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There are ethnic differences, including differences related to indigeneity, in the incidence of first episode psychosis (FEP) and pathways into care, but research on ethnic disparities in outcomes following FEP is limited.
Aims
In this study we examined social and health outcomes following FEP diagnosis for a cohort of Māori (Indigenous people of New Zealand) and non-Māori (non-Indigenous) young people. We have focused on understanding the opportunities for better outcomes for Māori by examining the relative advantage of non-Māori with FEP.
Method
Statistics New Zealand's Integrated Data Infrastructure was accessed to describe mental health and social service interactions and outcomes for a retrospective FEP cohort comprising 918 young Māori and 1275 non-Māori aged 13 to 25 at diagnosis. Logistic regression models were used to examine whether social outcomes including employment, benefit receipt, education and justice involvement in year 5 differed by indigeneity.
Results
Non-Māori young people were more likely than Māori to have positive outcomes in the fifth year after FEP diagnosis, including higher levels of employment and income, and lower rates of benefit receipt and criminal justice system involvement. These patterns were seen across diagnostic groups, and for both those receiving ongoing mental healthcare and those who were not.
Conclusions
Non-Māori experience relative advantage in outcomes 5 years after FEP diagnosis. Indigenous-based social disparities following FEP urgently require a response from the health, education, employment, justice and political systems to avoid perpetuating these inequities, alongside efforts to address the disadvantages faced by all young people with FEP.
Dans le contexte pandémique de la COVID-19, les personnes aînées se sont retrouvées confinées et isolées, et ce, même dans le cadre d’un milieu de vie collective. Cet article fait état d’une étude de la portée sur les bienfaits d’un chœur intergénérationnel pour personnes aînées et les stratégies à considérer pour sa mise en place. L’analyse de 16 études sur ce sujet a permis de se familiariser avec les résultats, les recommandations et les pistes de recherche en lien avec le bien-être et le sens de satisfaction que retirent les personnes aînées qui participent à un chœur, de même que des interventions en chant choral à privilégier. De plus, cette activité qui est peu couteuse et bénéfique est considérée comme une intervention de nature préventive qui contribue au bien-être des personnes aînées et à leur prise en charge pour un vieillissement en santé. Par ailleurs, les résultats suggèrent de continuer à documenter l’efficacité des stratégies proposées pour les améliorer ou les adapter afin de maximiser les effets positifs d’une telle activité sur le bien-être physique, social, émotionnel et cognitif des personnes aînées.
Emergency departments are high-risk settings for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) surface contamination. Environmental surface samples were obtained in rooms with patients suspected of having COVID-19 who did or did not undergo aerosol-generating procedures (AGPs). SARS-CoV-2 RNA surface contamination was most frequent in rooms occupied by coronavirus disease 2019 (COVID-19) patients who received no AGPs.
Clostridium botulinum causes infant botulism by colonising the intestines and producing botulinum neurotoxin in situ. Previous reports have linked infant botulism cases to C. botulinum spores in household dust, yet the baseline incidence of C. botulinum spores in residential households is currently unknown. Vacuum cleaner dust from 963 households in 13 major Canadian cities was tested for C. botulinum using a novel real-time PCR assay directed against all known subtypes of the botulinum neurotoxin gene. None of the samples tested positive for C. botulinum. Analysis of a random subset of samples by MALDI Biotyper revealed that the most common anaerobic bacterial isolates were of the genus Clostridium and the most common species recovered overall was Clostridium perfringens. Dust that was spiked with C. botulinum spores of each toxin type successfully produced positive real-time PCR reactions. These control experiments indicate that this is a viable method for the detection of C. botulinum spores in household dust. We make several recommendations for future work that may help discover a common environmental source of C. botulinum spores that could lead to effective preventative measures for this rare but deadly childhood disease.
To assess the impact of a 24-hour autocancellation of uncollected Clostridioides difficile samples in reducing reported healthcare-associated infections (HAIs).
The study was conducted in 17 hospitals in Pennsylvania.
Interventions:
Clostridioides difficile tests that are not collected within 24 hours are automatically canceled (“autocancel”) through the electronic health record. The intervention took place at 2 facilities (intervention period November 2021–July 2022) and subsequently at 15 additional facilities (April 2022–July 2022). Quality measures included percentage of orders canceled, C. difficile HAI rate, percent positivity of completed tests, and potential adverse outcomes of canceled or delayed testing.
