45 results
Dissonance in the face of Alzheimer's disease breakthroughs: clinician and lay stakeholder acceptance, concerns and willingness to pay for emerging disease-modifying therapies
- Irina Kinchin, Sharon Walsh, Rachel Dinh, Margaret Kapuwa, Sean P. Kennelly, Ann-Marie Miller, Ann Nolan, Sean O'Dowd, Laura O'Philbin, Suzanne Timmons, Iracema Leroi
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- Journal:
- The British Journal of Psychiatry , FirstView
- Published online by Cambridge University Press:
- 17 April 2024, pp. 1-7
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Background
Introducing new disease-modifying therapies (DMTs) for Alzheimer's disease demands a fundamental shift in diagnosis and care for most health systems around the world. Understanding the views of health professionals, potential patients, care partners and taxpayers is crucial for service planning and expectation management about these new therapies.
AimsTo investigate the public's and professionals’ perspectives regarding (1) acceptability of new DMTs for Alzheimer's disease; (2) perceptions of risk/benefits; (3) the public's willingness to pay (WTP).
MethodInformed by the ‘theoretical framework of acceptability’, we conducted two online surveys with 1000 members of the general public and 77 health professionals in Ireland. Descriptive and multivariate regression analyses examined factors associated with DMT acceptance and WTP.
ResultsHealthcare professionals had a higher acceptance (65%) than the general public (48%). Professionals were more concerned about potential brain bleeds (70%) and efficacy (68%), while the public focused on accessibility and costs. Younger participants (18–24 years) displayed a higher WTP. Education and insurance affected WTP decisions.
ConclusionsThis study exposes complex attitudes toward emerging DMTs for Alzheimer's disease, challenging conventional wisdom in multiple dimensions. A surprising 25% of the public expressed aversion to these new treatments, despite society's deep-rooted fear of dementia in older age. Healthcare professionals displayed nuanced concerns, prioritising clinical effectiveness and potential brain complications. Intriguingly, younger, better-educated and privately insured individuals exhibited a greater WTP, foregrounding critical questions about healthcare equity. These multifaceted findings serve as a guidepost for healthcare strategists, policymakers and ethicists as we edge closer to integrating DMTs into Alzheimer's disease care.
The impact of badmouthing of medical specialties to medical students
- Dylan Viani Walsh, Niamh Murphy, Shane Evans, Kieran C. Murphy, Allys Guerandel, Anne M. Doherty, Brian Hallahan, John Lally
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- Journal:
- Irish Journal of Psychological Medicine , First View
- Published online by Cambridge University Press:
- 14 February 2024, pp. 1-8
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Objectives:
This study aimed to evaluate the proportion of Irish medical students exposed to ‘badmouthing’ of different specialities and to ascertain: the degree of criticism of specialities based on the seniority of clinical or academic members of staff; if ‘badmouthing’ influenced student career choice in psychiatry; and attitudes of medical students towards psychiatry as a speciality and career choice.
Methods:Medical students in three Irish universities were invited to complete an online survey to determine the frequency and effect of non-constructive criticism on choice of medical specialty. The online questionnaire was distributed to Royal College of Surgeons in Ireland (RCSI), University of Galway (UoG) and University College Dublin (UCD) in the academic year 2020–2021.
Results:General practice (69%), surgery (65%) and psychiatry (50%) were the most criticised specialties. Criticism was most likely to be heard from medical students. 46% of students reported reconsidering a career in psychiatry due to criticism from junior doctors. There was a positive perception of psychiatry with 27% of respondents considering psychiatry as a first-choice specialty.
Conclusions:Criticism of psychiatry by doctors, academics and student peers negatively influences students’ career choice, which could be contributing to recruitment difficulties in psychiatry.
