Longitudinal studies are needed to examine relations between specific cognitive abilities and the different subcategories of cholesterol. (JINS, 2014, 20, 1–10)
Central to understanding of the behavioural consequences of depression has been the theory that the disorder is accompanied by an increased sensitivity to negative compared with positive reinforcement (negative bias), whereas other theorists have emphasized a global reduction in sensitivity to reinforcement in depression (blunting).
Method
In this study, we used a probabilistic selection task that was designed to examine independently rates of learning to predict both positive and negative reinforcement. Twenty-three depressed out-patients and 23 healthy controls from the local population participated in the study.
Results
No evidence for a negative bias was observed on the task, either during acquisition of the task or during generalization of the learned information. Depressed patients responded slower on the task than controls but showed a similar modulation of reaction times (RTs) as controls following reinforcement. Evidence for blunting was observed on the training phase, as reflected in reduced trial-by-trial adjustment during this phase. However, this effect was related specifically to the severity of anhedonia, as measured by the Snaith–Hamilton Pleasure Scale (SHAPS), and was independent of overall depression severity.
Conclusions
We argue that the observation of a negative bias or blunting in a group of depressed patients may be dependent on the neuropsychological task and the symptoms of the patients tested. Our results provide insight into how these theories might be further tested.
Effective species conservation depends upon correctly identifying the threatsthat cause decline or hinder recovery. Because estimates of the relativeviability of different populations of Endangered African wild dogs Lycaon pictus are most strongly influenced by adultand pup mortality, we analysed rates and causes of mortality in eight wild dogpopulations under study in southern and eastern Africa. The probabilities ofdetecting wild dog deaths were influenced by the monitoring methods used. Theleast biased estimates of mortality causes were obtained through intensivemonitoring of radio-collared individuals; this is impossible for pups, however.Mortality patterns varied substantially between populations. Rates ofhuman-caused mortality were higher for wild dogs radio-collared outsideprotected areas than for those collared inside, but rates of natural mortalitywere comparable, suggesting that anthropogenic mortality is additive to naturalmortality. The relative importance of factors such as snaring and infectiousdisease also varied regionally. Hence, although our analyses identified no newthreats beyond those highlighted in a 1997 range-wide Action Plan, they suggestthat local plans will be valuable to target conservation activities moreprecisely.