Community Pressure Ulcer Occurrence: Description On Hospital Admission

Abstract Purpose: To describe community-dwelling adults admitted to acute care with a present-on-admission (POA) pressure ulcer (PU). Specific aims: 1) Measure 1-year POA-PU prevalence, 2) Determine pre-hospital location of patients with POA-PU, 3) Describe demographics, PU characteristics, risk factors, and post-hospital outcome of community-dwelling adults admitted to hospital with a PU. Design: Retrospective descriptive study. Subjects and Setting: The sample included all adults, over age 18, admitted to an 800-bed urban academic medical center in New England over a 1-year period with a POA-PU. Methods: Subjects were identified from a clinically validated PU registry. Data were extracted electronically from selected standardized electronic health record (EHR) fields. Results: The prevalence of patients admitted to acute care with a POA-PU was 7.4%. For the majority (76.1%), the pre-hospital location was the community; the remainder came from a healthcare facility (23.9%). The community-dwelling subjects (N=1,022) had a mean age of 72.7 ± 15.4; 52.4% were male, 80.3% white, 30.9% lived alone, 99.2% were insured, and 30.6% college educated. They presented with a mean of 1.46 pressure ulcers, of which 37.5% were full thickness. Over half (51.5%) were discharged to a healthcare facility, 33% to home, and 14% died or received hospice care. The 30-day readmission rate was 15.5%. Conclusion: Clinically-validated surveillance data show a higher prevalence of POA-PU than reported with administrative data. Electronically-extracted EHR data provides population health evidence of community PU occurrence that may be useful for risk stratification, prevention, and care coordination for integrated health systems

A Systematic Review of Coach Feedback During Practice and Competition in Team Sports

Coach feedback is acknowledged to have a vital role in athlete learning, while systematic observation is a common tool used in measuring coach behaviour. The purpose of this review was to identify coaches’ use of feedback in developmental and performance contexts. A literature search was conducted using EBSCO HOST and SCOPUS databases. Studies were reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted from 31 studies which met the inclusion criteria. Analysis revealed three themes, 1) evidence base surrounding feedback types observed. 2) variation in observation tool and feedback types observed. 3) quality of coach feedback. The multiple feedback types measured across the studies included suggests there is limited agreement on the types of feedback most important to measure. For the impact of feedback to be better understood, the feedback types captured via systematic observation need revising in line with research that has identified the important characteristics of feedback. A greater evidence-informed approach to the observation of feedback may help to develop a greater critical understanding of the feedback process in learning and performance. Where there were consistencies in feedback type, the quality of the feedback delivered by coaches could be questioned

LMDA Canada Newsletter, Winter 2003/2004

Contents include: Letter from the Chair, The Naming of Process and the Process of Naming Or, When You\u27re Doing This Work, You\u27re Doing Dramaturgy, Opening the Lens...Mini-Conference Day One, Collaboration and Identity Mini-Conference Day Two, \u27Turgs in the Hood: LMDA Annual Conference in Chicago, LMDA Canada: Membership Contact Listhttps://soundideas.pugetsound.edu/lmdanewsletter/1025/thumbnail.jp

Trade in the balance: reconciling trade and climate policy: report of the Working Group on Trade, Investment, and Climate Policy

This repository item contains a report published by the Working Group on Trade, Investment, and Climate Policy at The Frederick S. Pardee Center for the Study of the Longer-Range Future at Boston University, and the Global Economic Governance Initiative at Boston University.This report outlines the general tensions between the trade and investment regime and climate policy, and outlines a framework toward making trade and investment rules more climate friendly. Members of the working group have contributed short pieces addressing a range of issues related to the intersection of trade and climate policy. The first two are by natural scientists. Anthony Janetos discusses the need to address the effects of international trade on efforts to limit the increase in global annual temperature to no more than 2oC over preindustrial levels. James J. Corbett examines the failure of the Trans Pacific Partnership (TPP) and the Transatlantic Trade and Investment Partnership (TTIP) to adequately address the environmental implications of shipping and maritime transport. The next two pieces are by economists who examine economic aspects of the trade-climate linkage. Irene Monasterolo and Marco Raberto discuss the potential impacts of including fossil fuel subsidies reduction under the TTIP. Frank Ackerman explores the economic costs of efforts to promote convergence of regulatory standards between the United States and the European Union under the TTIP. The following two contributions are by legal scholars. Brooke Güven and Lise Johnson explore the potential for international investment treaties to redirect investment flows to support climate change mitigation and adaptation, particularly with regard to China and India. Matt Porterfield provides an overview of the ways in which both existing and proposed trade and investment agreements could have either “climate positive” or “climate negative” effects on mitigation policies. The final article is by Tao Hu, a former WTO trade and environment expert advisor for China and currently at the World Wildlife Fund, arguing that the definition of environmental goods and services’ under the WTO negotiations needs to be expanded to better incorporate climate change

Insomnia, Psychiatric Disorders and Suicidal Ideation in a National Representative Sample of Active Canadian Forces Members