Hand hygiene behavior change: a review and pilot study of an automated hand hygiene reminder system implementation in a public hospital
- Arta Seferi, Kalliopi Parginos, Wiline Jean, Christopher Calero, Joshua Fogel, Shantel Modeste, Beverley-Ann Scott, Marjorie Daly-Walsh, Wilfredo Yap, Manjinder Kaur, Terence Brady, Theresa Madaline
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue 1 / 2023
- Published online by Cambridge University Press:
- 10 July 2023, e122
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Objective:
To review and study implementation of an automated hand hygiene reminder system (AHHRS).
Design:Prospective, nonrandomized, before-after quality improvement pilot study conducted over 6 months.
Setting:Medical-surgical unit (MSU) and medical intensive care unit (MICU) at a public hospital in New York City.
Participants:There were 2,642 healthcare worker observations in the direct observation (DO) period versus 265,505 in the AHHRS period, excluding AHHRS observations collected during the 1-month crossover period when simultaneous DO occurred.
Intervention:We compared hand hygiene adherence (HHA) measured by DO prior to the pilot and after AHHRS implementation. We compared changes in HHA and potential cross-contamination events (CCEs) (room exit and subsequent entry without HHA) from baseline for each biweekly period during the pilot.
Results:Engagement, education/training, data transparency, and optimization period resulted in successful implementation and adoption of the AHHRS. Observations were greater utilizing AHHRS than DO (265,505 vs 2,642, P < .01). Due to the expected Hawthorne effect, HHA was significantly less for AHHRS than DO in MSU (90.99% vs 97.21%, P < .01) and MICU (91.21% vs 98.65%, P < .01). HHA significantly improved from 86.47% to 89.68% in MSU (P < .001) and 85.93% to 91.24% in the MICU (P < .001) from the first biweekly period of AHHRS utilization to the last. CCE decreased from 73.42% to 65.11% in the MSU and significantly decreased from 81.22% to 53.19% in the MICU (P < .05).
Conclusions:We describe how an AHHRS approach was successfully implemented at our facility. With ongoing feedback and system optimization, AHHRS improved HHA and reduced CCE over time.
Clinical impact of healthcare-associated respiratory syncytial virus in hospitalized adults
- Alexandra Hill-Ricciuti, Edward E. Walsh, William G. Greendyke, Yoonyoung Choi, Angela Barrett, Luis Alba, Angela R. Branche, Ann R. Falsey, Matthew Phillips, Lyn Finelli, Lisa Saiman
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 44 / Issue 3 / March 2023
- Published online by Cambridge University Press:
- 14 November 2022, pp. 433-439
- Print publication:
- March 2023
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Objective:
To describe the clinical impact of healthcare-associated (HA) respiratory syncytial virus (RSV) in hospitalized adults.
Design:Retrospective cohort study within a prospective, population-based, surveillance study of RSV-infected hospitalized adults during 3 respiratory seasons: October 2017–April 2018, October 2018–April 2019, and October 2019–March 2020.
Setting:The study was conducted in 2 academically affiliated medical centers.
Patients:Each HA-RSV patient (in whom RSV was detected by PCR test ≥4 days after hospital admission) was matched (age, sex, season) with 2 community-onset (CO) RSV patients (in whom RSV was detected ≤3 days of admission).
Methods:Risk factors and outcomes were compared among HA-RSV versus CO-RSV patients using conditional logistic regression. Escalation of respiratory support associated with RSV detection (day 0) from day −2 to day +4 was explored among HA-RSV patients.
Results:In total, 84 HA-RSV patients were matched to 160 CO-RSV patients. In HA-RSV patients, chronic kidney disease was more common, while chronic respiratory conditions and obesity were less common. HA-RSV patients were not more likely to be admitted to an ICU or require mechanical ventilation, but they more often required a higher level of care at discharge compared with CO-RSV patients (44% vs 14%, respectively). Also, 29% of evaluable HA-RSV patients required respiratory support escalation; these patients were older and more likely to have respiratory comorbidities, to have been admitted to intensive care, and to die during hospitalization.
