Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention

Background: Access and equity in children’s therapy services may be improved by directing clinicians’ use of resources toward specific goals that are important to patients. A practice-change intervention (titled ‘Good Goals’) was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children’s occupational therapy services. Methods: Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and ‘tools for change’. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers’ observations. Results: Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists’ time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists’ behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children’s LoT decreased by two months [95% CI −8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists’ salary bands. Conclusions: Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts

Economic Damages of Wild Pigs in Non-Traditional Areas: From the Fairway to the After Life

Invasive wild pigs are widely known to cause damage to agricultural properties and commodities, but less has been reported about damages to other types of property. A survey was distributed to golf courses and cemeteries across Texas to explore the extent of damage these properties experience. While both property types reported significant damages, golf courses were found to experience more damage than cemeteries. Using average reported costs and predicted county-level damage, total costs for all golf courses and cemeteries across the state were estimated to exceed $1.6 million USD per year

Optimal spatial prioritization of control resources for elimination of invasive species under demographic uncertainty

Populations of invasive species often spread heterogeneously across a landscape, consisting of local populations that cluster in space but are connected by dispersal. A fundamental dilemma for invasive species control is how to optimally allocate limited fiscal resources across local populations. Theoretical work based on perfect knowledge of demographic connectivity suggests that targeting local populations from which migrants originate (sources) can be optimal. However, demographic processes such as abundance and dispersal can be highly uncertain, and the relationship between local population density and damage costs (damage function) is rarely known. We used a metapopulation model to understand how budget and uncertainty in abundance, connectivity, and the damage function, together impact return on investment (ROI) for optimal control strategies. Budget, observational uncertainty, and the damage function had strong effects on the optimal resource allocation strategy. Uncertainty in dispersal probability was the least important determinant of ROI. The damage function determined which resource prioritization strategy was optimal when connectivity was symmetric but not when it was asymmetric. When connectivity was asymmetric, prioritizing source populations had a higher ROI than allocating effort equally across local populations, regardless of the damage function, but uncertainty in connectivity structure and abundance reduced ROI of the optimal prioritization strategy by 57% on average depending on the control budget. With low budgets (monthly removal rate of 6.7% of population), there was little advantage to prioritizing resources, especially when connectivity was high or symmetric, and observational uncertainty had only minor effects on ROI. Allotting funding for improved monitoring appeared to be most important when budgets were moderate (monthly removal of 13–20% of the population). Our result showed that multiple sources of observational uncertainty should be considered concurrently for optimizing ROI. Accurate estimates of connectivity direction and abundance were more important than accurate estimates of dispersal rates. Developing cost-effective surveillance methods to reduce observational uncertainties, and quantitative frameworks for determining how resources should be spatially apportioned to multiple monitoring and control activities are important and challenging future directions for optimizing ROI for invasive species control programs

Risks of introduction and economic consequences associated with African swine fever, classical swine fever and foot-and-mouth disease: A review of the literature

African swine fever (ASF), classical swine fever (CSF) and foot-and-mouth disease (FMD) are considered to be three of the most detrimental animal diseases and are currently foreign to the U.S. Emerging and re-emerging pathogens can have tremendous impacts in terms of livestock morbidity and mortality events, production losses, forced trade restrictions, and costs associated with treatment and control. The United States is the world\u27s top producer of beef for domestic and export use and the world\u27s third-largest producer and consumer of pork and pork products; it has also recently been either the world\u27s largest or second largest exporter of pork and pork products. Understanding the routes of introduction into the United States and the potential economic impact of each pathogen are crucial to (a) allocate resources to prevent routes of introduction that are believed to be more probable, (b) evaluate cost and efficacy of control methods and (c) ensure that protections are enacted to minimize impact to the most vulnerable industries. With two scoping literature reviews, pulled from global data, this study assesses the risk posed by each disease in the event of a viral introduction into the United States and illustrates what is known about the economic costs and losses associated with an outbreak

Predicting Adverse Outcomes for Shiga Toxin–Producing Escherichia coli Infections in Emergency Departments

