Not Enough to Go Around: Statistical Analysis of Staffing of Child Life Programs

Child life programs are gaining popularity and support in pediatric care as the field grows. However, healthcare is growing rapidly and child life programs are struggling to advocate for their place within pediatric care despite the fact that the American Academy of Pediatrics defines child life as a necessity. This study seeks to answer the question: How does the level of pediatric care offered by a hospital affect the staffing of child life programs? The sample (N=154) hospital programs in this study offer varying levels of pediatric care. The independent variable is the level of pediatric care offered by hospitals, the dependent variables includes seven different staffing reports, and the control variables include demographics regarding bed size and percent budgets. Statistical analysis (ANOVA and ANCOVA) determined there is a statistically significant relationship between the level of pediatric care and staffing of child life programs. This relationship is impacted by the number of pediatric beds in a hospital. Future research should explore the relationship between adequate child life staffing and hospital revenue enhancement. This research is needed to show whether or not enhanced hospital revenue is due to an increased census, which could be a result of customer satisfaction from properly staffing child life programs

College students’ attitudes towards adults with developmental disabilities: Does direct contact make a difference?

Data were collected from thirty college students who participated in an alternative break trip and approximately seventy college students who did not attend the trip. Study subjects served as counselors at a camp for adults with developmental disabilities. Data were collected using five measures: a) before the week started, students filled out a survey which questioned their comfort level and attitude when interacting with this population; b) this same survey was administered to a random sample of college students who did not attend the break trip c) at camp, students kept a journal throughout the week documenting their experiences; d) students answered open ended questions after their experience regarding their attitude and perceptions post-camp; e) the first author actively conducted participant observation throughout the course of the week documenting personal own interactions with the college students. (Analysis of measures d) and e) were not used in this paper.) It was hypothesized is that there would be a direct positive correlation between amount of interaction and the increase of positive attitudes and perceptions of the college students towards adults with developmental disabilities

Water Clouds in Y Dwarfs and Exoplanets

The formation of clouds affects brown dwarf and planetary atmospheres of nearly all effective temperatures. Iron and silicate condense in L dwarf atmospheres and dissipate at the L/T transition. Minor species such as sulfides and salts condense in mid-late T dwarfs. For brown dwarfs below Teff=450 K, water condenses in the upper atmosphere to form ice clouds. Currently over a dozen objects in this temperature range have been discovered, and few previous theoretical studies have addressed the effect of water clouds on brown dwarf or exoplanetary spectra. Here we present a new grid of models that include the effect of water cloud opacity. We find that they become optically thick in objects below Teff=350-375 K. Unlike refractory cloud materials, water ice particles are significantly non-gray absorbers; they predominantly scatter at optical wavelengths through J band and absorb in the infrared with prominent features, the strongest of which is at 2.8 microns. H2O, NH3, CH4, and H2 CIA are dominant opacity sources; less abundant species such as may also be detectable, including the alkalis, H2S, and PH3. PH3, which has been detected in Jupiter, is expected to have a strong signature in the mid-infrared at 4.3 microns in Y dwarfs around Teff=450 K; if disequilibrium chemistry increases the abundance of PH3, it may be detectable over a wider effective temperature range than models predict. We show results incorporating disequilibrium nitrogen and carbon chemistry and predict signatures of low gravity in planetary- mass objects. Lastly, we make predictions for the observability of Y dwarfs and planets with existing and future instruments including the James Webb Space Telescope and Gemini Planet Imager.Comment: 23 pages, 20 figures, Revised for Ap

The MASSIVE Survey - X. Misalignment between Kinematic and Photometric Axes and Intrinsic Shapes of Massive Early-Type Galaxies