Results:
Of 6,101 orders, 1,090 (17.9%) were automatically canceled after not being collected for 24 hours during the intervention periods. The reported C. difficile HAI rates per 10,000 patient days did not significantly change. These rates were 8.07 in the 6-month preintervention period and 8.77 in the intervention period for facilities A and B combined (incidence rate ratio [IRR], 1.09; 95% CI, 0.88–1.34; P = .43), and were 5.23 HAIs per 10,000 patient days in the 6-month preintervention period and 5.33 in the intervention period for facilities C–Q combined (IRR, 1.02; 95% CI, 0.79–1.32; P = .87). From the preintervention to the intervention periods, the percent positivity rates of completed C. difficile tests increased by 1.1% for facilities A and B and by 1.4% for facilities C–Q. No adverse outcomes were observed.
Conclusions:
The 24-hour autocancellation of uncollected C. difficile orders reduced testing but did not result in reported HAI reduction.
Democratic cooperation is a particularly complex type of arrangement that requires attendant institutions to ensure that the problems inherent in collective action do not subvert the public good. It is perhaps due to this complexity that historians, political scientists, and others generally associate the birth of democracy with the emergence of so-called states and center it geographically in the “West,” where it then diffused to the rest of the world. We argue that the archaeological record of the American Southeast provides a case to examine the emergence of democratic institutions and to highlight the distinctive ways in which such long-lived institutions were—and continue to be—expressed by Native Americans. Our research at the Cold Springs site in northern Georgia, USA, provides important insight into the earliest documented council houses in the American Southeast. We present new radiocarbon dating of these structures along with dates for the associated early platform mounds that place their use as early as cal AD 500. This new dating makes the institution of the Muskogean council, whose active participants have always included both men and women, at least 1,500 years old, and therefore one of the most enduring and inclusive democratic institutions in world history.
We present the first Bayesian 14C modeling based on AMS ages from stratified sediments representing continuous occupation across the Early Bronze III/IV interface in the Southern Levant. This new high-precision modeling incorporates 12 calibrated AMS ages from Khirbat Iskandar Area C using OxCal 4.4.4 and the IntCal 20 calibration curve to specify the EB III/IV transition at or slightly before 2500 cal BCE. Our results contribute to the continuing emergence of a high chronology for the Levantine Early Bronze Age, which shifts the end of EB III 200–300 years earlier than the traditional time frame and increases the length of EB IV to about 500 years. Data from Khirbat Iskandar also help direct greater attention to the importance of sedentary communities through EB IV, in contrast to the traditional emphasis on non-sedentary pastoral encampments and cemeteries. Modeling of AMS data from Khirbat Iskandar bolsters the ongoing revision of Early Bronze Age Levantine chronology and its growing interpretive independence from Egyptian history and contributes particularly to re-examination of the EB III/IV nexus in the Southern Levant.
Early life adversity influences the diurnal cortisol rhythm, yet the relative influence of different characteristics of adversity remains unknown. In this study, we examine how developmental timing (childhood vs. adolescence), severity (major vs. minor), and domain of early life adversity relate to diurnal cortisol rhythms in late adolescence. We assessed adversity retrospectively in early adulthood in a subsample of 236 participants from a longitudinal study of a diverse community sample of suburban adolescents oversampled for high neuroticism. We used multilevel modeling to assess associations between our adversity measures and the diurnal cortisol rhythm (waking and bedtime cortisol, awakening response, slope, and average cortisol). Major childhood adversities were associated with flatter daily slope, and minor adolescent adversities were associated with greater average daily cortisol. Examining domains of childhood adversities, major neglect and sexual abuse were associated with flatter slope and lower waking cortisol, with sexual abuse also associated with higher cortisol awakening response. Major physical abuse was associated with higher waking cortisol. Among adolescent adversities domains, minor neglect, emotional abuse, and witnessing violence were associated with greater average cortisol. These results suggest severity, developmental timing, and domain of adversity influence the association of early life adversity with stress response system functioning.
Despite evidence of gender differences in bipolar disorder characteristics and comorbidity, there is little research on the differences in treatment and service use between men and women with bipolar disorder.
Aims
To use routine data to describe specialist mental health service contact for bipolar disorder, including in-patient, community and support service contacts; to compare clinical characteristics and mental health service use between men and women in contact with secondary services for bipolar disorder.
Method
Cross-sectional analysis of mental health patients with bipolar disorder in New Zealand, based on complete national routine health data.
Results
A total of 3639 individuals were in contact with specialist mental health services with a current diagnosis of bipolar disorder in 2015. Of these 58% were women and 46% were aged 45 and over. The 1-year prevalence rate of bipolar disorder leading to contact with specialist mental health services was 1.56 (95% CI 1.50–1.63) per 100 000 women and 1.20 (95% CI 1.14–1.26) per 100 000 men. Rates of bipolar disorder leading to service contact were 30% higher in women than men (rate ratio 1.30, 95% CI 1.22–1.39). The majority (68%) had a diagnosis of bipolar I disorder. Women were more likely to receive only out-patient treatment and have comorbid anxiety whereas more men had substance use disorder, were convicted for crimes when unwell, received compulsory treatment orders and received in-patient treatment.