Conclusions:HA-RSV in adults may be associated with escalation in respiratory support and an increased level of support in living situation at discharge. Infection prevention and control strategies and RSV vaccination of high-risk adults could mitigate the risk of HA-RSV.
44 - Undergraduate Research in Social Work Education
- from Part III.6 - Disciplines A–Z
- Edited by Harald A. Mieg, Humboldt-Universität zu Berlin, Elizabeth Ambos, Angela Brew, Macquarie University, Sydney, Dominique Galli, Indiana University–Purdue University, Indianapolis, Judith Lehmann, Universidad de Buenos Aires, Argentina
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- The Cambridge Handbook of Undergraduate Research
- Published online:
- 11 August 2022
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- 07 July 2022, pp 414-422
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Summary
Undergraduate research education is increasingly important for social work practitioners given the demands for evidence-based practice in social service delivery. Increasingly research competency or new knowledge integration into practice has been identified as a professional responsibility. However, social workers eill often not use or engage in research in their practice settings, tasking social work educators to address this gap through developing innovative undergraduate curricula through which student learners can be engaged. This chapter examines the literature in this area and identifies several proposed engagement strategies such as incorporating research tasks directly into coursework, creating research assistant positions or internships, developing partnerships with community-based agencies to provide applied research opportunities or through case study scenarios and guest speakers, and using ‘real’ research datasets for qualitative/quantitative training. Building mentorship opportunities through research teams including undergraduate and graduate students to facilitate both teaching and learning opportunities in research may also be of benefit.
What are the mechanisms and contexts by which care groups achieve social and behavioural change in low- and middle-income countries? Group motivation findings from a realist synthesis
- Pieternella Pieterse, Aisling Walsh, Ellen Chirwa, Anne Matthews
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- Journal:
- Public Health Nutrition / Volume 25 / Issue 10 / October 2022
- Published online by Cambridge University Press:
- 01 June 2022, pp. 2908-2919
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Objective:
Infant and under-five mortality rates in low- and middle-income countries (LMIC) can be reduced by encouraging behaviours such as sleeping under insecticide-treated bed nets, exclusive breast-feeding for the first 6 months, regular handwashing, etc. Community-based volunteer or peer-to-peer mechanisms are cost-effective ways of promoting these lifesaving practices. However, the sustainability and reach of community-based behaviour change promotion remains a challenge. Our inquiry focuses on the utilisation, by non-governmental organisations (NGO), of Care Groups, a peer-to-peer behaviour change intervention. We asked: What are the mechanisms and contexts by which Care Groups achieve social and behavioural change in nutrition, health and other sectors?
Design:Realist synthesis reviewing forty-two texts that contained empirical evidence about Care Group interventions.
Setting:LMIC.
Participants:We held consultations with a research reference group, which included Care Group and nutrition experts, and Care Group – implementing NGO staff in Malawi.
Results:Different types of motivation drive the establishment and the sustainability of peer group interventions. A certain amount of motivation was derived from the resources provided by the NGO establishing the Care Groups. Subsequently, both volunteers and neighbourhood group members were motivated by the group dynamics and mutual support, as well as support from the wider community. Finally, volunteers and group members alike became self-motivated by their experience of being involved in group activities.
Conclusions:When designing and implementing community-based behaviour change interventions, awareness of the multi-directional nature of the motivating drivers that are experienced by peer- or community group members is important, to optimise these groups’ reach and sustainability.
