Wellness Lessons From Transportation Companies, Research Report WP 11-01

The purpose of this report is to describe wellness programs and offer two suggestions for improving how they are delivered to commercial drivers and operators. It is not a large sample empirical study from which generalizations can be made. Rather, the Mineta Transportation Institute commissioned brief case studies of transportation companies to show what several organizations have done. Stress, nicotine use, sleep apnea, obesity and lack of information are significant barriers to wellness in commercial drivers/operators. Many wellness programs ask the individual driver/operator to lose weight; exercise more; and monitor blood pressure, glucose, cholesterol and other such indicators of health. However, little is done to change the environment or adopt structural interventions such as forbidding nicotine use, as is possible in 20 states. Other structural interventions include those possible at the levels of the company and community, including access to healthy food rather than the junk food drivers often can find on the road. At the societal level, more public transit that gets people walking and out of their cars, cities designed for people to walk and cycle in rather than drive from work to a sprawling suburb, and encouraging food manufacturers to make healthy food (rather than a toxic mix of sodium, fat and sugar to boost one’s craving for a particular food) are just a few measures that could improve the health and well being of the public. The Union Pacific Corporation (rail transportation), and Con-way Freight (trucking) are included because they were willing to share information and are large publicly traded companies. The Utah Transit Authority (UTA) is included because other transit authorities recommended it to the authors, as it has a long history in wellness as part of local government and it too chose to participate. Two issues are discussed: the first is the importance of using the mitigation of erectile dysfunction in the promotion of wellness programs to commercial drivers/operators and the second issue is to urge employers to consider banning tobacco use, both on and off the job, where legal

Adult basic education in NSW 1970-2018 : official stories and stories from practice

University of Technology Sydney. Faculty of Arts and Social Sciences.This thesis traces the development of adult literacy provision in NSW over its 40 year history, with particular focus on the discursive tensions between policy and practice. A major and overriding theme has been the move away from a philosophy of humanist education and a socio-cultural view of literacy, towards an economically driven, human capital view of literacy. The study analyses the changing socio-economic background to the development of the field of adult literacy (later called adult basic education) and the ways in which resulting public and policy discourses have impacted the field. In the foundation years, the public discourse of liberal humanism was reflected in the professional discourse. From the early 1990s however, a tension began to emerge as the public and policy discourse moved increasingly towards an instrumentalist, human capital view. The study illuminates the increasing discursive tensions between policy and practice and between the public and professional discourses that have sought to shape the field. Discourse theory, with its focus on power relations, as developed for example by Foucault (1972), and elaborated by Gee (2015) and Fairclough (2015), informs the analysis of the ways in which these discursive struggles have defined and redefined the field over the period discussed. Building on this understanding of discourse, the main conceptual resource employed is that of Actor Network Theory (ANT) (Callon 1986; Latour 2005). It is chosen as a useful lens through which to view the multiplicity of ‘actors’ both human and non-human, that have interacted in a non-linear and fluid fashion to influence the direction of the field. The study uses a number of the concepts described by ANT theorists to illuminate the ways in which some assemblages of actors came to exert power and advance a dominant discourse of literacy, whilst the influence of others declined. A number of past and present practitioners were interviewed in order to capture the teachers’ voices or ‘stories from practice’, thus informing and giving life to our understanding of the development of the field. Analysis of documentary and archival evidence provides a further perspective on the ‘official stories’. The primary rationale for the study was a wish to commit the narrative to the public memory in order assist present and future practitioners to contextualise their practice. The study concludes with a consideration of some possible implications that it offers to practitioners and activists in their challenge to the present discourse surrounding the field

Polypharmacy and emergency readmission to hospital after critical illness:a population-level cohort study

From PubMed via Jisc Publications RouterPolypharmacy is common and closely linked to drug interactions. The impact of polypharmacy has not been previously quantified in survivors of critical illness who have reduced resilience to stressors. Our aim was to identify factors associated with preadmission polypharmacy and ascertain whether polypharmacy is an independent risk factor for emergency readmission to hospital after discharge from a critical illness. A population-wide cohort study consisting of patients admitted to all Scottish general ICUs between January 1, 2011 and December 31, 2013, whom survived their ICU stay. Patients were stratified by presence of preadmission polypharmacy, defined as being prescribed five or more regular medications. The primary outcome was emergency hospital readmission within 1 yr of discharge from index hospital stay. Of 23 844 ICU patients, 29.9% were identified with polypharmacy (n=7138). Factors associated with polypharmacy included female sex, increasing age, and social deprivation. Emergency 1-yr hospital readmission was significantly higher in the polypharmacy cohort (51.8% vs 35.8%, P<0.001). After confounder adjustment, patients with polypharmacy had a 22% higher hazard of emergency 1-yr readmission (adjusted hazard ratio 1.22, 95% confidence interval 1.16-1.28, P<0.001). On a linear scale of polypharmacy each additional prescription conferred a 3% increase in hazard of emergency readmission by 1 yr (adjusted hazard ratio 1.03, 95% confidence interval 1.02-1.03, P<0.001). This national cohort study of ICU survivors demonstrates that preadmission polypharmacy is an independent risk factor for emergency readmission. In an ever-growing era of polypharmacy, this risk factor may represent a substantial burden in the at-risk post-intensive care population.126pubpub