Conclusions
Although the prevalence of bipolar disorder is equal between men and women in the population, women were more likely to have contact with specialist services for bipolar disorder but had a lower intensity of service interaction.
The seroprevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) IgG antibody was evaluated among employees of a Veterans Affairs healthcare system to assess potential risk factors for transmission and infection.
Methods:
All employees were invited to participate in a questionnaire and serological survey to detect antibodies to SARS-CoV-2 as part of a facility-wide quality improvement and infection prevention initiative regardless of clinical or nonclinical duties. The initiative was conducted from June 8 to July 8, 2020.
Results:
Of the 2,900 employees, 51% participated in the study, revealing a positive SARS-CoV-2 seroprevalence of 4.9% (72 of 1,476; 95% CI, 3.8%–6.1%). There were no statistically significant differences in the presence of antibody based on gender, age, frontline worker status, job title, performance of aerosol-generating procedures, or exposure to known patients with coronavirus infectious disease 2019 (COVID-19) within the hospital. Employees who reported exposure to a known COVID-19 case outside work had a significantly higher seroprevalence at 14.8% (23 of 155) compared to those who did not 3.7% (48 of 1,296; OR, 4.53; 95% CI, 2.67–7.68; P < .0001). Notably, 29% of seropositive employees reported no history of symptoms for SARS-CoV-2 infection.
Conclusions:
The seroprevalence of SARS-CoV-2 among employees was not significantly different among those who provided direct patient care and those who did not, suggesting that facility-wide infection control measures were effective. Employees who reported direct personal contact with COVID-19–positive persons outside work were more likely to have SARS-CoV-2 antibodies. Employee exposure to SARS-CoV-2 outside work may introduce infection into hospitals.
Aberrant salience may contribute to the development of schizophrenia symptoms via alterations in reward processing and motivation. However, tests of this hypothesis have yielded inconsistent results. These inconsistencies may reflect problems with the validity and specificity of measures of aberrant salience in schizophrenia. Therefore, we investigated relationships among measures of aberrant salience, reward, and motivation in schizophrenia and anxiety.
Method
Individuals with schizophrenia (n = 30), anxiety (n = 33) or unaffected by mental disorder (n = 30) completed measures of aberrant salience [Aberrant Salience Inventory (ASI), Salience Attribution Test (SAT)], motivation (Effort Expenditure for Reward Task), and reinforcer sensitivity (Stimulus Chase Task).
Results
Schizophrenia participants scored higher than anxiety (d = 0.71) and unaffected (d = 1.54) groups on the ASI and exhibited greater aberrant salience (d = 0.60) and lower adaptive salience (d = 0.98) than anxious participants on the SAT. There was no evidence of a correlation between measures of aberrant salience. Schizophrenia was associated with related deficits in motivated behaviour and maladaptive reward processing. However, these differences in reward processing did not correlate with aberrant salience measures.
Conclusions
The results suggest that key measures of aberrant salience have limited specificity and validity. These problems may account for inconsistent findings reported in the literature.
Clinical Nursing Skills provides students with a strong, industry-focused foundation in nursing across various clinical settings. It includes the essential theory as well as relevant practical examples, which illustrate the skills required to prepare students for the workplace and help them achieve clinical competence. Each chapter is written by leading academics and based on the registered nurse standards for practice. Pedagogical features include learning objectives, reflective questions, clinical tips, full-colour images, in-situ troubleshooting case studies, skills in practice case studies, keys terms and definitions, and research topics for further study. Clinical Nursing Skills is a highly practical and authoritative resource designed to educate the next generation of nurses. The book comes with free access to the VitalSource etext. This enhanced version of Clinical Nursing Skills houses homework assignments, tutorial assistance, guided solutions and additional content in one convenient resource, which you can download to your computer or mobile device.
Limpets and barnacles are important components of intertidal assemblages worldwide. This study examines the effects of barnacles on the foraging behaviour of the limpet Patella vulgata, which is the main algal grazer in the North-west Atlantic. The behaviour of limpets on a vertical seawall on the Isle of Man (UK) was investigated using autonomous radio-telemetry, comparing their activity patterns on plots characterized by dense barnacle cover and plots from which the barnacles had been removed. Limpet behaviour was investigated at mid-shore level, but two different elevations were considered. This experiment revealed a significant effect of barnacle cover on the activity of P. vulgata. Limpets on smooth surfaces spent a greater proportion of total time active than did limpets on barnacles. Movement activity was also greater in areas that were lower down in the tidal range. In general, limpets were either predominantly active during diurnal high or nocturnal low tides and always avoided nocturnal high tides. Individuals on barnacles at the higher elevation concentrated their activity during nocturnal low water. All the other groups of limpets (smooth surfaces on the upper level and all individuals on the lower shore) had more excursions centred around daylight hours with an equal distribution of activity between periods of low and high water. Inter-individual variability was, however, pronounced.
