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To determine if the high-level personal protective equipment used in the treatment of high-consequence infectious diseases is effective at stopping the spread of pathogens to healthcare personnel (HCP) while doffing.
Background:
Personal protective equipment (PPE) is fundamental to the safety of HCPs. HCPs treating patients with high-consequence infectious diseases use several layers of PPE, forming complex protective ensembles. With high-containment PPE, step-by-step procedures are often used for donning and doffing to minimize contamination risk to the HCP, but these procedures are rarely empirically validated and instead rely on following infection prevention best practices.
Methods:
A doffing protocol video for a high-containment PPE ensemble was evaluated to determine potential contamination pathways. These potential pathways were tested using fluorescence and genetically marked bacteriophages.
Results:
The experiments revealed existing protocols permit contamination pathways allowing for transmission of bacteriophages to HCPs. Updates to the doffing protocols were generated based on the discovered contamination pathways. This updated doffing protocol eliminated the movement of viable bacteriophages from the outside of the PPE to the skin of the HCP.
Conclusions:
Our results illustrate the need for quantitative, scientific investigations of infection prevention practices, such as doffing PPE.
Philosophical perspectives on time perception often make reference to the experience of music, and for good reason. Listening to a melody takes time, for the reason that melodies have temporal parts. Just as works of paradigmatic visual arts such as painting or sculpture are extended in space, musical works are extended in time. ‘Music’, as Jonathan Kramer puts it, ‘unfolds in time’. Consider hearing any sequences of notes, for example a broken A Minor chord. First one hears the A, then the C, then the E. The sounding of each note occupies a distinct temporal location. One hears the A only when A is played, C only when C is played, and E only when E is played. One way to put this is to say that one's auditory experience is restricted to the present. One hears only what is being played at the time of one's hearing. Indeed, in perceptual experience one seems to be aware of perceived events as present. The note that one hears seems to be happening now. In this respect, auditory perception differs from memory. In memory one is aware of events that occurred at a time before one's remembering of them.
These are truisms. Yet they come into apparent conflict with the equally obvious fact that in hearing the broken chord, we hear the progression from one note to the next. We hear, one might say, not only the notes but also the relations between them. These relations can be temporal – A occurs before C – or aesthetic – A harmonises with C. But if we can hear a relation between two notes, A and C say, surely we must, at that moment, be hearing both A and C. For presumably we could not hear the relation between A and C if we cannot hear the notes that are so related. But since A and C occur at different times, it seems that there must be a moment at which we hear what occurred at an earlier time. That, however, is inconsistent with the truism that we hear only what is played at the time of hearing.
For more than a decade, Improving Access to Psychological Therapies (IAPT) has been training a new workforce of psychological therapists. Despite evidence of stress and burnout both in trainee mental health professionals, and qualified IAPT clinicians, little is known about these topics in IAPT trainees. Consequently, this systematic review sought to establish the current state of the literature regarding stress and burnout in IAPT trainees. Electronic databases were searched to identify all published and available unpublished work relating to the topic. On the basis of pre-established eligibility criteria, eight studies (including six unpublished doctoral theses) were identified and assessed for quality. This review identifies that research into the experience of IAPT trainees is under-developed. Existing evidence tentatively suggests that IAPT trainees may experience levels of stress and burnout that are higher than their qualified peers and among the higher end of healthcare professionals more generally. The experience of fulfilling dual roles as mental health professionals and university students concurrently appears to be a significant source of stress for IAPT trainees. More research regarding the levels and sources of stress and burnout in IAPT trainees is urgently needed to confirm and extend these findings. Recommendations for future research in the area are given.
Key learning aims
(1) To establish the current state of the literature regarding stress and burnout in IAPT trainees.
(2) To raise practitioner, service and education-provider awareness regarding the levels and perceived sources of stress and burnout in IAPT trainees.
(3) To make recommendations regarding future research on the topic.
Head impact exposure (HIE) in youth football is a public health concern. The objective of this study was to determine if one season of HIE in youth football was related to cognitive changes.
Method:
Over 200 participants (ages 9–13) wore instrumented helmets for practices and games to measure the amount of HIE sustained over one season. Pre- and post-season neuropsychological tests were completed. Test score changes were calculated adjusting for practice effects and regression to the mean and used as the dependent variables. Regression models were calculated with HIE variables predicting neuropsychological test score changes.