Illuminating evaporating protostellar outflows: ERIS/SPIFFIER reveals the dissociation and ionization of HH 900

Protostellar jets and outflows are signposts of active star formation. In H II regions, molecular tracers like CO only reveal embedded portions of the outflow. Outside the natal cloud, outflows are dissociated, ionized, and eventually completely ablated, leaving behind only the high-density jet core. Before this process is complete, there should be a phase where the outflow is partially molecular and partially ionized. In this paper, we capture the HH 900 outflow while this process is in action. New observations from the ERIS/SPIFFIER near-IR integral field unit (IFU) spectrograph using the K-middle filter ($\lambda$=2.06-2.34 $\mu$m) reveal H$_2$ emission from the dissociating outflow and Br-$\gamma$ tracing its ionized skin. Both lines trace the wide-angle outflow morphology but H$_2$ only extends $\sim$5000 au into the H II region while Br-$\gamma$ extends the full length of the outflow ($\sim$12,650 au), indicating rapid dissociation of the molecules. H$_2$ has higher velocities further from the driving source, consistent with a jet-driven outflow. Diagnostic line ratios indicate that photoexcitation, not just shocks, contributes to the excitation in the outflow. We argue that HH 900 is the first clear example of an evaporating molecular outflow and predict that a large column of neutral material that may be detectable with ALMA accompanies the dissociating molecules. Results from this study will help guide the interpretation of near-IR images of externally irradiated jets and outflows such as those obtained with the James Webb Space Telescope (JWST) in high-mass star-forming regions where these conditions may be common.Comment: MNRAS, accepte

Illuminating evaporating protostellar outflows: ERIS/SPIFFIER reveals the dissociation and ionization of HH 900

Protostellar jets and outflows are signposts of active star formation. In H II regions, molecular tracers like CO only reveal embedded portions of the outflow. Outside the natal cloud, outflows are dissociated, ionized, and eventually completely ablated, leaving behind only the high-density jet core. Before this process is complete, there should be a phase where the outflow is partially molecular and partially ionized. In this paper, we capture the HH 900 outflow while this process is in action. New observations from the Enhanced Resolution Imager and Spectrograph/SPIFFIER near-infrared (IR) integral field unit spectrograph using the K-middle filter (λ = 2.06–2.34 μm) reveal H2 emission from the dissociating outflow and Br-γ tracing its ionized skin. Both lines trace the wide-angle outflow morphology but H2 only extends ∼5000 au into the H II region while Br-γ extends the full length of the outflow (∼12 650 au), indicating rapid dissociation of the molecules. H2 has higher velocities further from the driving source, consistent with a jet-driven outflow. Diagnostic line ratios indicate that photoexcitation, not just shocks, contributes to the excitation in the outflow. We argue that HH 900 is the first clear example of an evaporating molecular outflow and predict that a large column of neutral material that may be detectable with Atacama Large Millimeter Array accompanies the dissociating molecules. Results from this study will help guide the interpretation of near-IR images of externally irradiated jets and outflows such as those obtained with the JWST in high-mass star-forming regions where these conditions may be common

‘Intensive care unit survivorship’ - a constructivist grounded theory of surviving critical illness

Aims & objectiveTo theorise ICU survivorship after a critical illness based on longitudinal qualitative data.BackgroundIncreasingly patients survive episodes of critical illness. However, the short and long term impact of critical illness include physical, psychological, social and economic challenges long after hospital discharge. An appreciation is emerging that care needs to extend beyond critical illness to enable patients to reclaim their lives post-discharge with the term ‘Survivorship’ being increasingly used in this context. What constitutes critical illness survivorship has, to date, not been theoretically explored.DesignLongitudinal-qualitative and constructivist Grounded Theory. Interviews (n = 46) with 17 participants were conducted at four time points: (1) before discharge from hospital, (2) 4-6 weeks post-discharge, (3) 6 months and (4) 12 months post-discharge across two adult intensive care setting.MethodIndividual face-to-face interviews. Data analysis followed the principles of Charmaz's Constructivist Grounded Theory. ‘ICU survivorship’ emerged as the core category and was theorised using concepts such as Status Passages, Liminality and Temporality to understand the various transitions participants made post-critical illness.FindingsIntensive care survivorship describes the unscheduled status passage of falling critically ill and being taken to the threshold of life and the journey to a life post-critical illness. Surviving critical illness goes beyond recovery; surviving means ‘moving on’ to life post-critical illness. ‘Moving on’ incorporates a re-definition of self that incorporates any lingering intensive care legacies and being in control of one's life again.Relevance to clinical practiceFor healthcare professionals and policy makers it is important to realise that recovery and transitioning through to survivorship happens within an individual's time frame, not a schedule imposed by the healthcare system. Currently there are no care pathways or policies in place for critical illness survivors that would support ICU survivors and their families in the transitions to survivorship

