Banning open carry of unloaded handguns decreases firearm-related fatalities and hospital utilization.

BackgroundSince 1967, in California it has been illegal to openly carry a loaded firearm in public except when engaged in hunting or law enforcement. However, beginning January 1, 2012, public open carry of unloaded handguns also became illegal. Fatal and non-fatal (NF) firearm injuries were examined before and after adoption of the 2012 ban to quantify the effect of the new law on public health.MethodsState-level data were obtained directly from California and nine other US state inpatient and emergency department (ED) discharge databases, and the Centers for Disease Control Web-Based Injury Statistics Query and Reporting System. Case numbers of firearm fatalities, NF hospitalizations, NF ED visits, and state-level population estimates were extracted. Each incident was classified as unintentional, self-inflicted, or assault. Crude incidence rates were calculated. The strength of gun laws was quantified using the Brady grade. There were no changes to open carry in these nine states during the study. Using a difference-in-difference technique, the rate trends 3 years preban and postban were compared.ResultsThe 2012 open carry ban resulted in a significantly lower incident rate of both firearm-related fatalities and NF hospitalizations (p<0.001). The effect of the law remained significant when controlling for baseline state gun laws (p<0.001). Firearm incident rate drops in California were significant for male homicide (p=0.023), hospitalization for NF assault (p=0.021  male; p=0.025 female), and ED NF assault visits (p=0.04). No significant decreases were observed by sex for suicides or unintentional injury. Changing the law saved an estimated 337 lives (3.6% fewer deaths) and 1285 NF visits in California during the postban period.DiscussionOpen carry ban decreases fatalities and healthcare utilization even in a state with baseline strict gun laws. The most significant impact is from decreasing firearm-related fatal and NF assaults.Level of evidenceIII, epidemiology

Looking back and moving forward: A scoping review of research on preschool autism interventions in the field of speech-language pathology

Background & Aims: Speech-language pathology services are frequently accessed by families of children who have suspected or diagnosed autism. This is expected given that social communication differences are a core feature of autism. This review looked broadly at the state of research in the field of speech-language pathology and preschool autism interventions in order to identify the types of studies that could be used to inform the practices of speech-language pathologists (SLPs), and to identify gaps in the field so they can be addressed in future research. Specifically, we examined the extent of research conducted on interventions delivered (at least in part) by SLPs to preschool children with suspected or diagnosed autism, identified the range of skill development areas targeted within the studies, and explored the characteristics of the interventions (i.e., theoretical models underlying the programs, service delivery models, treatment dosage). Methods: A scoping review of articles published between 1980 and 2019 was conducted using the five phases outlined by the Arksey and O’Malley framework: (a) articulating the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data; and (e) collating, summarizing, and reporting the results. Main Contribution/Results: A total of 114 studies met inclusion criteria with most published since 2010 and conducted within North America. Case study or single-subject study designs were the most frequently used. Interventions delivered solely by SLPs and by multiprofessional teams that included SLPs were relatively equally represented. Across the included studies, nine skill development areas were targeted, but interventions targeting social communication, language, and augmentative communication skills made up the vast majority of studies. There was relatively even distribution of interventions informed by child-centered, clinician-directed, and hybrid models. Explicit information detailing intervention characteristics (e.g., treatment dosage, professional training of clinicians delivering the intervention) was poorly reported in many studies. For those studies providing details, there was a great deal of variability in the nature of interventions (e.g., service delivery models, SLPs’ role, dosage). Conclusions: This review revealed that research in the area of autism interventions delivered, at least in part, by SLPs has markedly increased over the past 10 years. Still, there remains a need for more research, and greater transparency detailing the nature of the interventions being investigated. The research conducted to date captures the versatility of the SLP’s role within preschool autism intervention. Improved reporting and studies with strong methodological rigor focused on capturing the complex and individualized nature of interventions are needed, as are intervention studies aligned with real-world community practice

Dementia ambient care: a holistic approach to the management of dementia in multiple care settings

Assistive technologies that continuously monitor the person with dementia’s behavioural, cognitive, and emotional state facilitate more objective means of assessing, monitoring, and supporting the individual than that provided by traditional questionnaires. The “Dementia Ambient Care” (Dem@Care) EU-FP7-funded project investigated the use of multiple wearable (actigraphy, 2D/3D cameras, microphones) and ambient (visual and infrared cameras, sleep) sensors for the recording of daily activities, lifestyle patterns, emotions, and speech, to develop a novel approach to the holistic management of dementia, in multiple care settings. This paper presents findings from the use of Dem@Care for remote monitoring and support in the home of the person with mild dementia, and for the clinical assessment and management of Behavioural and Psychological Symptoms of Dementia (BPSD) for people in more advanced stages in a residential care setting. Four ‘home’ participant cases will be discussed; two in Greece and two in Ireland. An intervention study will also be presented comprising of residents from three specialist dementia care units in northern Sweden; two in the experimental group and one in the control group. In each setting, sensor data were analysed using state-of-the-art knowledge-driven interpretation techniques based on Semantic Web technologies. Patterns of sleep, physical activity, daily living activities, and stress/anxiety over time were identified. Through specific user interfaces, clinicians and formal caregivers were able to monitor the sensor recordings and the relevant analysis in order to propose new, or to adapt older, supports and interventions. Results indicate that such sensor-based information can have a positive impact on the assessment of BPSD in residential care settings. While at home, the person with dementia and their family caregiver could monitor summaries of their own activities, and read personalized messages, prompts and advice, thus providing timely support and enabling independent living for longer

Balancing cognitive diversity and mutual understanding in multidisciplinary teams.