Results:
For the full sample, a small effect was found with season average rotational values predicting changes in list-learning such that HIE was related to negative score change: standardized beta (β) = -.147, t(205) = -2.12, and p = .035. When analyzed by age clusters (9–10, 11–13) and adding participant weight to models, the R2 values increased. Splitting groups by weight (median split), found heavier members of the 9–10 cohort with significantly greater change than lighter members. Additionaly, significantly more participants had clinically meaningful negative changes: X2 = 10.343, p = .001.
Conclusion:
These findings suggest that in the 9–10 age cluster, the average seasonal level of HIE had inverse, negative relationships with cognitive change over one season that was not found in the older group. The mediation effects of age and weight have not been explored previously and appear to contribute to the effects of HIE on cognition in youth football players.
Morning coffee is a common remedy following disrupted sleep, yet each factor can independently impair glucose tolerance and insulin sensitivity in healthy adults. Remarkably, the combined effects of sleep fragmentation and coffee on glucose control upon waking per se have never been investigated. In a randomised crossover design, twenty-nine adults (mean age: 21 (sd 1) years, BMI: 24·4 (sd 3·3) kg/m2) underwent three oral glucose tolerance tests (OGTT). One following a habitual night of sleep (Control; in bed, lights-off trying to sleep approximately 23.00–07.00 hours), the others following a night of sleep fragmentation (as Control but waking hourly for 5 min), with and without morning coffee approximately 1 h after waking (approximately 300 mg caffeine as black coffee 30 min prior to OGTT). Individualised peak plasma glucose and insulin concentrations were unaffected by sleep quality but were higher following coffee consumption (mean (normalised CI) for Control, Fragmented and Fragmented + Coffee, respectively; glucose: 8·20 (normalised CI 7·93, 8·47) mmol/l v. 8·23 (normalised CI 7·96, 8·50) mmol/l v. 8·96 (normalised CI 8·70, 9·22) mmol/l; insulin: 265 (normalised CI 247, 283) pmol/l; and 235 (normalised CI 218, 253) pmol/l; and 310 (normalised CI 284, 337) pmol/l). Likewise, incremental AUC for plasma glucose was higher in the Fragmented + Coffee trial compared with Fragmented. Whilst sleep fragmentation did not alter glycaemic or insulinaemic responses to morning glucose ingestion, if a strong caffeinated coffee is consumed, then a reduction in glucose tolerance can be expected.
Our ALMA observations of HCO+ and HCN show such redshifted absorption toward an isolated core, BHR 71. Both lines show a similar redshifted absorption profile. We also found emissions of complex organic molecules (COMs) around 345 GHz from a compact region centered on the continuum source, which is barely resolved with a beam of 0″27, corresponding to ∼50 AU.
The current study examined within- and cross-language connectivity in four priming conditions: repetition, translation, within-language semantic and cross-language semantic priming. Unbalanced Hebrew–English bilinguals (N = 89) completed a lexical decision task in one of the four conditions in both languages. Priming effects were significantly larger from L1 to L2 for translation priming and marginally so for cross-language semantic priming. Priming effects were comparable for L1 and L2 in repetition and within-language semantic priming. These results support the notion that L1 words are more effective primes but also that L2 targets benefit more from priming. This pattern of results suggests that the lower frequency of use of L2 lexical items in unbalanced bilinguals contributes to asymmetrical cross-language priming via lower resting-level activation of targets and not only via less efficient lexical activation of primes, as highlighted by the BIA+ model.
A low-volume (21.5 L/ha) spinning disc (controlled droplet applicator) and a high-volume (187 L/ha) boom-nozzle applicator were compared in applying tank mixtures of the weed pathogen Colletotrichum gloeosporioides (Penz.) Sacc. f. sp.] aeschynomene (henceforth designated C.G.A.) and acifluorfen {5-[2-chloro-4-(trifluoromethyl)phenoxy]-2-nitrobenzoic acid} for control of northern jointvetch [Aeschynomene virginica (L.) B.S.P. # AESVI] and hemp sesbania [Sesbania exaltata (Raf.) Rydb. ex A.W. Hill # SEBEX] in soybean [Glycine max (L.) Merr. ‘Tracy M’]. Application with a spinning disc did not increase control of either weed species over the boom-nozzle applicator. C.G.A. controlled northern jointvetch in 2 of 3 yr. Northern jointvetch control with the spinning-disc was poorer at lower rates in years of unfavorable environment. Acifluorfen at 0.56 kg ai/ha and applied with either applicator controlled hemp sesbania satisfactorily.
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.
Small food store interventions show promise to increase healthy food access in under-resourced areas. However, none have tested the impact of price discounts on healthy food supply and demand. We tested the impact of store-directed price discounts and communications strategies, separately and combined, on the stocking, sales and prices of healthier foods and on storeowner psychosocial factors.