The family physician is key to facilitating access to psychiatric treatment for young people with first-episode psychosis, and this involvement can reduce aversive events in pathways to care. Those who seek help from primary care tend to have longer intervals to psychiatric care, and some people receive ongoing psychiatric treatment from the family physician.
Aims
Our objective is to understand the role of the family physician in help-seeking, recognition and ongoing management of first-episode psychosis.
Method
We will use a mixed-methods approach, incorporating health administrative data, electronic medical records (EMRs) and qualitative methodologies to study the role of the family physician at three points on the pathway to care. First, help-seeking: we will use health administrative data to examine access to a family physician and patterns of primary care use preceding the first diagnosis of psychosis; second, recognition: we will identify first-onset cases of psychosis in health administrative data, and look back at linked EMRs from primary care to define a risk profile for undetected cases; and third, management: we will examine service provision to identified patients through EMR data, including patterns of contacts, prescriptions and referrals to specialised care. We will then conduct qualitative interviews and focus groups with key stakeholders to better understand the trends observed in the quantitative data.
Discussion
These findings will provide an in-depth description of first-episode psychosis in primary care, informing strategies to build linkages between family physicians and psychiatric services to improve transitions of care during the crucial early stages of psychosis.
To many observers across the political spectrum, American democracy appears under threat. What does the Trump presidency portend for American politics? How much confidence should we have in the capacity of American institutions to withstand this threat? We argue that understanding what is uniquely threatening to democracy requires looking beyond the particulars of Trump and his presidency. Instead, it demands a historical and comparative perspective on American politics. Drawing on insights from the fields of comparative politics and American political development, we argue that Trump’s election represents the intersection of three streams in American politics: polarized two-party presidentialism; a polity fundamentally divided over membership and status in the political community, in ways structured by race and economic inequality; and the erosion of democratic norms. The current political circumstance threatens the American democratic order because of the interactive effects of institutions, identity, and norm-breaking.
This paper presents detailed observations of the regularly rippled surface on an Antarctic blue-ice area near Svea, at five sites. The wavelength of the ripples was found to be 20–24 cm, while the wave height (crest–trough) was 1–2 cm. The ripple crests are generally oriented perpendicular to the direction of the strongest winds. Repeated measurements show that wave heights increase throughout the summer, with most ablation occurring in the wave troughs. This implies that traditional methods of measuring ablation (such as stakes when a rod on the ice surface is used to define a mean surface height) tend to underestimate total ablation because they sample only crests. One site exhibited significant migration of the surface ripples of about 2 cm month−1 in the downwind direction, whereas three other sites showed no significant wave movement. The formation and the specific characteristics of the surface ripples are most likely caused by self-amplifying interaction mechanisms between the free ice surface and the overlying turbulent atmosphere, which necessarily involve spatial variations in sublimation. A simple model was used to quantify the interaction between the surface ripples, the airflow aloft and the sublimation rate. The model is able to predict wavelengths and migration rates that are in reasonable agreement with the observations.
Traditionally, Weimar cinema has been equated with the work of a handful of auteurist filmmakers and a limited number of canonical films. Often a single, limited phenomenon, "expressionist film," has been taken as synonymous with the cinema of the entire period. But in recent decades, such reductive assessments have been challenged by developments in film theory and archival research that highlight the tremendous richness and diversity of Weimar cinema. This widening of focus has brought attention to issues such as film as commodity; questions of technology and genre; transnational collaborations and national identity; effects of changes in socioeconomics and gender roles on film spectatorship; and connections between film and other arts and media. Such shifts have been accompanied by archival research that has made a cornucopia of new information available, now augmented by the increased availability of films from the period on DVD. This wealth of new source material calls fora re-evaluation of Weimar cinema that considers the legacies of lesser-known directors and producers, popular genres, experiments of the artistic avant-garde, and nonfiction films, all of which are aspects attended to by the essays in this volume.
Contributors: Ofer Ashkenazi, Jaimey Fisher, Veronika Fuechtner, Joseph Garncarz, Barbara Hales, Anjeana Hans, Richard W. McCormick, Nancy P.Nenno, Elizabeth Otto, Mihaela Petrescu, Theodore F. Rippey, Christian Rogowski, Jill Smith, Philipp Stiasny, Chris Wahl, Cynthia Walk, Valerie Weinstein, Joel Westerdale.
Christian Rogowski is Professor of German at Amherst College.