Objective: To assess the performance of a hemolytic uremic syndrome (HUS) severity score among children with Shiga toxin-producing Escherichia coli (STEC) infections and HUS by stratifying them according to their risk of adverse events. The score has not been previously evaluated in a North American acute care setting. Study design: We reviewed medical records of children \u3c18 years old infected with STEC and treated in 1 of 38 participating emergency departments in North America between 2011 and 2015. The HUS severity score (hemoglobin [g/dL] plus 2-times serum creatinine [mg/dL]) was calculated using first available laboratory results. Children with scores \u3e13 were designated as high-risk. We assessed score performance to predict severe adverse events (ie, dialysis, neurologic complication, respiratory failure, and death) using discrimination and net benefit (ie, threshold probability), with subgroup analyses by age and day-of-illness. Results: A total of 167 children had HUS, of whom 92.8% (155/167) had relevant data to calculate the score; 60.6% (94/155) experienced a severe adverse event. Discrimination was acceptable overall (area under the curve 0.71, 95% CI 0.63-0.79) and better among children \u3c5 years old (area under the curve 0.77, 95% CI 0.68-0.87). For children \u3c5 years, greatest net benefit was achieved for a threshold probability \u3e26%. Conclusions: The HUS severity score was able to discriminate between high- and low-risk children \u3c5 years old with STEC-associated HUS at a statistically acceptable level; however, it did not appear to provide clinical benefit at a meaningful risk threshold

Vertical structure of a supernova-driven turbulent magnetized ISM

Stellar feedback drives the circulation of matter from the disk to the halo of galaxies. We perform three-dimensional magnetohydrodynamic simulations of a vertical column of the interstellar medium with initial conditions typical of the solar circle in which supernovae drive turbulence and determine the vertical stratification of the medium. The simulations were run using a stable, positivity-preserving scheme for ideal MHD implemented in the FLASH code. We find that the majority (\approx 90 %) of the mass is contained in thermally-stable temperature regimes of cold molecular and atomic gas at T < 200 K or warm atomic and ionized gas at 5000 K < T < 10^{4.2} K, with strong peaks in probability distribution functions of temperature in both the cold and warm regimes. The 200 - 10^{4.2} K gas fills 50-60 % of the volume near the plane, with hotter gas associated with supernova remnants (30-40 %) and cold clouds (< 10 %) embedded within. At |z| ~ 1-2 kpc, transition-temperature (10^5 K) gas accounts for most of the mass and volume, while hot gas dominates at |z| > 3 kpc. The magnetic field in our models has no significant impact on the scale heights of gas in each temperature regime; the magnetic tension force is approximately equal to and opposite the magnetic pressure, so the addition of the field does not significantly affect the vertical support of the gas. The addition of a magnetic field does reduce the fraction of gas in the cold (< 200 K) regime with a corresponding increase in the fraction of warm (~ 10^4 K) gas. However, our models lack rotational shear and thus have no large-scale dynamo, which reduces the role of the field in the models compared to reality. The supernovae drive oscillations in the vertical distribution of halo gas, with the period of the oscillations ranging from ~ 30 Myr in the T < 200 K gas to ~ 100 Myr in the 10^6 K gas, in line with predictions by Walters & Cox.Comment: Accepted for publication in ApJ. Replacement corrects an error in the observed CNM pressure distribution in Figure 15 and associated discussio

Abnormal cognition, sleep, EEG and brain metabolism in a novel knock-in Alzheimer mouse, PLB1

Peer reviewedPublisher PD

Precision Measurement of the Proton and Deuteron Spin Structure Functions g2 and Asymmetries A2

We have measured the spin structure functions g2p and g2d and the virtual photon asymmetries A2p and A2d over the kinematic range 0.02 < x < 0.8 and 0.7 < Q^2 < 20 GeV^2 by scattering 29.1 and 32.3 GeV longitudinally polarized electrons from transversely polarized NH3 and 6LiD targets. Our measured g2 approximately follows the twist-2 Wandzura-Wilczek calculation. The twist-3 reduced matrix elements d2p and d2n are less than two standard deviations from zero. The data are inconsistent with the Burkhardt-Cottingham sum rule if there is no pathological behavior as x->0. The Efremov-Leader-Teryaev integral is consistent with zero within our measured kinematic range. The absolute value of A2 is significantly smaller than the sqrt[R(1+A1)/2] limit.Comment: 12 pages, 4 figures, 2 table

Creating a positive casual academic identity through change and loss

Neoliberalism has significantly impacted higher education institutes across the globe by increasing the number of casual and non-continuing academic positions. Insecure employments conditions have not only affected the well-being of contingent staff, but it has also weakened the democratic, intellectual and moral standing of academic institutions. This chapter provides one practitioner’s account of the challenges of casual work, but rather than dwelling on the negativities, it outlines the potential richness of an identity based on insecurity and uncertainty. This exploration draws on the literature of retired academics and identity theory to illustrate the potential generative spaces within an undefined and incoherent identity