Alien Registration- Bowen, Caroline (Durham, Androscoggin County)

https://digitalmaine.com/alien_docs/30044/thumbnail.jp

Outcomes of care programme approach, dual diagnosis, carer support and psychological therapy inductions

An obstacle into psychiatry, for many trainees, is the challenge of an imprecise job design and uncertainty about the psychiatrist’s job design across many complex, often ad hoc care situations involving multiple professions and organizations. The UK’s NHS has introduced inductions for trainee psychiatrists geared towards improving that. Are the induction programmes effective? This article presents an analysis of the outcomes (N = 1,115), revealing a consistent interaction of CPA, dual diagnosis, carer support and psychological therapy inductions. Psychiatrists who attend all four have the best perceptions about their job design, strongest teamwork approach, and highest motivation

Preparation and properties of potassium-vermiculite films

Flexible films of vermiculite have been prepared from aqueous suspensions after swelling by cation exchange and mechanical delamination. Two different swelling cations, lithium and butylammonium, have been investigated. The degree of swelling and delamination during the suspension preparation was characterized by the percentage of water reabsorbed by dried clays and the adsorption of methylene blue. The vermiculite saturated with lithium ions is more easily delaminated but contains more water than those saturated with butylammonium. Good quality coherent flexible films could be prepared from both the lithium and butylammonium exchanged vermiculites but the high percentage of water found in the films has a detrimental effect on their dielectric properties. To reduce the amount of water in the exchanged vermiculites a second ion exchange with potassium, a less hydratable cation, was investigated. Films prepared after exchange with potassium showed significant improvements in their dielectric properties, with a dielectric constant ∈ around 10 and a dissipation factor tan δ around 0.06 at 25 °C and a frequency of 1 kH

Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial

Background Preterm pre-labour ruptured membranes close to term is associated with increased risk of neonatal infection, but immediate delivery is associated with risks of prematurity. The balance of risks is unclear. We aimed to establish whether immediate birth in singleton pregnancies with ruptured membranes close to term reduces neonatal infection without increasing other morbidity. Methods The PPROMT trial was a multicentre randomised controlled trial done at 65 centres across 11 countries. Women aged over 16 years with singleton pregnancies and ruptured membranes before the onset of labour between 34 weeks and 36 weeks and 6 days weeks who had no signs of infection were included. Women were randomly assigned (1:1) by a computer-generated randomisation schedule with variable block sizes, stratified by centre, to immediate delivery or expectant management. The primary outcome was the incidence of neonatal sepsis. Secondary infant outcomes included a composite neonatal morbidity and mortality indicator (ie, sepsis, mechanical ventilation ≥24 h, stillbirth, or neonatal death); respiratory distress syndrome; any mechanical ventilation; and duration of stay in a neonatal intensive or special care unit. Secondary maternal outcomes included antepartum or intrapartum haemorrhage, intrapartum fever, postpartum treatment with antibiotics, and mode of delivery. Women and caregivers could not be masked, but those adjudicating on the primary outcome were masked to group allocation. Analyses were by intention to treat. This trial is registered with the International Clinical Trials Registry, number ISRCTN44485060. Findings Between May 28, 2004, and June 30, 2013, 1839 women were recruited and randomly assigned: 924 to the immediate birth group and 915 to the expectant management group. One woman in the immediate birth group and three in the expectant group were excluded from the primary analyses. Neonatal sepsis occurred in 23 (2%) of 923 neonates whose mothers were assigned to immediate birth and 29 (3%) of 912 neonates of mothers assigned to expectant management (relative risk [RR] 0·8, 95% CI 0·5–1·3; p=0·37). The composite secondary outcome of neonatal morbidity and mortality occurred in 73 (8%) of 923 neonates of mothers assigned to immediate delivery and 61 (7%) of 911 neonates of mothers assigned to expectant management (RR 1·2, 95% CI 0·9–1·6; p=0·32). However, neonates born to mothers in the immediate delivery group had increased rates of respiratory distress (76 [8%] of 919 vs 47 [5%] of 910, RR 1·6, 95% CI 1·1–2·30; p=0·008) and any mechanical ventilation (114 [12%] of 923 vs 83 [9%] of 912, RR 1·4, 95% CI 1·0–1·8; p=0·02) and spent more time in intensive care (median 4·0 days [IQR 0·0–10·0] vs 2·0 days [0·0–7·0]; p<0·0001) compared with neonates born to mothers in the expectant management group. Compared with women assigned to the immediate delivery group, those assigned to the expectant management group had higher risks of antepartum or intrapartum haemorrhage (RR 0·6, 95% CI 0·4–0·9), intrapartum fever (0·4, 0·2–0·9), and use of postpartum antibiotics (0·8, 0·7–1·0), and longer hospital stay (p<0·0001), but a lower risk of caesarean delivery (RR 1·4, 95% CI 1·2–1·7). Interpretation In the absence of overt signs of infection or fetal compromise, a policy of expectant management with appropriate surveillance of maternal and fetal wellbeing should be followed in pregnant women who present with ruptured membranes close to term

