1,310 research outputs found
Long-term Effects from Early Exposure to Research: Evidence from the NIH âYellow Beretsâ
In the late 1960s, the federal government was looking for young, healthy men to enlist in the military to help ensure success in the Vietnam War. Not enough men were voluntarily choosing to enlist. In 1969, the federal government implemented a lottery draft. Recruiters traveled the U.S. encouraging enlistment and explaining the draft requirements. They made visits to medical schools explaining options to newly minted MDs. Those options included: (1) be drafted and (possibly) go to war or (2) enlist in the Public Health Service (PHS) using the skills learned in their medical profession in the U.S. The PHS included an option to travel to Bethesda, Maryland and enlist as a Training Associate (TA) at the National Institutes of Health (NIH) to work in one of the scientific intramural labs on campus and receive training by some of the top medical research scientists in the nation.
For this study, we searched the National Archives for the physical paper applications of those individuals who applied to the NIH Intramural Training Associates program before, during, and after the lottery draft. We digitalized their applications, combed public documents in search of up-to-date career information, and linked them to their publications and patents to-date. We created a rich linked dataset of administrative records from which we examine the impact of early career, high intensity research training on the probability of staying in research and the overall impact on advancing science. This paper describes our results evaluating the impact of this federal program
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Circles of support and accountability (CoSA): a review of the development of CoSA and its international implementation
Circles of Support and Accountability (CoSA) was initially developed in Canada as a community-based program designed to assist in the community reintegration of individuals who are deemed a high or very high risk of sexual recidivism. This article outlines the historical foundations and frameworks of the CoSA model and examines the recruitment and training of CoSA volunteers. It reviews the impact that CoSA has on recidivism, as well as the psychosocial implications of the model on the former offenders participating in CoSA (the âCore Membersâ), volunteers, and the community at large. International implementation of CoSA is addressed by a review of project initiatives undertaken around the world. This article concludes by addressing the future directions of CoSA, both within Canada and internationally
Retractions
To what extent does âfalse scienceâ impact the rate and direction of scientific change? We examine the impact of over 1,100 scientific retractions on the citation trajectories of articles that are related to retracted papers in intellectual space but were published prior to the retraction event. Following retraction and relative to carefully selected controls, related articles experience a lasting five to ten percent decline in the rate of citations received. This penalty is more severe when the retracted article involves fraud or misconduct, rather than honest mistakes. In addition, we find that the arrival rate of new articles and funding ows into these fields decrease after a retraction.National Science Foundation (U.S.) (SciSIP Program Award SBE-0738142)National Science Foundation (U.S.) (SciSIP Program Award SBE-0738394
Management of HIV-infected patients in the intensive care unit
The widespread use of combination antiretroviral therapies (cART) has converted the prognosis of HIV infection from a rapidly progressive and ultimately fatal disease to a chronic condition with limited impact on life expectancy. Yet, HIV-infected patients remain at high risk for critical illness due to the occurrence of severe opportunistic infections in those with advanced immunosuppression (i.e., inaugural admissions or limited access to cART), a pronounced susceptibility to bacterial sepsis and tuberculosis at every stage of HIV infection, and a rising prevalence of underlying comorbidities such as chronic obstructive pulmonary diseases, atherosclerosis or non-AIDS-defining neoplasms in cART-treated patients aging with controlled viral replication. Several patterns of intensive care have markedly evolved in this patient population over the late cART era, including a steady decline in AIDS-related admissions, an opposite trend in admissions for exacerbated comorbidities, the emergence of additional drivers of immunosuppression (e.g., anti-neoplastic chemotherapy or solid organ transplantation), the management of cART in the acute phase of critical illness, and a dramatic progress in short-term survival that mainly results from general advances in intensive care practices. Besides, there is a lack of data regarding other features of ICU and post-ICU care in these patients, especially on the impact of sociological factors on clinical presentation and prognosis, the optimal timing of cART introduction in AIDS-related admissions, determinants of end-of-life decisions, long-term survival, and functional outcomes. In this narrative review, we sought to depict the current evidence regarding the management of HIV-infected patients admitted to the intensive care unit
Intensive care of the cancer patient: recent achievements and remaining challenges
A few decades have passed since intensive care unit (ICU) beds have been available for critically ill patients with cancer. Although the initial reports showed dismal prognosis, recent data suggest that an increased number of patients with solid and hematological malignancies benefit from intensive care support, with dramatically decreased mortality rates. Advances in the management of the underlying malignancies and support of organ dysfunctions have led to survival gains in patients with life-threatening complications from the malignancy itself, as well as infectious and toxic adverse effects related to the oncological treatments. In this review, we will appraise the prognostic factors and discuss the overall perspective related to the management of critically ill patients with cancer. The prognostic significance of certain factors has changed over time. For example, neutropenia or autologous bone marrow transplantation (BMT) have less adverse prognostic implications than two decades ago. Similarly, because hematologists and oncologists select patients for ICU admission based on the characteristics of the malignancy, the underlying malignancy rarely influences short-term survival after ICU admission. Since the recent data do not clearly support the benefit of ICU support to unselected critically ill allogeneic BMT recipients, more outcome research is needed in this subgroup. Because of the overall increased survival that has been reported in critically ill patients with cancer, we outline an easy-to-use and evidence-based ICU admission triage criteria that may help avoid depriving life support to patients with cancer who can benefit. Lastly, we propose a research agenda to address unanswered questions
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Flexible visiting positively impacted on patients, families and staff in an Australian Intensive Care Unit: A before-after mixed method study
Background
The admission of a relative to intensive care is stressful for families. To help them support the patient, families need assurance, information and an ability to be near their sick relative. Flexible visiting enables patient access but the impact of this on patients, families and staff is not clear.
