Quantification of sediment-water interactions in a polluted tropical river through biogeochemical modeling

Diagenetic modeling presents an interesting and robust way to understand sediment-water column processes. Here we present the application of such a model to the Day River in Northern Vietnam, a system that is subject to high levels of domestic wastewater inputs from the Hanoi metropolitan area. Experimental data from three areas of different water and sediment quality, combined with some additional data from the river, are used to set up and calibrate a diagenetic model. The model was used to determine the role of the sediments as a sink for carbon and nutrients and shows that in the dry season, 27% of nitrogen, 25% of carbon, and 38% of phosphorus inputs into the river system are stored in sediments. The corresponding numbers during the rainy season are 15%, 10%, and 20%, respectively. The diagenetic model was then used to test the impact of an improvement in the treatment of Hanoi's municipal wastewater. We show that improved wastewater treatment could reduce by about 17.5% the load of organic matter to the sediment. These results are the first to highlight the importance of sediments as a potential removal mechanism of organic matter and nutrients from the water column in this type of highly impacted tropical urban river, further demonstrating that rivers need to be considered as reaction sites and not just as inert conduits

Visibility of age restriction warnings, harm reduction messages, and terms and conditions::A content analysis of paid-for gambling advertising in the United Kingdom.

Objective: The inclusion and design of age restriction warnings, harm reduction messages, and terms and conditions (T&Cs) in gambling advertising is self-regulated in the United Kingdom. Our study examines the visibility and nature of this information in a sample of paid-for gambling adverts. Study design: Content analysis of a stratified random sample of gambling adverts (n=300) in the United Kingdom from eight paid-for advertising channels (March 2018). Methods: For each advert, we assessed whether any age restriction warnings, harm reduction messages, and T&Cs were present. If so, visibility was scored on a five-point scale ranging from Very poor (25% of advert), which had high inter-rater reliability. Descriptive information on position, design, and tone of language was recorded. Results: One-in-seven adverts (14%) did not feature an age restriction warning or harm reduction message. In adverts that did, 84% of age restriction warnings and 54% of harm reduction messages had very poor visibility. At least one-in-ten adverts did not contain T&Cs. In adverts that did, 73% had very poor visibility. For age restriction warnings, harm reduction messages, and T&Cs, most appeared in small fonts and outside the main advert frame. Most harm reduction messages did not actually reference gambling-related harms. Conclusion: Age restriction warnings, harm reduction messages, and T&Cs do not always appear in paid-for gambling advertising. When they do, visibility is often very poor and the messaging not clear. The findings do not support a self-regulatory approach to managing this information in gambling adverts

Experiences of Pain in Hospitalized Children During Hematopoietic Stem Cell Transplantation Therapy

Children undergoing hematopoietic stem cell transplantation (HSCT) are vulnerable to pain due to the intensity and toxicity of this treatment. An instrumental case study design of two qualitative phases was conducted to examine the pain experiences of hospitalized children during HSCT therapy and how contextual factors related to the pediatric HSCT environment influenced their experience of pain. The Social Communication Model of Pain provided the conceptual framework for the study. In Phase 1, semi-structured interviews were conducted with parents of a child undergoing HSCT therapy at two time points. Phase 2 was conducted as a naturalistic observational study of the clinical care provided to children and semi-structured interviews with health-care providers. Children experienced complex and multifaceted pain with physical, psychological, and contextual contributors. Understanding the many factors contributing to the child’s pain experience can inform strategies to improve the management of pain during HSCT therapy. </jats:p

Longitudinal investigation of the role of temperament and stressful life events in childhood anxiety

