Estimating Unemployment Duration

macroeconomics, unemployment

Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria

Objectives A drive to promote advance care planning at a population level has led to a proliferation of online advance care directive (ACD) templates but little information to guide consumer choice. The current study aimed to appraise the quality of online ACD templates promoted for use in Australia. Methods A systematic review of online Australian ACD templates was conducted in February 2014. ACD templates were identified via Google searches, and quality was independently appraised by two reviewers against criteria from the 2011 report A National Framework for Advance Care Directives. Bias either towards or against future medical treatment was assessed using criteria designed to limit subjectivity. Results Fourteen online ACD templates were included, all of which were available only in English. Templates developed by Southern Cross University best met the framework criteria. One ACD template was found to be biased against medical treatment – the Dying with Dignity Victoria Advance Healthcare Directive. Conclusions More research is needed to understand how online resources can optimally elicit and record consumers’ individual preferences for future care. Future iterations of the framework should address online availability and provide a simple rating system to inform choice and drive quality improvement

"Stretched thin with little children” – smoking perceptions and experiences of families seeking help with parenting

Cigarette smoking is the leading preventable cause of poor pregnancy outcomes. Pregnancy is a trigger for smoking cessation yet, up to 50% of parents will relapse in the early years of their child’s life. The smoking-related perceptions and experiences of eleven parents seeking professional help with the care and parenting of babies and toddlers were explored, using semi-structured interviews. Inductive thematic analysis identified three themes: parenting as a change catalyst, smoking as a parenting challenge and smoking as a coping strategy. Becoming a parent is a catalyst to reduce the associated risks and stigma associated with smoking, but maintaining rules and boundaries can be perceived as a further burden for parents who are struggling to care for their infant. When faced with difficulties with parenting, parents may revert to smoking as a coping strategy. Based on these study findings, interventions targeting gender norms may be useful in addressing smoking cessation

The Predictive Relationship Between Psychological Capital and Academic Burnout in Postgraduate Students

Purpose: The purpose of this quantitative correlational study was to determine if, or to what extent, the composite and sub-composite categories of Psychological Capital (PsyCap) predict academic burnout in American postgraduate health science students at a university in the Southeastern United States. Methods: The variables of the study were measured by the Psychological Capital Questionnaire (PCQ-24) and the Maslach Burnout Inventory-Student Survey (MBI-SS). A convenience sampling method was used to collect data from the target population, which included a final sample of 90 health science postgraduate students. Results: A simple linear regression analysis revealed that PsyCap was a significant and negative predictor of academic burnout (F(1,88) = 12.00, p \u3c .001, R2 = 0.12; B = -0.28, t(88) = -3.46, p \u3c .001). Additionally, multiple linear regression analysis revealed that only one sub-category of PsyCap, labeled as Optimism, was a significant and negative predictor of academic burnout (F(4,85) = 5.17, p \u3c .001, R2= 0.20; B = -0.90, t(85) = -3.17, p = .002). Conclusion: The findings may be used by higher education instructors, advisors, and administrators in the United States to adopt policies, practices, programs, student advising, and student mentorship that foster PsyCap and Optimism development in students, which may mitigate the risks and consequences of academic burnout

A systematic review of assessment approaches to predict opioid misuse in people with cancer.