Objective
To assess the impact of flexible visiting from the perspective of patients, families, and Intensive Care Unit (ICU) staff.
Methods
A before-after mixed method study was used with interviews, focus groups and surveys. Patients were interviewed, family members completed the Family Satisfaction in ICU survey and ICU staff completed a survey and participated in focus groups following the introduction of 21â
h per day visiting in a tertiary ICU. The study was conducted within a philosophy of family-centred care.
Results
All interviewed patients (nâ
=â
12) positively evaluated the concept of extended visiting hours. Family membersâ (nâ
=â
181) overall âsatisfaction with careâ did not change; however 85% were âvery satisfiedâ with increased visiting flexibility. Seventy-six percent of family visits continued to occur within the previous visiting hours (11â
amâ8â
pm) with the remaining 24% taking place during the newly available visiting hours. Families recognised the priority of patient care with their personal needs being secondary. Three-quarters of ICU staff were âsatisfiedâ with flexible visiting and suggested any barriers could be overcome by role modelling family inclusion.
Conclusion
Patients, families and ICU staff positively evaluated flexible visiting hours in this ICU. Although only a minority of families took advantage of the increased hours they indicated appreciation for the additional opportunities. Junior staff may benefit from peer-support to develop family inclusion skills. More flexible visiting times can be incorporated into usual ICU practice in a manner that is viewed positively by all stakeholders
Studentsâ Confidence and Interest in Palliative and Bereavement Care: A European Study
As part of a European Erasmus Plus project entitled Death Education for Palliative Psychology, this study assessed the ways in which Masterâs Degree students in psychology and the creative arts therapies self-rated their confidence and interest in death education and palliative and bereavement care. In five countries (Austria, Israel, Italy, Poland, Romania), 344 students completed an online questionnaire, and 37 students were interviewed to better understand their views, interest, and confidence. The results revealed some significant differences between countries, and showed that older respondents with previous experience as formal caregivers for end-of-life clients showed greater interest in obtaining practical clinical competence in these fields. A mediation analysis indicated that studentsâ previous care experiences and past loss experiences were related to studentsâ current interest in death education and palliative and bereavement care through the mediation of their sense of confidence in this field. The qualitative findings identified five shared themes: life and death, learning about death, the psychological burden, personal experience and robust training, and four key training needs. Overall, studentsâ interest in studying and working with terminal illness and death are rooted in internal resources, a preliminary sense of confidence, but also external requirements
Intensive care unit prognostic factors in critically ill patients with advanced solid tumors: a 3-year retrospective study
Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium.
BACKGROUND: Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. METHODS: To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups' findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. RESULTS: There is no change in the classifications of "proven," "probable," and "possible" IFD, although the definition of "probable" has been expanded and the scope of the category "possible" has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. CONCLUSIONS: These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk
Background Light in Potential Sites for the ANTARES Undersea Neutrino Telescope
The ANTARES collaboration has performed a series of {\em in situ}
measurements to study the background light for a planned undersea neutrino
telescope. Such background can be caused by K decays or by biological
activity. We report on measurements at two sites in the Mediterranean Sea at
depths of 2400~m and 2700~m, respectively. Three photomultiplier tubes were
used to measure single counting rates and coincidence rates for pairs of tubes
at various distances. The background rate is seen to consist of three
components: a constant rate due to K decays, a continuum rate that
varies on a time scale of several hours simultaneously over distances up to at
least 40~m, and random bursts a few seconds long that are only correlated in
time over distances of the order of a meter. A trigger requiring coincidences
between nearby photomultiplier tubes should reduce the trigger rate for a
neutrino telescope to a manageable level with only a small loss in efficiency.Comment: 18 pages, 8 figures, accepted for publication in Astroparticle
Physic
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