The current study investigated the longitudinal relationships between BI, life events, and anxiety in a sample of 102 behaviourally inhibited (BI) and 100 uninhibited (BUI) children aged 3 to 4 years. Children’s parents completed questionnaires on BI, stressful life events, and anxiety symptoms, and were administered a diagnostic interview three times in a 5-year period. In line with our hypotheses, negative life events, and negative behaviour- dependent life events (i.e. life events that are related to the children’s own behaviours) in particular, and the impact of negative life events, were predictive of increases in subsequent anxiety symptoms, the likelihood of having an anxiety disorder, and increased number of anxiety diagnoses over the five year follow-up period. Experiencing more positive, behaviour-independent life events decreased the risk of being diagnosed with an anxiety disorder. Furthermore, differences were found in life events between BI and BUI children. That is, BI children experienced fewer positive and specifically positive behaviour-dependent life events, and the impact of these positive life events was also lower in BI children than in BUI children. However, BI did not interact with life events in the prediction of anxiety problems as hypothesized. Therefore, this study seems to indicate that BI and life events act as additive risk factors in the development of anxiety problems

Creating a journal club competition improves paediatric nurses' participation and engagement

© 2015 Elsevier Ltd.Background: To improve journal club participation, innovative approaches are required but few have been described. It was unknown if adding an element of competition, to an established journal club, would increase nurses' participation. Objective: To explore the impact on attendance and participation in a hospital-wide nursing journal club through the introduction of an element of competition. Design: A descriptive exploratory study. Setting and participants: An Australian specialist tertiary paediatric hospital with over 1600 nurses. Methods: In 2013, 12 hospital wards/departments were randomly assigned a month each to present journal club. Nurses were supported to evaluate an article according to a published framework. A predetermined rubric guided marking. Post competition, all hospital nurses received an anonymous online survey invitation. Demographic, Likert scale and qualitative data were collected. Questions elicited attitudes and perceived barriers or facilitators to participation in the journal club. Results: Compared to 2012, there was a statistically significant increase in journal club attendance (2013 median = 20.5 [IQR = 18.2, 27.7] vs. 2012 median = 9 [IQR = 6.5, 12.5], Mann-Whitney U test, p < 0.01). Full online survey responses were received from 289/1674 (response rate 17.3%) of sent invitations (Non-Attendees n = 224, Attendees n = 65 (including 18 presenters). Overall, Attendees reported journal club had a positive impact on their professional engagement. Presenters rated the journal club format highly as it developed skills and increased their confidence in journal club presentation. Emergent themes were time and location, engagement, topics and content. Conclusion: A competition format can increase nurses' journal club attendance and participation. Further work is required to establish applicability of this format to other settings

Medication communication between nurses and doctors for paediatric acute care: An ethnographic study

AIMS AND OBJECTIVES: To examine how communication between nurses and doctors occurred for managing medications in inpatient paediatric settings. BACKGROUND: Communication between health professionals influences medication incidents' occurrence and safe care. DESIGN: An ethnographic study was undertaken. METHODS: Semi-structured interviews, observations and focus groups were conducted in three clinical areas of an Australian tertiary paediatric hospital. Data were transcribed verbatim and thematically analysed using the Medication Communication Model. RESULTS: The actual communication act revealed professionals' commitment to effective medication management and the influence of professional identities on medication communication. Nurses and doctors were dedicated to providing safe, effective medication therapy for children, within their scope of practice and perceived role responsibilities. Most nurses and junior doctors used tentative language in their communication while senior doctors tended to use direct language. Irrespective of language style, nurses actively engaged with doctors to promote patients' needs. Yet, the medical hierarchical structure, staffing and attendant expectations influenced communication for medication management, causing frustration among nurses and doctors. Doctors' lack of verbal communication of documented changes to medication orders particularly troubled nurses. Nurses persisted in their efforts to acquire appropriate orders for safe medication administration to paediatric patients. CONCLUSIONS: Collaborative practice between nurses and doctors involved complex, symbiotic relationships. Their dedication to providing safe medication therapy to paediatric patients facilitated effective medication management. At times, shortcomings in inter-disciplinary communication impacted on potential and actual medication incidents. RELEVANCE TO CLINICAL PRACTICE: Understanding of the complexities affecting medication communication between nurses and doctors helps to ensure inter-professional respect for each other's roles and inherent demands. Interdisciplinary education delivered in health care organisations would facilitate greater clarity in communication related to medications. Encouraging the use of concise, clear words in communication would help to promote improved understanding between parties, and accuracy and efficacy of medication management. This article is protected by copyright. All rights reserved