Background Past research on the association between insomnia and suicidal ideation (SI) has produced mixed findings. The current study explored the relationship between insomnia, SI, and past-year mental health status among a large Canadian Forces (CF) sample. Method Data was obtained from the 2013 Canadian Forces Mental Health Survey (CFMHS), and included a large representative sample of Canadian Regular Forces personnel (N = 6700). A series of univariate logistic regressions were conducted to test individual associations between past-year mental health status, insomnia, and potential confounds and SI. Mental health status included three groups: 0, 1, or two or more probable diagnoses of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD) and alcohol abuse/dependence. Stepwise multivariate logistic regression was used to assess the relationship between insomnia and SI with mental health status as a moderator. Results 40.8% of respondents reported experiencing insomnia. Both insomnia and number of mental health conditions incrementally increased the risk of SI. However, past-year mental health status was a significant moderator of this relationship, such that for CF personnel with either no (AOR = 1.61, 1.37–1.89) or only one past-year mental health condition (AOR = 1.39, 1.12–1.73), an incremental increase in insomnia was associated with an increased likelihood of SI. However, in personnel with two or more past-year mental health disorders, insomnia was no longer significantly associated with SI (AOR = 1.04, 0.81–1.33). Conclusions Insomnia significantly increased the odds of SI, but only among individuals with no or one mental health condition. Findings highlight the importance of assessing insomnia among CF members in order to further suicide prevention efforts

Exploring the Ambulatory Transitional Care Experience from Residential Aged Care Facilities (RACF) to Ambulatory Care Services

Objective(s): To explore the transitional care journey through Ambulatory care Services (ACS) for older residents from Residential Aged Care Facilities (RACF). To develop a clearer understanding of older residents needs and any gaps in current services provided; and to inform the development of a model of care to improve the resident’s transitional care journey Study Design: A qualitative project design using extensive stakeholder engagement Method: The Ambulatory Care (AC) experience was explored through semi-structured interviews with residents and their carers to determine gaps in transitional care continuity. Focus groups with RACF and ACS staff were also utilized. Journey mapping was used to support anecdotal evidence. Results: Three residents and 2 carers were interviewed and a total of 40 RACF and ACS staff attended 5 focus groups. Principal Findings: Qualitative data analysis identified four main themes across the transition journey: Inconsistent and adhoc communication; Just waiting around; Is it doing more harm than good?; and Unmet expectations.Conclusion: The results of this study have highlighted shortcomings in the provision of quality care in this transitional care group of older clients. A collaborative approach across organizational boundaries is necessary to ensure the development of an integrated person centered model to ensure the best transition to ambulatory care for RACF residents exists

Manufacturing Orgasm: Visuality, Aurality, and Female Sexual Pleasure in Tsai Ming-liang’s The Wayward Cloud

publication-status: Publishedtypes: Article© 2011 by IntellectIn the study of both sex and the city, sound tends to be an aspect that does not receive as much attention as visuality. By examining the sound of sex in Tsai Ming-liang’s 2005 film, The Wayward Cloud, this article will argue that the aural is privileged over the visual and explore its implications for female subjectivity, sexual intimacy and gender politics. It suggests that the film challenges us to think whether it might be possible to forge what Mary Ann Doane calls ‘a political erotics of the voice’, but in a wayward manner that deploys comatose bodies that have no voice, that fragments the unity of voice and body and that privileges the representation of the sonic over the visual in a cinematic tradition that generally dictates otherwise

Burden of HIV among primary school children and feasibility of primary school-linked HIV testing in Harare, Zimbabwe: a mixed methods study.

Population-based surveys in Southern Africa suggest a substantial burden of undiagnosed HIV-infected long-term survivors of mother-to-child transmission. We conducted an HIV prevalence survey of primary school pupils in Harare, Zimbabwe, and evaluated school-linked HIV counselling and testing (HCT) for pupils, their families and schoolteachers. Population-weighted cluster sampling was used to select six primary schools. Randomly selected class-grade pupils underwent anonymous HIV testing, with concurrent school-linked family HCT offered during the survey. Focus group discussions and interviews were conducted with pupils, parents/guardians, counsellors, and schoolteachers. About 4386 (73%) pupils provided specimens for anonymous HIV testing. Median age was 9 years (IQR 8-11), and 54% were female. HIV prevalence was 2.7% (95% CI: 2.2-3.1) with no difference by gender. HIV infection was significantly associated with orphanhood, stunting, wasting, and being one or more class grades behind in school due to illness (p<0.001). After adjusting for covariates, orphanhood and stunting remained significantly associated with being HIV positive (p<0.001). Uptake of diagnostic HIV testing by pupils was low with only 47/4386 (1%) pupils undergoing HCT. The HIV prevalence among children under 15 years who underwent HIV testing was 6.8%. The main barrier to HIV testing was parents' fear of their children experiencing stigma and of unmasking their own HIV status should the child test HIV positive. Most guardians believed that a child's HIV-positive result should not be disclosed and the child could take HIV treatment without knowing the reason. Increased recognition of the high burden of undiagnosed HIV infection in children is needed. Despite awareness of the benefits of HIV testing, HIV-related stigma still dominates parents/guardians' psychological landscape. There is need for comprehensive information and support for families to engage with HIV testing services