A longitudinal qualitative exploration of healthcare and informal support needs among survivors of critical illness: the RELINQUISH protocol

Introduction and background: Survival following critical illness is associated with a significant burden of physical, emotional and psychosocial morbidity. Recovery can be protracted and incomplete, with important and sustained effects upon everyday life, including family life, social participation and return to work. In stark contrast with other critically ill patient groups (eg, those following cardiothoracic surgery), there are comparatively few interventional studies of rehabilitation among the general intensive care unit patient population. This paper outlines the protocol for a sub study of the RECOVER study: a randomised controlled trial evaluating a complex intervention of enhanced ward-based rehabilitation for patients following discharge from intensive care. Methods and analysis: The RELINQUISH study is a nested longitudinal, qualitative study of family support and perceived healthcare needs among RECOVER participants at key stages of the recovery process and at up to 1 year following hospital discharge. Its central premise is that recovery is a dynamic process wherein patients’ needs evolve over time. RELINQUISH is novel in that we will incorporate two parallel strategies into our data analysis: (1) a pragmatic health services-oriented approach, using an a priori analytical construct, the ‘Timing it Right’ framework and (2) a constructivist grounded theory approach which allows the emergence of new themes and theoretical understandings from the data. We will subsequently use Qualitative Health Needs Assessment methodology to inform the development of timely and responsive healthcare interventionsthroughout the recovery process.Ethics and dissemination: The protocol has been approved by the Lothian Research Ethics Committee (protocol number HSRU011). The study has been added to the UK Clinical Research Network Database(study ID. 9986). The authors will disseminate the findings in peer reviewed publications and to relevant critical care stakeholder groups

Direct microscopy versus sputum cytology analysis and bleach sedimentation for diagnosis of tuberculosis: a prospective diagnostic study.

ABSTRACT: BACKGROUND: Diagnostic options for pulmonary tuberculosis in resource-poor settings are commonly limited to smear microscopy. We investigated whether bleach concentration by sedimentation and sputum cytology analysis (SCA) increased the positivity rate of smear microscopy for smear-positive tuberculosis. METHODS: We did a prospective diagnostic study in a Medecins Sans Frontieres-supported hospital in Mindouli, Republic of Congo. Three sputum samples were obtained from 280 consecutive pulmonary tuberculosis suspects, and were processed according to WHO guidelines for direct smear microscopy. The remainder of each sputum sample was homogenised with 2.6% bleach, sedimented overnight, smeared, and examined blinded to the direct smear result for acid-fast bacilli (AFB). All direct smears were assessed for quality by SCA. If a patient produced fewer than three good-quality sputum samples, further samples were requested. Sediment smear examination was performed independently of SCA result on the corresponding direct smear. Positivity rates were compared using McNemar's test. RESULTS: Excluding SCA, 43.2% of all patients were diagnosed as positive on direct microscopy of up to three samples. 47.9% were diagnosed on sediment microscopy, with 48.2% being diagnosed on direct microscopy, sediment microscopy, or both. The positivity rate increased from 43.2% to 47.9% with a case definition of one positive smear ([greater than or equal to]1 AFB/100 high power fields) of three, and from 42.1% to 43.9% with two positive smears. SCA resulted in 87.9% of patients producing at least two good-quality sputum samples, with 75.7% producing three or more. Using a case definition of one positive smear, the incremental yield of bleach sedimentation was 14/121, or 11.6% (95% CI 6.5-18.6, p=0.001) and in combination with SCA was 15/121, or 12.4% (95% CI 7.1-19.6, p=0.002). Incremental yields with two positive smears were 5/118, or 4.2% (95% CI 1.4-9.6, p=0.062) and 7/118, or 5.9% (95% CI 2.4-11.8, p=0.016), respectively. CONCLUSIONS: The combination of bleach sedimentation and SCA resulted in significantly increased microscopy positivity rates with a case definition of either one or two positive smears. Implementation of bleach sedimentation led to a significant increase in the diagnosis of smear-positive patients. Implementation of SCA did not result in significantly increased diagnosis of tuberculosis, but did result in improved sample quality. Requesting extra sputum samples based on SCA results, combined with bleach sedimentation, could significantly increase the detection of smear-positive patients if routinely implemented in resource-limited settings where gold standard techniques are not available. We recommend that a pilot phase is undertaken before routine implementation to determine the impact in a particular context