Examining the frequency and nature of gambling marketing in televised broadcasts of professional sporting events in the United Kingdom

Objective: Gambling operators in the United Kingdom have introduced a voluntary ban on adverts broadcast during televised sport before 21:00 (the 'whistle-to-whistle' ban). To inform debates around the potential effectiveness of this ban, we examine the frequency and nature of gambling marketing in televised broadcasts across professional sporting events. Study Design: Frequency analysis of verbal and visual gambling marketing references during television broadcasts of football (n=5), tennis, Formula 1, boxing and rugby union (each n=1) from 2018. Methods: For each gambling reference, we coded: whether it appeared in-play or out-of-play; location (e.g. pitch-side advertising); format (e.g. branded merchandise); duration (seconds); number of identical references visible simultaneously; brand; and presence of age restriction or harm reduction messages. Results: Boxing contained the most gambling references, on average, per broadcast minute (4.70 references), followed by football (2.75), rugby union (0.55), and tennis (0.11). Formula 1 contained no gambling references. In boxing, references most frequently appeared within the area-of-play. For football and rugby union, references most frequently appeared around the pitch border or within the area-of-play (e.g. branded shirts). Only a small minority of references were for adverts during commercial breaks that would be subject to the whistle-to-whistle ban(e.g. 2% of references in football). Less than 1% of references in boxing, and only 3% of references in football, contained age restriction or harm-reduction messages. Conclusions: As gambling sponsorship extends much beyond adverts in commercial breaks, the 'whistle-to-whistle' ban will have limited effect on gambling exposure. Gambling sponsorship activities rarely contain harm reduction messages

Імітаційне комп'ютерне моделювання процесу організації підприємницького інноваційного центру за допомогою програмного пакету «Ithink»

В статті робиться спроба розробки та застосування імітаційної моделі створення підприємницького інноваційного центру з метою поширення переваг і можливостей інноваційної діяльності в регіональній економіці. Для розробки імітаційної моделі використовується пакет програмного продукту «Ithink», який став широко застосовуватися в моделюванні різноманітних економічних процесів в економіці і якій дозволив створити робочі моделі таких процесів, враховуючи різнобічні фактори впливу на вказані процеси та визначити наслідки їх дії з послідовним корегуванням та відпрацюванням самих моделей в реальній практиці.The article is aimed to propose a simulating model of the creation of the innovational regional center to examine the advantages and innovational possibilities in the regional economy. The popular software “I think” which has become widely used in modeling different similar economic processes, is used for the development of the simulation model. This gives the possibility to take into consideration various factors of influence on these processes and calculate their consequences with the option of their gradual correction and working out the models in the real practice

Dealing with Time in Health Economic Evaluation: Methodological Issues and Recommendations for Practice

Time is an important aspect of health economic evaluation, as the timing and duration of clinical events, healthcare interventions and their consequences all affect estimated costs and effects. These issues should be reflected in the design of health economic models. This article considers three important aspects of time in modelling: (1) which cohorts to simulate and how far into the future to extend the analysis; (2) the simulation of time, including the difference between discrete-time and continuous-time models, cycle lengths, and converting rates and probabilities; and (3) discounting future costs and effects to their present values. We provide a methodological overview of these issues and make recommendations to help inform both the conduct of cost-effectiveness analyses and the interpretation of their results. For choosing which cohorts to simulate and how many, we suggest analysts carefully assess potential reasons for variation in cost effectiveness between cohorts and the feasibility of subgroup-specific recommendations. For the simulation of time, we recommend using short cycles or continuous-time models to avoid biases and the need for half-cycle corrections, and provide advice on the correct conversion of transition probabilities in state transition models. Finally, for discounting, analysts should not only follow current guidance and report how discounting was conducted, especially in the case of differential discounting, but also seek to develop an understanding of its rationale. Our overall recommendations are that analysts explicitly state and justify their modelling choices regarding time and consider how alternative choices may impact on results