Rapid Ultrasensitive Detection of Clostridiodes difficile Toxins in Stool Samples Using A Single-Molecule Counting Method
- Don Straus, Ann Zuniga, Alejandra Garces, Andrew Tempesta, Adam Williams, Bill Lauzier, Jennifer Hickey, Sadanand Gite, Selina Clancy, Yismel Rosario, Bruce Walsh, Jayson Bowers
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s450-s451
- Print publication:
- October 2020
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Background:Clostridiodes difficile infection is considered an urgent antibiotic resistance threat by the CDC, accounting for ∼225,000 hospitalizations, 12,800 deaths, and ∼$1 billion in healthcare costs in the United States in 2017. The presence of the secreted toxins that cause the devastating symptoms of this gastrointestinal infection are diagnostic of C. difficile infection (CDI). However, the rapid testing methods currently used to detect CDI lack accuracy. Enzyme immunoassays are specific but lack sensitivity because they do not detect CDI patients that have low levels of the toxins. Nucleic acid amplification tests (NAATs) are sensitive, but they lack specificity because they detect patients colonized with C. difficile in the dormant spore form that does not produce the toxins. This insufficiency has resulted in the adoption of complex multitest algorithms for C. difficile diagnosis. We present results for a new toxin test that demonstrates both high clinical sensitivity and clinical specificity for C. difficile toxin B on a fully automated benchtop platform. Methods: The detection technology uses nonmagnified digital imaging to count single toxin molecules that tether together target-specific magnetic and fluorescent particles. The 30-minute method includes the use of a dye cushion to eliminate wash steps and the need for time-consuming specimen preparation steps. We determined analytical performance characteristics of the test using negative clinical stool samples spiked with purified toxin. To assess clinical performance, we tested 785 stool samples from 5 clinical sites and compared the results with the cellular cytotoxicity neutralization assay (CCNA). Results: The test’s limit of detection for toxin B was 60 pg/mL. A comparison of the new test to the CCNA reference method gave 98% positive percentage agreement (83 of 85 samples) and 95% negative percentage agreement (667 of 700 samples). Conclusions: The new method demonstrated 96% accuracy compared to the gold standard for C. difficile toxin tests. The results also demonstrate an analytical sensitivity (limit of detection, 60 pg/mL). Thus, the test has the potential to detect CDI patients missed by enzyme immunoassay (EIA) tests due to their low analytical sensitivity. Because the test detects toxins directly, it is expected to have a lower false-positive rate than NAAT methods, which detect patients colonized with the non–toxin-producing spore form. A single accurate test for toxin-producing C. difficile could eliminate the need for multitest algorithms.
Funding: First Light Diagnostics, Inc., provided support for this study.
Disclosures: Donald Straus reports that he is the founder and chief scientific officer of First Light Diagnostics (FLDx) with salary and ownership interest in the form of stocks, stock options, and warrants. Adam Williams reports salary from First Light Diagnostics.
Mood and neural responses to social rejection do not seem to be altered in resilient adolescents with a history of adversity
- Jessica Fritz, Jason Stretton, Adrian Dahl Askelund, Susanne Schweizer, Nicholas D. Walsh, Bernet M. Elzinga, Ian M. Goodyer, Paul O. Wilkinson, Anne-Laura van Harmelen
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- Journal:
- Development and Psychopathology / Volume 32 / Issue 2 / May 2020
- Published online by Cambridge University Press:
- 21 March 2019, pp. 411-423
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Childhood adversity (CA) increases the risk of subsequent mental health problems. Adolescent social support (from family and/or friends) reduces the risk of mental health problems after CA. However, the mechanisms of this effect remain unclear, and we speculate that they are manifested on neurodevelopmental levels. Therefore, we investigated whether family and/or friendship support at ages 14 and 17 function as intermediate variables for the relationship between CA before age 11 and affective or neural responses to social rejection feedback at age 18. We studied 55 adolescents with normative mental health at age 18 (26 with CA and therefore considered “resilient”), from a longitudinal cohort. Participants underwent a Social Feedback Task in the magnetic resonance imaging scanner. Social rejection feedback activated the dorsal anterior cingulate cortex and the left anterior insula. CA did not predict affective or neural responses to social rejection at age 18. Yet, CA predicted better friendships at age 14 and age 18, when adolescents with and without CA had comparable mood levels. Thus, adolescents with CA and normative mood levels have more adolescent friendship support and seem to have normal mood and neural responses to social rejection.