L’incidence du volet scolaire du projet Ruelle de l’Avenir sur la motivation et la performance d’élèves de milieux défavorisés

L’évolution de la motivation et de la performance d’élèves du primaire ayant profité du volet scolaire du projet Ruelle de l’Avenir (N = 139) a été comparée à celle d’un groupe témoin (N = 164) issu du même milieu défavorisé. Les analyses de variance à mesures répétées (MANOVA) et les analyses complémentaires (ANOVA) indiquent une augmentation significative de la perception de l’utilité de l’école, du français et des mathématiques, de même qu’une amélioration de la performance en écriture et en mathématiques pour le groupe expérimental. L’importance du partenariat et du choix des situations d’apprentissage en milieux défavorisés est discutée

Comparison of Ten Interventions for a 7-year-old with Unintelligible Speech

The management of speech impairment of unknown origin in children requires SLPs to make important clinical decisions around assessment, analysis, diagnosis and intervention. Ideally, clinicians should be guided in their decision making by evidence. Over thirty years ago, this was a relatively straightforward task. Most children’s speech problems were assessed, analysed and treated from an articulation perspective. Since the paradigm shift from articulation to phonology, clinical decision making has become more challenging. This challenge is in part due to the increase in possible approaches. This short course will outline the application of ten intervention approaches to one child and will conclude with a description and outcomes of one intervention approach Internationally recognized phonologists and speech researchers will present ten intervention approaches for Jarrod, a seven-year-old boy with highly unintelligible speech. Each theoretical framework will be outlined, followed by relevant methods of assessment and recommendations for intervention based on analysis data. Videos of the child during assessment will be shown to help participants understand his speech sound system. The intervention that was implemented will be summarized and results will be provided. Participants in this session will have opportunities to compare major phonological evaluation and intervention approaches currently being used in Australia, America, Canada, and England

Joint inversion of proxy system models to reconstruct paleoenvironmental time series from heterogeneous data

Paleoclimatic and paleoenvironmental reconstructions are fundamentally uncertain because no proxy is a direct record of a single environmental variable of interest; all proxies are indirect and sensitive to multiple forcing factors. One productive approach to reducing proxy uncertainty is the integration of information from multiple proxy systems with complementary, overlapping sensitivity. Mostly, such analyses are conducted in an ad hoc fashion, either through qualitative comparison to assess the similarity of single-proxy reconstructions or through step-wise quantitative interpretations where one proxy is used to constrain a variable relevant to the interpretation of a second proxy. Here we propose the integration of multiple proxies via the joint inversion of proxy system and paleoenvironmental time series models in a Bayesian hierarchical framework. The “Joint Proxy Inversion” (JPI) method provides a statistically robust approach to producing self-consistent interpretations of multi-proxy datasets, allowing full and simultaneous assessment of all proxy and model uncertainties to obtain quantitative estimates of past environmental conditions. Other benefits of the method include the ability to use independent information on climate and environmental systems to inform the interpretation of proxy data, to fully leverage information from unevenly and differently sampled proxy records, and to obtain refined estimates of proxy model parameters that are conditioned on paleo-archive data. Application of JPI to the marine Mg∕Ca and δ18O proxy systems at two distinct timescales demonstrates many of the key properties, benefits, and sensitivities of the method, and it produces new, statistically grounded reconstructions of Neogene ocean temperature and chemistry from previously published data. We suggest that JPI is a universally applicable method that can be implemented using proxy models of wide-ranging complexity to generate more robust, quantitative understanding of past climatic and environmental change