CONTEXT: Cancer prevalence is increasing, with many patients requiring opioid analgesia. Clinicians need to ensure patients receive adequate pain relief. However, opioid misuse is widespread, and cancer patients are at risk. OBJECTIVES: This study aims (1) to identify screening approaches that have been used to assess and monitor risk of opioid misuse in patients with cancer; (2) to compare the prevalence of risk estimated by each of these screening approaches; and (3) to compare risk factors among demographic and clinical variables associated with a positive screen on each of the approaches. METHODS: Medline, Cochrane Controlled Trial Register, PubMed, PsycINFO, and Embase databases were searched for articles reporting opioid misuse screening in cancer patients, along with handsearching the reference list of included articles. Bias was assessed using tools from the Joanna Briggs Suite. RESULTS: Eighteen studies met the eligibility criteria, evaluating seven approaches: Urine Drug Test (UDT) (n = 8); the Screener and Opioid Assessment for Patients with Pain (SOAPP) and two variants, Revised and Short Form (n = 6); the Cut-down, Annoyed, Guilty, Eye-opener (CAGE) tool and one variant, Adapted to Include Drugs (n = 6); the Opioid Risk Tool (ORT) (n = 4); Prescription Monitoring Program (PMP) (n = 3); the Screen for Opioid-Associated Aberrant Behavior Risk (SOABR) (n = 1); and structured/specialist interviews (n = 1). Eight studies compared two or more approaches. The rates of risk of opioid misuse in the studied populations ranged from 6 to 65%, acknowledging that estimates are likely to have varied partly because of how specific to opioids the screening approaches were and whether a single or multi-step approach was used. UDT prompted by an intervention or observation of aberrant opioid behaviors (AOB) were conclusive of actual opioid misuse found to be 6.5-24%. Younger age, found in 8/10 studies; personal or family history of anxiety or other mental ill health, found in 6/8 studies; and history of illicit drug use, found in 4/6 studies, showed an increased risk of misuse. CONCLUSIONS: Younger age, personal or familial mental health history, and history of illicit drug use consistently showed an increased risk of opioid misuse. Clinical suspicion of opioid misuse may be raised by data from PMP or any of the standardized list of AOBs. Clinicians may use SOAPP-R, CAGE-AID, or ORT to screen for increased risk and may use UDT to confirm suspicion of opioid misuse or monitor adherence. More research into this important area is required. SIGNIFICANCE OF RESULTS: This systematic review summarized the literature on the use of opioid misuse risk approaches in people with cancer. The rates of reported risk range from 6 to 65%; however, true rate may be closer to 6.5-24%. Younger age, personal or familial mental health history, and history of illicit drug use consistently showed an increased risk of opioid misuse. Clinicians may choose from several approaches. Limited data are available on feasibility and patient experience. PROSPERO registration number. CRD42020163385

Content and quality of websites supporting self-management of chronic breathlessness in advanced illness: A systematic review

Chronic breathlessness is a common, burdensome and distressing symptom in many advanced chronic illnesses. Self-management strategies are essential to optimise treatment, daily functioning and emotional coping. People with chronic illness commonly search the internet for advice on self-management. A review was undertaken in June 2015 to describe the content and quality of online advice on breathlessness self-management, to highlight under-served areas and to identify any unsafe content. Google was searched from Sydney, Australia, using the five most common search terms for breathlessness identified by Google Trends. We also hand-searched the websites of national associations. Websites were included if they were freely available in English and provided practical advice on self-management. Website quality was assessed using the American Medical Association Benchmarks. Readability was assessed using the Flesch-Kincaid grades, with grade 8 considered the maximum acceptable for enabling access. Ninety-one web pages from 44 websites met the inclusion criteria, including 14 national association websites not returned by Google searches. Most websites were generated in the USA (n=28, 64%) and focused on breathing techniques (n=38, 86%) and chronic obstructive pulmonary disease (n=27, 61%). No websites were found to offer unsafe advice. Adherence to quality benchmarks ranged from 9% for disclosure to 77% for currency. Fifteen (54%) of 28 written websites required grade ≈ 3/49 reading level. Future development should focus on advice and tools to support goal setting, problem solving and monitoring of breathlessness. National associations are encouraged to improve website visibility and comply with standards for quality and readability

ACCELERATED SITE TECHNOLOGY DEPLOYMENT COST AND PERFORMANCE REPORT COMPARABILITY OF ISOCS INSTRUMENT IN RADIONUCLIDE CHARACTERICATION AT BROOKHAVEN NATIONAL LABORATORY