We use spatially resolved two-dimensional stellar velocity maps over a $107"\times 107"$ field of view to investigate the kinematic features of 90 early-type galaxies above stellar mass $10^{11.5}M_\odot$ in the MASSIVE survey. We measure the misalignment angle $\Psi$ between the kinematic and photometric axes and identify local features such as velocity twists and kinematically distinct components. We find 46% of the sample to be well aligned ($\Psi < 15^{\circ}$), 33% misaligned, and 21% without detectable rotation (non-rotators). Only 24% of the sample are fast rotators, the majority of which (91%) are aligned, whereas 57% of the slow rotators are misaligned with a nearly flat distribution of $\Psi$ from $15^{\circ}$ to $90^{\circ}$. 11 galaxies have $\Psi \gtrsim 60^{\circ}$ and thus exhibit minor-axis ("prolate") rotation in which the rotation is preferentially around the photometric major axis. Kinematic misalignments occur more frequently for lower galaxy spin or denser galaxy environments. Using the observed misalignment and ellipticity distributions, we infer the intrinsic shape distribution of our sample and find that MASSIVE slow rotators are consistent with being mildly triaxial, with mean axis ratios of $b/a=0.88$ and $c/a=0.65$. In terms of local kinematic features, 51% of the sample exhibit kinematic twists of larger than $20^{\circ}$, and 2 galaxies have kinematically distinct components. The frequency of misalignment and the broad distribution of $\Psi$ reported here suggest that the most massive early-type galaxies are mildly triaxial, and that formation processes resulting in kinematically misaligned slow rotators such as gas-poor mergers occur frequently in this mass range.Comment: Accepted to MNRA

Understanding the timing of Chinese border incursions into India

Since the 1960s China and India have engaged in a dispute about the demarcation of their shared border. This territorial dispute led to a brief war in 1962, and recurring flare-ups over the following decades, including during the summer of 2020. The potential for further escalation of this dispute poses significant risks to Indian and Chinese civilians, US foreign policy objectives, and the stability of the international economic system. Despite the importance of this dispute, there have been relatively few attempts to understand the correlates of Chinese incursions. This paper addresses this important question by leveraging past work on the study of conflicts between states to derive a set of testable explanations about the impact of China–India relations, internal political affairs, international political issues, and domestic economic factors on the likelihood of incursions. The study uses 15 years of original data on monthly Chinese incursions into India along with a monthly dataset containing 18 independent variables, to develop a detailed statistical understanding of the factors that trigger Chinese incursions across the Indian border with a lead time between 1 and 6 months. The quantitative study finds that Chinese incursions are more likely when Chinese leadership is early in their tenure, but more likely when Indian leadership is in the later stages of their tenure. The results also show that closer cooperation between India and the US may trigger additional Chinese incursions into India. Finally, lower consumer confidence in the Chinese economy is consistently related to an increased likelihood of incursions. These findings have implications for the maintenance of peace and India’s national security policies. Periods of Chinese uncertainty, particularly when their economy exhibits weakness and when Chinese leaders are in the early stages of their tenure are more likely to experience incursions. Further, the strengthening of the US–Indian alliance, as well as increased conflict between India and Pakistan, create the potential for an elevated risk of incursions. During these periods India should likely be on higher alert, while India and Indian allies should signal the importance of diplomatic solutions for the dispute

Unique chemical parameters and microbial activity lead to increased archaeological preservation at the Roman frontier site of Vindolanda, UK

Waterlogged burial conditions impact upon artefact preservation. One major determinant of preservation is presence and behaviour of microorganisms, however, unravelling the mechanisms, especially in waterlogged conditions is challenging. In this study, we analysed elemental composition, bacterial diversity and community structure from excavation trenches at the Roman Site of Vindolanda, Northumberland, UK, using pXRF and 16S rRNA gene amplicon sequencing. Excavation trenches provide information of different occupation periods. The results indicated that microbial communities were dominated by Firmicutes, Bacteroidetes and Proteobacteria at a phylum level. Samples which also had visible vivianite presence showed that there were marked increases in Methylophilus. Methylophilus might be associated with favourable preservation in these anaerobic conditions. More research is needed to clearly link the presence of Methylophilus with vivianite production. The study emphasises the need for further integration of chemical and microbiome approaches, especially in good preservation areas, to explore microbial and chemical degradation mechanisms

Interventions to increase access to or uptake of physical health screening in people with severe mental illness: a realist review