‘In what orbit we shall find ourselves, no one could predict’: institutional reform, the university merger and ecclesiastical influence on Irish higher education in the 1960s
- Ann Nolan, John Walsh
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- Journal:
- Irish Historical Studies / Volume 41 / Issue 159 / May 2017
- Published online by Cambridge University Press:
- 11 July 2017, pp. 77-96
- Print publication:
- May 2017
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This paper explores the persistence of ecclesiastical influence on higher education in Ireland during an era of far-reaching policy change in the 1960s. The extensive interaction between political and official elites and the Catholic bishops offers a fascinating insight into the complex and contested process of policy formulation during an era of transformation in higher education. This study offers a re-interpretation of Whyte’s thesis that the Irish bishops displayed a ‘new flexibility’ in their response to governmental policy initiatives during this period, especially the initiative for university merger launched by Donogh O’Malley in 1967. Catholic prelates, notably John Charles McQuaid, the influential archbishop of Dublin, were pursuing a traditional Catholic religious and socio-political agenda in higher education, which sought not so much to accommodate new official initiatives as to shape such reforms in the ideological direction favoured by the bishops. McQuaid in particular enjoyed exceptional access to policy-makers and was an indispensable partner in launching the initiative for the university merger. The eventual failure of the merger, which was influenced by the successful resistance of academic elites and the declining significance of religious divisions in higher education, underlined the limits of ecclesiastical power in a rapidly changing society.
Once a Sacred and Secluded Place: Early Bronze Age Monuments at Church Lawton, near Alsager, Cheshire
- Malcolm Reid, with contributions from , Ian Brooks, Jim Innes, Stuart Needham, Fiona Roe, Ian Smith, Sam Walsh, Ann Woodward
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- Journal:
- Proceedings of the Prehistoric Society / Volume 80 / December 2014
- Published online by Cambridge University Press:
- 12 November 2014, pp. 237-277
- Print publication:
- December 2014
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Two round barrows were excavated in 1982–3 at Church Lawton near to the eastern edge of the Cheshire and Staffordshire Plain. One of the barrows was defined by a ring of nine glacial boulders and it is possible that these monoliths initially formed a free-standing stone circle. The remains constitute a rare example of the use of stone to enhance a Bronze Age barrow in the lowlands of central western England. Beneath the mound demarcated by the boulders were the burnt remains of a small, roughly rectangular turf stack associated with fragments of clay daub and pieces of timber. No direct evidence of burial was found within the monument. A radiocarbon date suggests that the structural sequence began sometime in the late 3rd–early 2nd millennium cal bc. The other barrow was principally a two-phased construction and contained urned and un-urned cremation burials. A battle-axe was placed next to one of the burials. Radiocarbon dates obtained from the cremations and associated deposits indicate that individuals were being interred from the late 3rd or early 2nd millennium cal bc, with the practice continuing until the middle of the 2nd millennium. The barrows formed part of a cemetery, consisting of three known mounds.
Algorithm for Quantifying Frontal EMG Responsiveness for Sedation Monitoring
- Timo Petteri Lapinlampi, Hanna Elina Viertiö-Oja, Matti Helin, Kimmo Henrik Uutela, Mika Olli Kristian Särkelä, Anne Vakkuri, Gordon Bryan Young, Timothy Simon Walsh
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 41 / Issue 5 / September 2014
- Published online by Cambridge University Press:
- 30 October 2014, pp. 611-619
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Introduction
To study stimulation-related facial electromyographic (FEMG) activity in intensive care unit (ICU) patients, develop an algorithm for quantifying the FEMG activity, and to optimize the algorithm for monitoring the sedation state of ICU patients.
MethodsFirst, the characteristics of FEMG response patterns related to vocal stimulation of 17 ICU patients were studied. Second, we collected continuous FEMG data from 30 ICU patients. Based on these data, we developed the Responsiveness Index (RI) algorithm that quantifies FEMG responses. Third, we compared the RI values with clinical sedation level assessments and adjusted algorithm parameters for best performance.