This report describes a DOE Accelerated Site Technology Deployment project being conducted at Brookhaven National Laboratory to deploy innovative, radiological, in situ analytical techniques. The technologies are being deployed in support of efforts to characterize the Brookhaven Graphite Research Reactor (BGRR) facility, which is currently undergoing decontamination and decommissioning. This report focuses on the deployment of the Canberra Industries In Situ Object Counting System (ISOCS) and assesses its data comparability to baseline methods of sampling and laboratory analysis. The battery-operated, field deployable gamma spectrometer provides traditional spectra of counts as a function of gamma energy. The spectra are then converted to radionuclide concentration by applying innovative efficiency calculations using monte carlo statistical methods and pre-defined geometry templates in the analysis software. Measurement of gamma emitting radionuclides has been accomplished during characterization of several BGRR components including the Pile Fan Sump, Above Ground Ducts, contaminated cooling fans, and graphite pile internals. Cs-137 is the predominant gamma-emitting radionuclide identified, with smaller quantities of Co-60 and Am-241 detected. The Project used the Multi-Agency Radiation Survey and Site Investigation Manual guidance and the Data Quality Objectives process to provide direction for survey planning and data quality assessment. Analytical results have been used to calculate data quality indicators (DQI) for the ISOCS measurements. Among the DQIs assessed in the report are sensitivity, accuracy, precision, bias, and minimum detectable concentration. The assessment of the in situ data quality using the DQIs demonstrates that the ISOCS data quality can be comparable to definitive level laboratory analysis when the field instrument is supported by an appropriate Quality Assurance Project Plan. A discussion of the results obtained by ISOCS analysis of objects that could not be analyzed readily by conventional methods demonstrates a powerful application of the instrument. In conclusion, a comparison of costs associated with the analysis on the ISOCS instrument to the costs of conventional sampling and laboratory analysis is presented

Health service utilisation associated with chronic breathlessness: random population sample.

Background Most health service utilisation studies are of people with specific diagnoses or demographic characteristics, and rarely of specific chronic symptoms. The aim of this study was to establish whether population-level health service utilisation increases in people with chronic breathlessness. Methods A cross-sectional analysis was carried out of the South Australian Health Omnibus Survey 2017, a multi-stage, clustered area, systematic sampling survey of adults where questions are administered face-to-face in respondents’ homes. Self-report of health service utilisation in the previous 3 months (medical consultations, emergency department, hospital admission), chronic breathlessness (severity, duration, modified Medical Research Council (mMRC) breathlessness scale) and demographic data were used to predict self-reported health service utilisation. Results A total of 2898 people were included (49.0% male; median age 48.0 years (IQR 32.0–63.0); 64.1% educated beyond school; 55.4% in work; 73.5% had outpatient contact; 6.3% had a hospital admission in the previous 3 months). Chronic breathlessness (mMRC ≥1) was reported by 8.8% of respondents. In bivariable analyses, people with greater contact with health services were older, and a higher proportion were overweight/obese and had more severe chronic breathlessness. In multivariable analyses, chronic breathlessness and older age were positively associated with outpatient care and inpatient care, and people with chronic breathlessness were hospitalised for longer (incidence rate ratio 2.5; 95% CI 1.4–4.5). Conclusion There is a significant association between worse chronic breathlessness and increased health service utilisation. There is a need for greater understanding of factors that initiate contact with health services

The association between cognitive impairment and functional outcome in hospitalised older patients: a systematic review and meta-analysis

BACKGROUND: in hospitalised older adults, cognitive impairments are common and may be associated with functional outcomes. Our aim was to systematically review this association. METHOD: we systematically searched MEDLINE, CINAHL, AMED and PsycINFO from inception to April 2016. Non-English language studies were filtered out at search stage. All types of studies were considered for inclusion except reviews, conference abstracts, dissertations and case studies. Population: community-dwelling or institutionalised older adults aged 65 years or more, who are acutely hospitalised and have information on history of dementia and/or cognitive scores on admission. Setting: acute hospital (excluding critical care and subacute or intermediate care). Outcome of interest: change in a measure of physical function or disability between pre-admission or admission, and discharge or post-discharge. This review was registered on PROSPERO (CRD42016035978). RESULTS: the search returned 5,988 unique articles, of which 34 met inclusion criteria. All studies were observational, with 30 prospective and 4 retrospective from 14 countries, recruiting from general medicine (n = 11), geriatric medicine (n = 11) and mixed (n = 12) wards. Twenty-six studies (54,637 participants) were suitable for the quantitative synthesis. The meta-analysis suggested that cognitive impairment was associated with functional decline in hospitalised older adults (risk ratio (RR): 1.64; 95% confidence interval (CI): 1.45–1.86; P < 0.01). Results were similar in subanalyses focusing on diagnosis of dementia (RR: 1.36; 95% CI: 1.05–1.76; P = 0.02; n= 2,248) or delirium (RR: 1.55; 95% CI: 1.31–1.83; P < 0.01; n= 1,677). CONCLUSION: cognitive impairments seem associated with functional decline in hospitalised older people. Causality cannot be inferred, and limitations include low quality of studies and possible confounding