Objectives: To identify and evaluate interventions aimed at increasing uptake of, or access to, physical health screening by adults with severe mental illness; to examine why interventions might work. Design: Realist review. Setting: Primary, secondary and tertiary care. Results: A systematic search identified 1448 studies, of which 22 met the inclusion criteria. Studies were from Australia (n=3), Canada (n=1), Hong Kong (n=1), UK (n=11) and USA (n=6). The studies focused on breast cancer screening, infection preventive services and metabolic syndrome (MS) screening by targeting MSrelated risk factors. The interventions could be divided into those focusing on (1) health service delivery changes (12 studies), using quality improvement, randomised controlled trial, cluster randomised feasibility trial, retrospective audit, cross-sectional study and satisfaction survey designs and (2) tests of tools designed to facilitate screening (10 studies) using consecutive case series, quality improvement, retrospective evaluation and pre–post audit study designs. All studies reported improved uptake of screening, or that patients had received screening they would not have had without the intervention. No estimation of overall effect size was possible due to heterogeneity in study design and quality. The following factors may contribute to intervention success: staff and stakeholder involvement in screening, staff flexibility when taking physical measurements (eg, using adapted equipment), strong links with primary care and having a pharmacist on the ward. Conclusions: A range of interventions may be effective, but better quality research is needed to determine any effect size. Researchers should consider how interventions may work when designing and testing them in order to target better the specific needs of this population in the most appropriate setting. Behaviour-change interventions to reduce identified barriers of patient and health professional resistance to screening this population are required. Resource constraints, clarity over professional roles and better coordination with primary care need to be addresse

Antidepressant and antipsychotic drug prescribing and diabetes outcomes: A systematic review of observational studies

AIMS: Psychotropic medication may be associated with adverse effects, including among people with diabetes. We conducted a systematic review of observational studies investigating the association between antidepressant or antipsychotic drug prescribing and type 2 diabetes outcomes. METHODS: We systematically searched PubMed, EMBASE, and PsycINFO to 15th August 2022 to identify eligible studies. We used the Newcastle-Ottawa scale to assess study quality and performed a narrative synthesis. RESULTS: We included 18 studies, 14 reporting on antidepressants and four on antipsychotics. There were 11 cohort studies, one self-controlled before and after study, two case-control studies, and four cross-sectional studies, of variable quality with highly heterogeneous study populations, exposure definitions, and outcomes analysed. Antidepressant prescribing may be associated with increased risk of macrovascular disease, whilst evidence on antidepressant and antipsychotic prescribing and glycaemic control was mixed. Few studies reported microvascular outcomes and risk factors other than glycaemic control. CONCLUSIONS: Studies of antidepressant and antipsychotic drug prescribing in relation to diabetes outcomes are scarce, with shortcomings and mixed findings. Until further evidence is available, people with diabetes prescribed antidepressants and antipsychotics should receive monitoring and appropriate treatment of risk factors and screening for complications as recommended in general diabetes guidelines

Aerial dissemination of Clostridium difficile spores

Background: Clostridium difficile-associated diarrhoea (CDAD) is a frequently occurring healthcare-associated infection, which is responsible for significant morbidity and mortality amongst elderly patients in healthcare facilities. Environmental contamination is known to play an important contributory role in the spread of CDAD and it is suspected that contamination might be occurring as a result of aerial dissemination of C. difficile spores. However previous studies have failed to isolate C. difficile from air in hospitals. In an attempt to clarify this issue we undertook a short controlled pilot study in an elderly care ward with the aim of culturing C. difficile from the air. Methods: In a survey undertaken during February (two days) 2006 and March (two days) 2007, air samples were collected using a portable cyclone sampler and surface samples collected using contact plates in a UK hospital. Sampling took place in a six bedded elderly care bay (Study) during February 2006 and in March 2007 both the study bay and a four bedded orthopaedic bay (Control). Particulate material from the air was collected in Ringer's solution, alcohol shocked and plated out in triplicate onto Brazier's CCEY agar without egg yolk, but supplemented with 5 mg/L of lysozyme. After incubation, the identity of isolates was confirmed by standard techniques. Ribotyping and REP-PCR fingerprinting were used to further characterise isolates. Results: On both days in February 2006, C. difficile was cultured from the air with 23 samples yielding the bacterium (mean counts 53 – 426 cfu/m3 of air). One representative isolate from each of these was characterized further. Of the 23 isolates, 22 were ribotype 001 and were indistinguishable on REP-PCR typing. C. difficile was not cultured from the air or surfaces of either hospital bay during the two days in March 2007. Conclusion: This pilot study produced clear evidence of sporadic aerial dissemination of spores of a clone of C. difficile, a finding which may help to explain why CDAD is so persistent within hospitals and difficult to eradicate. Although preliminary, the findings reinforce concerns that current C. difficile control measures may be inadequate and suggest that improved ward ventilation may help to reduce the spread of CDAD in healthcare facilities