BACKGROUND: Interprofessional health care teams are increasingly utilized in health care organizations. Although there is support for their capacity to solve complex problems, there is also evidence that such teams are not always successful. In an effort to understand the capacity of interprofessional teams to innovate successfully, we investigate the role of cognitive diversity to establish whether and how knowledge differences lead to innovation. PURPOSES: The aim of this study was to construct and investigate a model of team innovation predicted by cognitive diversity. In addition to investigating the direct impact of cognitive diversity in interprofessional health care teams, we develop a model incorporating mediated and moderated effects. In this study, we explore the role of debate as a mediating factor capable of explaining the impact of cognitive diversity on innovation. We further propose that the link between cognitive diversity and innovation through debate is contingent upon trans-specialist knowledge, knowledge shared by health care professionals, spanning specialist divides and enabling mutual understanding. METHODOLOGY: The hypotheses were investigated using a cross-sectional, correlational design. Survey data received from 75 interprofessional teams employed in an acute care setting, representing a 36% response rate, were used to investigate our model. FINDINGS: Analysis supports a significant relationship between cognitive diversity and debate, which is stronger when teams rate highly for trans-specialist knowledge. Results also support a positive relationship between debate and innovation and our full moderated mediated pathway. PRACTICE IMPLICATIONS: A range of strategies are indicated by our results to increase innovation in interprofessional teams. In particular, interventions such as interprofessional education and training, which have been shown to facilitate the development of shared language and meaning, are recommended by our findings

Ageing in place: a multi-sensor system for home-based enablement of people with dementia

Background. The quality of life of the person with dementia is often impacted by a loss of autonomy and independence that can arise during dementia progression. Ambient assistive technologies represent a way of enabling independence and facilitating “ageing in place” by supporting the health, lifestyle, and safety of the person with dementia in an unobtrusive manner. We investigated their use in five frequently problematic areas for people with dementia: sleep, daily living activities, physical activity, social interaction, and mood. Methods: This study was part of the EU-FP7 Dem@Care project examining the use of ambient and wearable sensors by people with dementia and their informal caregivers. We used a multiple case-study design with purposive sampling of people with early stage dementia. An individualised sensor “toolbox” and intervention strategy was developed for participants based on a clinical assessment of their needs across the five domains of interest. Sensor data was aggregated over time (up to 18 months) to identify changes in behavioural patterns that could signify improvement, stasis, or the possible deterioration of function. Results: Sleep patterns for all participants remained stable over time, but objective monitoring found high levels of sleep interruptions and recurring ‘problematic’ sleep episodes. It also highlighted the influence of physical activity levels on sleep quality, thus increasing awareness of behaviours that were detrimental to health and well-being. Functional decline was found in some activities of daily living but not in all, and rehabilitation strategies were successful in some but not in all cases. Sensors were generally acceptable to participants providing they functioned accurately, were unobtrusive, and required little or no new learning. Difficulties obtaining informed third-party consent restricted the use of ambient video cameras in the home, as did their potential mis-use as survelliance tools. Conclusions: These results demonstrate the ability of multi-sensor systems to support “ageing in place” by preserving autonomy, promoting independence, and facilitating home-based living for longer. There remains a need for discussion, however, of the ethical challenges that can arise with the use of these technologies in a vulnerable population

Experiences of providing formal home and community dementia care in ireland: advocating for a holistic systemic approach

Background: Access to formal dementia care services varies widely within and across European countries. This paper presents Irish data from one study within the Access to Timely Formal Care (Actifcare) JPND-funded research project. This study explored the professional experiences, and perceived barriers and facilitators in accessing formal home- and community-based health and social care from the perspectives of healthcare professionals and expert stakeholders in a unique position to influence dementia policy in Ireland. Methods: An exploratory qualitative design with purposive sampling was used. Three focus groups were conducted with healthcare professionals from a variety of backgrounds (n=18; years experience M=11.35, SD=7.22). One group took place in a rural setting, one in south and one in north Dublin. Seven interviews with policy and political decision makers also took place. Discussions followed an agreed structure, were audio-recorded, transcribed, and analysed using inductive content analysis. Results: Narratives revealed a wide range of themes describing barriers and facilitators for the use of formal dementia care at (1) an individual level – relating to every person involved, such as needs-focused care and capacity and rights; (2) a system level – relating to the health and social care system in Ireland, such as service design, service availability and case management; and (3) overarching aspects that were important on both levels, such as education, awareness, influence and community engagement. Conflicting views emerged between healthcare professionals regarding the most appropriate time for care, and among experts regarding the definition and location of any case management support. Conclusions: These findings are interpreted in the context of the 2014 National Dementia Strategy and they support the increasing body of evidence that highlights the very clear gaps that exist between the formal home- and community-based care that is available in Ireland, and the care advocated for by health professionals and policy makers alike

Анализ видового состава насаждений сквера перед ТЦ «Пассаж» (Екатеринбург)

Semi-structured interview schedule. (DOCX 12 kb