ResultsIn patients who produced a clinically observed response to the vocal stimulus, the poststimulus FEMG power was 0.33 µV higher than the prestimulus power. In nonresponding patients, there was no difference. The sensitivity and specificity of the developed RI for detecting deep sedation in the subgroup with low probability of encephalopathy were 0.90 and 0.79, respectively.
ConclusionConsistent FEMG patterns were found related to standard stimulation of ICU patients. A simple and robust algorithm was developed and good correlation with clinical sedation scores achieved in the development data.
Development of a competency framework for the nutrition in emergencies sector
- Jessica Meeker, Abigail Perry, Carmel Dolan, Colleen Emary, Kate Golden, Caroline Abla, Anne Walsh, Ali Maclaine, Andrew Seal
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- Journal:
- Public Health Nutrition / Volume 17 / Issue 3 / March 2014
- Published online by Cambridge University Press:
- 08 October 2013, pp. 689-699
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Objective
There is a recognised need to strengthen capacity in the nutrition in emergencies sector and for greater clarity on the role of emergency nutritionists and the skills they require. Competency frameworks are an important tool for human resource development and have been developed for several other humanitarian sectors. We therefore developed a technical competency framework for practitioners in nutrition in emergencies.
DesignExisting competency frameworks were reviewed and interviews conducted to explore methods used in developing competency frameworks for other sectors. Competencies were identified through interviews with field experts, feedback from course trainees, academic course content and job specifications. Competencies were then categorised and behavioural indicators developed for each. The draft framework was then reviewed by members of the Global Nutrition Cluster and modified in an iterative process.
SettingGlobal.
SubjectsNot applicable.
ResultsA wide range of competencies were identified as essential for nutritionists working in emergencies, covering technical skills and general core competencies. The proposed framework contains twenty competency areas with 161 behavioural indicators categorised into three levels, corresponding to the requirements of progressively more senior roles. Many of the competencies are common across development and emergency nutrition.
ConclusionsThe proposed technical competency framework should prove to be a valuable tool in creating standards within the sector and promoting effective capacity strengthening and professionalisation. Continued research is needed to validate the framework, optimise methods for assessment, develop approaches to integrate it within the sector and measure its impact on performance.
Core Competencies for Disaster Medicine and Public Health
- Lauren Walsh, Italo Subbarao, Kristine Gebbie, Kenneth W. Schor, Jim Lyznicki, Kandra Strauss-Riggs, Arthur Cooper, Edbert B. Hsu, Richard V. King, John A. Mitas II, John Hick, Rebecca Zukowski, Brian A. Altman, Ruth Anne Steinbrecher, James J. James
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 6 / Issue 1 / March 2012
- Published online by Cambridge University Press:
- 08 April 2013, pp. 44-52
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Effective preparedness, response, and recovery from disasters require a well-planned, integrated effort with experienced professionals who can apply specialized knowledge and skills in critical situations. While some professionals are trained for this, others may lack the critical knowledge and experience needed to effectively perform under stressful disaster conditions. A set of clear, concise, and precise training standards that may be used to ensure workforce competency in such situations has been developed. The competency set has been defined by a broad and diverse set of leaders in the field and like-minded professionals through a series of Web-based surveys and expert working group meetings. The results may provide a useful starting point for delineating expected competency levels of health professionals in disaster medicine and public health.
