The goal dependent automaticity of drinking habits

In recent treatments of habitual social behaviour, habits are conceptualised as a form of goal-directed automatic behaviour that are mentally represented as goal-action links. Three experiments tested this conceptualisation in the context of students’ drinking (alcohol consumption) habits. Participants were randomly assigned to conditions where either a goal related to drinking behaviour (socialising) was activated, or an unrelated goal was activated. In addition, participants’ drinking habits were measured. The dependent variable in Experiments 1 and 2 was readiness to drink, operationalised by speed of responding to the action concept “drinking” in a verb verification task. Experiment 3 used uptake of a voucher to measure drinking behaviour. Findings supported the view that when habits are established, simply activating a goal related to the focal behaviour automatically elicits that behaviour. These findings are consistent with a goal-dependent conception of habit. Possibilities for interventions designed to attenuate undesirable habitual behaviours are considered

An empirical study of assurance in the UK government major projects portfolio: from data to recommendations, to action or inaction

© 2020, Emerald Publishing Limited. Purpose: Effective and robust governance of major projects and programmes in the public sector is crucial to the accountability of the state and the transparency of state spending. The theoretical discourse on governance, in the context of projects and programmes, is not fully mature, although is now sufficiently well developed to warrant an increased scholarly focus on practice. This paper aims to contribute to the empirical literature through a study of assurance routines in the UK Government Major Projects Portfolio (GMPP). Design/methodology/approach: A framework analysis approach to the evaluation of a subset of GMPP database generates original insights into (1) the framing of assurance review recommendations, (2) the treatment of assurance review data and (3) the subsequent tracking of the implementation of actions arising from the assurance review process. Findings: The analysis reveals that the “delivery confidence” of the major projects and programmes included in this study improves during the time that they are assured on the GMPP. This would suggest that “enhanced” governance routines are desirable in programmes and projects that exhibit high degrees of complexity and scale. Originality/value: The research findings contribute to the wider conversations in this journal and elsewhere on project governance routines and governance-as-practice in the context of government and public services

Nurses’ education, knowledge and perceptions of peripheral intravenous catheter management: A web-based, cross-sectional survey

Background: Peripheral intravenous catheters (PIVCs) are the most used invasive medical device. Unfortunately, PIVCs fail for a variety of reasons and failure often results in serious adverse events leading to patient discomfort, infection, delays in treatment, increased healthcare costs, and even death. In Australia, qualified nurses assess, manage, and remove a PIVC as part of their clinical role. To date, no study has described the current state of knowledge and confidence (self-efficacy) about PIVCs from the perspectives of qualified nurses working in Australian hospital settings. Aims: To describe the current state of knowledge and confidence (self-efficacy) about PIVC management from the perspectives of qualified nurses working in Australian hospital settings. To explore how these related to the education received by these nurses. Methods: An online cross-sectional survey. Findings: Qualified nurses in Australia thought that education about PIVCs was important and that it should be underpinned by evidence-based guidelines. Knowledge Test score for the sample was 12.4/17 (SD 2.1), this equates to a mean grade of 73.0%. Respondents reported very high levels of confidence about caring for a patient with a PIVC in situ. Conclusion: Despite the frequent and increasing use of PIVCs and importantly the documented adverse events associated with poor assessment, management and inappropriate removal, qualified nurses’ knowledge and confidence remain poorly reported. We demonstrated fundamental gaps in qualified nurses’ knowledge in relation to assessment, management, and removal of PIVCs

Transition from community dwelling to retirement village in older adults:cognitive functioning and psychological health outcomes

Supported living and retirement villages are becoming a significant option for older adults with impairments, with independence concerns or for forward planning in older age, but evidence as to psychological benefits for residents is sparse. This study examined the hypothesis that the multi-component advantages of moving into a supported and physically and socially accessible ‘extra-care’ independent living environment will impact on psychological and functioning measures. Using an observational longitudinal design, 161 new residents were assessed initially and three months later, in comparison to 33 older adults staying in their original homes. Initial group differences were apparent but some reduced after three months. Residents showed improvement in depression, perceived health, aspects of cognitive function and reduced functional limitations, while controls showed increased functional limitations (worsening). Ability to recall specific autobiographical memories, known to be related to social problem solving, depression and functioning in social relationships, predicted change in communication limitations, and cognitive change predicted changes in recreational limitations. Change in anxiety and memory predicted change in depression. Findings suggest that older adults with independent living concerns who move to an independent but supported environment can show significant benefits in psychological outcomes and reduction in perceived impact of health on functional limitations in a short period. Targets for focused rehabilitation are indicated, but findings also validate development of untargeted general supportive environments

General practice registrars’ clinical uncertainty, and in-consultation information- and assistance-seeking