Design
Factorial design randomized controlled trial.
Setting
Twenty-four corner stores in low-income neighbourhoods of Baltimore City, MD, USA.
Subjects
Stores were randomized to pricing intervention, communications intervention, combined pricing and communications intervention, or control. Stores that received the pricing intervention were given a 10–30 % price discount by wholesalers on selected healthier food items during the 6-month trial. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests and refrigerators.
Results
All interventions showed significantly increased stock of promoted foods v. control. There was a significant treatment effect for daily unit sales of healthy snacks (β=6·4, 95 % CI 0·9, 11·9) and prices of healthy staple foods (β=–0·49, 95 % CI –0·90, –0·03) for the combined group v. control, but not for other intervention groups. There were no significant intervention effects on storeowner psychosocial factors.
Conclusions
All interventions led to increased stock of healthier foods. The combined intervention was effective in increasing sales of healthier snacks, even though discounts on snacks were not passed to the consumer. Experimental research in small stores is needed to understand the mechanisms by which store-directed price promotions can increase healthy food supply and demand.
Greenhouse studies were conducted to evaluate the influence of selected adjuvants on glyphosate efficacy on yellow nutsedge and tuber production. Glyphosate was applied at 0, 0.25, 0.43, 0.87, 1.26 (1× rate), and 1.74 kg ae ha−1 at 31 d after yellow nutsedge was planted. Each rate was mixed with one of the following adjuvants: ammonium sulfate (AMS), AMS plus nonionic surfactant (NIS), or AMS plus an experimental adjuvant (W-7995) plus NIS. Plants were evaluated for injury and for the number and size of tubers produced. Dose–response curves based on log-logistic models were used to determine the effective glyphosate rate plus adjuvant that provided both 90% effective dose (ED90) for yellow nutsedge injury and reduced tuber production. Addition of NIS to glyphosate plus AMS resulted in the greatest yellow nutsedge injury at 28 d after treatment (DAT). Addition of the experimental adjuvant plus NIS resulted in injury similar to NIS alone. The ED90 for injury at 28 DAT was 2.12 kg ha−1 with glyphosate plus AMS and NIS compared with 2.18 kg ha−1 for W-7995 plus NIS and 3.06 kg ha−1 with AMS alone. The ED90 rates with different adjuvants represent 168%, 173%, and 243% of the highest glyphosate rate (1.26 kg ha−1) labeled for application on many glyphosate-resistant crops. However, the estimated ED90 to reduce small, medium, large, and total tubers were 1.60, 1.50, 1.63, and 1.66 kg ha−1, respectively. Increases in labeled rates of glyphosate may be required to reduce yellow nutsedge tuber production in field conditions. Use of lower glyphosate rates should be discouraged because it may increase tuber production and exacerbate yellow nutsedge expansion in infested fields.
Theorists of emotion typically recognize a number of features common to them: emotions are intentional, being directed towards objects in one's environment (including oneself); emotions involve the evaluation or appraisal of those objects as possessing various positive or negative values; emotions feel a certain way, in that there is something it is like to undergo an emotional experience; and finally emotions are expressed, involving a readiness or disposition to move one's body in a number of ways. Emotional expression in its variety – the topic of this volume of essays – is a phenomenon with which we are intimately familiar. It is something that we experience, both in ourselves and others, on a daily basis. As Edith Stein wrote, somewhat poetically,
I blush for shame, I irately clench my fist, I angrily furrow my brow, I groan with pain, am jubilant with joy […] as I live through the feeling, I feel it terminate in an expression or release expression out of itself.
(Stein [1917]1970: 51)
But is a phenomenological description such as this supported by the scientific study and philosophical analysis of emotional expression? What is it for something to be an emotional expression and how do such expressions relate to other aspects of human psychology and behaviour? A common thought is that emotional expressions serve to communicate the emotional state of the expresser; indeed, the facial expression of emotion is often taken as the paradigm case in which the psychological states of others are made manifest to us (see, e.g., McNeill 2012; Smith 2013). Is this common-sense picture correct? In what sense can emotional expressions be thought of as communicative and what is it that they communicate? Further, emotional expressions are naturally thought to be subject to certain norms: a particular facial expression is required for an apology to be considered sincere, another when receiving a gift and so on. What, we may ask, is the role of such norms in guiding our emotional behaviour and how do they interact with the ‘release’ of emotional expression that Stein speaks of? These questions are amongst those pursued in the chapters of this volume and may be thought to fall under three broad headings: the nature of emotional expression, the communicative role of emotional expression and the normative significance of emotional expression.