(Disaster Med Public Health Preparedness. 2012;6:44–52)
Choline supplementation and measures of choline and betaine status: a randomised, controlled trial in postmenopausal women
- Julie M. W. Wallace, Jacqueline M. McCormack, Helene McNulty, Paula M. Walsh, Paula J. Robson, Maxine P. Bonham, Maresa E. Duffy, Mary Ward, Anne M. Molloy, John M. Scott, Per M. Ueland, J. J. Strain
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- Journal:
- British Journal of Nutrition / Volume 108 / Issue 7 / 14 October 2012
- Published online by Cambridge University Press:
- 15 December 2011, pp. 1264-1271
- Print publication:
- 14 October 2012
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Choline is an essential nutrient and can also be obtained by de novo synthesis via an oestrogen responsive pathway. Choline can be oxidised to the methyl donor betaine, with short-term supplementation reported to lower plasma total homocysteine (tHcy); however, the effects of longer-term choline supplementation are less clear. We investigated the effect of choline supplementation on plasma concentrations of free choline, betaine and tHcy and B-vitamin status in postmenopausal women, a group more susceptible to low choline status. We also assessed whether supplementation altered plasma lipid profiles. In this randomised, double-blinded, placebo-controlled study, forty-two healthy postmenopausal women received 1 g choline per d (as choline bitartrate), or an identical placebo supplement with their habitual diet. Fasting blood samples were collected at baseline, week 6 and week 12. Administration of choline increased median choline and betaine concentrations in plasma, with significant effects evident after 6 weeks of supplementation (P < 0·001) and remaining significant at 12 weeks (P < 0·001); no effect was observed on folate status or on plasma lipids. Choline supplementation induced a median (25th, 75th percentile) change in plasma tHcy concentration at week 6 of − 0·9 ( − 1·6, 0·2) μmol, a change which, when compared to that observed in the placebo group 0·6 ( − 0·4, 1·9) μmol, approached statistical significance (P = 0·058). Choline supplementation at a dose of 1 g/d significantly increases the circulating concentration of free choline, and can also significantly increase the concentration of the methyl donor, betaine, thereby potentially enhancing the betaine–homocysteine methyltransferase-mediated remethylation of tHcy. This trial was registered at http://www.controlled-trials.com/ISRCTN82708510.
Practice guidelines need to address the ‘how’ and the ‘what’ of implementation
- Ann McKillop, Jackie Crisp, Kenneth Walsh
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- Journal:
- Primary Health Care Research & Development / Volume 13 / Issue 1 / 05 January 2012
- Published online by Cambridge University Press:
- 13 October 2011, pp. 48-59
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Aim
The aim of this study was to explore the realities of everyday nursing practice associated with the implementation of a guideline for the assessment and management of cardiovascular risk.
BackgroundThe use of clinical practice guidelines is pivotal to improving health outcomes. However, the implementation of guidelines into practice is complex, unpredictable and, in spite of much investigation, remains resistant to explanation of what works and why. Exploration of the nature of guideline implementation has the potential to illuminate the complexities of guideline implementation by focussing on the nature of practice. Nurses are well placed at the front line of primary health care to contribute to an understanding of how guideline implementation plays out in their everyday practice.
MethodsQualitative description was used, involving focus groups and interviews with 32 participants (20 nurses, four doctors, five managers and three funder/planners), to explore the use of a guideline in everyday primary health-care practice. Thematic analysis of data was managed through an inductive process of familiarisation, coding, categorising and generation of themes.
FindingsFour themes were generated from the data portraying the realities of guideline implementation for primary health-care nurses: self-managing patient, everyday nursing practice, developing new relationships in the health team and impact on health-care delivery. The findings reveal that, even with the best of intentions to implement the guideline, health professionals were frustrated and at a loss as to how to achieve that in practice. Consequently, cardiovascular risk assessment and management was uneven and fragmented. Primary health-care practice environments vary so much that solutions to the difficulties of implementing evidence into practice requires context-specific solution-finding through collaborative teamwork. Furthermore, the attention of guideline developers, health-care policymakers, funders and researchers requires direct focus on the ‘how’ and the ‘what’ of evidence implementation.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. 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Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- Book:
- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Tardive dyskinesia on low dose risperidone
- Tolulope Alugo, Finian Kelly, Ann O'Grady-Walsh, Peter Whitty
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- Journal:
- Irish Journal of Psychological Medicine / Volume 27 / Issue 1 / March 2010
- Published online by Cambridge University Press:
- 13 June 2014, pp. 45-46
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- March 2010
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Tardive dyskinesia is a neurological disorder characterised by involuntary and purposeless movements affecting any part of the body. These movements typically occur in the oro-facial area and the patient is usually unaware of them. There are inconsistent findings in the literature on the risk factors for developing tardive dyskinesia. Nevertheless, previous reports indicate that tardive dyskinesia is more common in female patients, patients with a history of alcohol and substance misuse, affective disorders, and intellectual disability. The dose, class and duration of antipsychotic nmedication may also be independent risk factors. We report on the case of a patient who developed tardive dyskinesia on a low dose of the second generation antipsychotic risperidone.