Purpose: To explore the association of Australian general practitioner (GP) registrars’ responses to uncertainty with their in-consultation information-, advice- and assistance-seeking.Design/methodology/approach: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) cohort study in four Australian states. In ReCEnT, GP registrars record details of 60 consecutive consultations, six-monthly, three times during training.Outcome factors in logistic regression models included whether the registrar sought in-consultation information or assistance from (i) their supervisor or (ii) an electronic or paper-based source. Independent variables were the four independent subscales of the Physicians’ Reaction to Uncertainty (PRU) instrument, as well as registrar, practice and consultation variables.Findings: 589 registrars contributed details of 70,412 consultations.On multivariable analysis, scores on the two ‘affective’ PRU subscales ‘anxiety regarding diagnosis/management’ (OR 1.03; 95% confidence intervals [CIs] [1.01, 1.05], p = 0.003) and ‘concern about a bad outcome’ (OR 1.03; 95% CIs [1.01, 1.06], p = 0.008) were significantly associated with seeking supervisor assistance. There was no association with ‘behavioural’ subscales ‘reluctance to disclose uncertainty to patients’ and ‘reluctance to disclose mistakes to physicians’.None of the PRU subscales were significantly associated with information-seeking from electronic or hard copy sources.Research implications: Further research is required to explore the role of uncertainty within registrar–supervisor interactions and to define the role of supervisors in registrars’ functional adaptation to clinical uncertainty (including how best to support and train supervisors in this role).Practical implications: GP registrars’ ‘affective’ responses to clinical uncertainty are associated with assistance-seeking from clinical supervisors. While in-consultation assistance-seeking may promote registrars’ tolerance of uncertainty, it may also contribute to supervisor workload.Originality/value: This is the first study to examine trainees’ levels of uncertainty and their seeking of information and assistance.Limitations: We have not investigated whether registrars’ seeking assistance resolved or attenuated, for the index problem, their anxiety or concern

Anthropogenic disruptions to longstanding patterns of trophic-size structure in vertebrates

Diet and body mass are inextricably linked in vertebrates: while herbivores and carnivores have converged on much larger sizes, invertivores and omnivores are, on average, much smaller, leading to a roughly U-shaped relationship between body size and trophic guild. Although this U-shaped trophic-size structure is well documented in extant terrestrial mammals, whether this pattern manifests across diverse vertebrate clades and biomes is unknown. Moreover, emergence of the U-shape over geological time and future persistence are unknown. Here we compiled a comprehensive dataset of diet and body size spanning several vertebrate classes and show that the U-shaped pattern is taxonomically and biogeographically universal in modern vertebrate groups, except for marine mammals and seabirds. We further found that, for terrestrial mammals, this U-shape emerged by the Palaeocene and has thus persisted for at least 66 million years. Yet disruption of this fundamental trophic-size structure in mammals appears likely in the next century, based on projected extinctions. Actions to prevent declines in the largest animals will sustain the functioning of Earth's wild ecosystems and biomass energy distributions that have persisted through deep time

Implementing paediatric appropriate use criteria for endotracheal suction to reduce complications in mechanically ventilated children with respiratory infections

BackgroundEndotracheal suction is used to maintain endotracheal tube patency. There is limited guidance to inform clinical practice for children with respiratory infections.ObjectiveThe objective of this study was to determine whether implementation of a paediatric endotracheal suction appropriate use guideline Paediatric AirWay Suction (PAWS) is associated with an increased use of appropriate and decreased use of inappropriate suction interventions.MethodsA mixed-method, pre-implementation–post-implementation study was conducted between September 2021 and April 2022. Suction episodes in mechanically ventilated children with a respiratory infection were eligible. Using a structured approach, we implemented the PAWS guideline in a single paediatric intensive care unit. Evaluation included clinical (e.g., suction intervention appropriateness), implementation (e.g., acceptability), and cost outcomes (implementation costs). Associations between implementation of the PAWS guideline and appropriateness of endotracheal suction intervention use were investigated using generalised linear models.ResultsData from 439 eligible suctions were included in the analysis. Following PAWS implementation, inappropriate endotracheal tube intervention use reduced from 99% to 58%, an absolute reduction (AR) of 41% (95% confidence interval [CI]: 25%, 56%). Reductions were most notable for open suction systems (AR: 48%; 95% CI: 30%, 65%), 0.9% sodium chloride use (AR: 23%; 95% CI: 8%, 38%) and presuction and postsuction manual bagging (38%; 95% CI: 16%, 60%, and 86%; 95% CI: 73%, 99%), respectively. Clinicians perceived PAWS as acceptable and suitable for use.ConclusionsImplementation of endotracheal tube suction appropriate use guidelines in a mixed paediatric intensive care unit was associated with a large reduction in inappropriate suction intervention use in paediatric patients with respiratory infections

Multilocus species identification and fungal DNA barcoding: insights from blue stain fungal symbionts of the mountain pine beetle.Mol

Abstract There is strong community-wide interest in applying molecular techniques to fungal species delimitation and identification, but selection of a standardized region or regions of the genome has not been finalized. A single marker, the ribosomal DNA internal transcribed spacer region, has frequently been suggested as the standard for fungi. We used a group of closely related blue stain fungi associated with the mountain pine beetle (Dendroctonus ponderosae Hopkins) to examine the success of such single-locus species identification, comparing the internal transcribed spacer with four other nuclear markers. We demonstrate that single loci varied in their utility for identifying the six fungal species examined, while use of multiple loci was consistently successful. In a literature survey of 21 similar studies, individual loci were also highly variable in their ability to provide consistent species identifications and were less successful than multilocus diagnostics. Accurate species identification is the essence of any molecular diagnostic system, and this consideration should be central to locus selection. Moreover, our study and the literature survey demonstrate the value of using closely related species as the proving ground for developing a molecular identification system. We advocate use of a multilocus barcode approach that is similar to the practice employed by the plant barcode community, rather than reliance on a single locus