Contributors
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- By Kathryn Andolsek, Barbara S. Apgar, Deborah Bostock, Kay Bauman, Abenaa Brewster, Sandra K. Burge, Nancy Davidson, Mary-Anne Enoch, Margaret Gradison, Cathrine Hoyo, William J. Hueston, Victoria S. Kaprielian, Connie Marsh, Diana McNeill, Phillippa J. Miranda, Tanya A. Miszko, Cathleen Morrow, Gwendolyn Murphy, Jo Ann Rosenfeld, Ellen L. Sakornbut, Jeannette E. South-Paul, Valerie Ulstad, Meghan Walsh, Cheryl E. Woodson
- Edited by Jo Ann Rosenfeld, The Johns Hopkins University School of Medicine
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- Handbook of Women's Health
- Published online:
- 26 December 2009
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- 22 October 2009, pp ix-x
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Do statistics lie? Suicide in Kildare – and in Ireland
- Dermot Walsh, Ann Cullen, Rachel Cullivan, Brendan O'donnell
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- Psychological Medicine / Volume 20 / Issue 4 / November 1990
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- 09 July 2009, pp. 867-871
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This study, reporting a ten-year investigation of suicide in Kildare, found that the suicide rate based on clinical assessment of coroner's records was very close to the Central Statistics Office (CSO) figure for Kildare and for Ireland as a whole for the same period. Dublin data for 1977–1981 confirmed these findings. Since in the 1960s similar clinical assessment concluded that CSO rates underestimated suicide by a factor of two or over, we believe that changes in CSO coding procedures whereby more deaths are now coded to suicide than was the case in the past have resulted in current CSO data reflecting accurately the rate of clinical suicide. There has been more than a three-fold increase in CSO suicide rates in Ireland between 1968 and 1987. Even allowing for improved CSO practices there still remains a considerable excess of suicide deaths which indicates a doubling of ‘real’ suicide in Ireland over these twenty years.
Partition of circulating triglycerides between formation of milk fat and other metabolic pathways in sheep
- R. F. Glascock, R. W. Smith, Ann Walsh
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- The Journal of Agricultural Science / Volume 101 / Issue 1 / August 1983
- Published online by Cambridge University Press:
- 27 March 2009, pp. 33-38
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An emulsion of [3H]triglycerides was used to investigate how circulating triglycerides are partitioned between milk fat, body fat and use as an energy source in lactating sheep. Immediately after intravenous injection of the emulsion the radioactivity in the blood was predominantly associated with the triglycerides of the fraction that contained chylomicrons and very low density lipoproteins. The radioactive triglyceride was used both as a precursor of milk fat and as a source of energy. The proportions utilized for these two purposes were determined experimentally and the amount retained in the carcass lipids was found by difference. In separate control experiments with nonlactating sheep the total radioactivity in the body lipids was determined by carcass analysis. This total together with that accounted for by oxidation amounted to 98% of the total radioactivity injected. These results established that the emulsion was a reliable model for the purpose intended.
The proportion of the labelled triglyceride that appeared in milk fat declined from 45% at 17 days after lambing to 8–10% at 73 days after lambing. The proportion that was oxidized was also lower in late lactation so that retention in carcass lipids was substantially increased at that time.