Training health visitors in cognitive behavioural and person-centred approaches for depression in postnatal women as part of a cluster randomised trial and economic evaluation in primary care: the PoNDER trial

Aim: This paper aims to describe the training preparation for health visitors who took part in the intervention arm of a cluster randomised controlled trial and economic evaluation of training for health visitors – the POstNatal Depression Economic evaluation and Randomised (the PoNDER) trial. A secondary aim is to make available, by electronic links, the training manuals developed for and used for the cognitive behavioural approach (CBA) and the person-centred approach (PCA) training for the health visitors. The paper is of relevance to health visitors, general practitioners, nurse practitioners, midwives, clinical psychologists, mental health nurses, community psychiatric nurses, counsellors, and service commissioners. Background: The trial clinical outcomes have been published, indicating the pragmatic effectiveness of the package of training for health visitors to identify depressive symptoms and provide a psychologically informed intervention. The training was associated with a reduction in depressive symptoms at six months postnatally among intervention group women and some evidence of a benefit for the intervention group for some of the secondary outcomes at 18 months follow-up. Methods: The two experimental interventions examined in the PoNDER trial built upon promising work on the potential for psychological interventions to help women recover from postnatal depression as an alternative to pharmaceutical interventions and to address the limitations of previous research in the area. Findings: The package of health visitor training comprised the development of clinical skills in assessing postnatal women and identifying depressive symptoms, and the delivery of a CBA or a PCA for eligible women. This was the largest trial a health visitor intervention and of postnatal depression ever conducted. We are aware of no other rigorously performed trial that has published details of an extensively tested training programme for the benefit of health-care professionals and clients

An anatomical study of additional radial wrist extensors including a unique extensor carpi radialis accessorius

Background: In this study, 82 forearms from 41 cadavers were dissected to establish the incidence of variant additional radial wrist extensors. Three variants have been described in the literature: extensor carpi radialis intermedius (ECRI), extensor carpi radialis accessorius (ECRA) and extensor carpi radialis tertius (ECRT). Materials and methods: Of the 41 cadavers studied, 5/41 (12%) had an additional radial wrist extensor. Of these 5 individuals, 2 had bilateral additional muscles and 3 were unilateral. Of the 82 forearms, 7/82 (9%) had additional radial wrist extensors. Results: We found 4 examples of ECRI and 3 examples of ECRA. We did not find any examples of ECRT. One specimen of ECRA had an atypical, previously undescribed, course. Conclusions: These accessory muscles are of clinical relevance, as they may be a contributing factor in tennis elbow and nerve entrapment, or cause diagnostic confusion, especially in ultrasound scans. However, they may also be used for tendon transfer. Of the 7 muscles found in the current study, 3 would have been suitable for such procedures.

Exploring Cooperation Between Secondary Agricultural Educators and Livestock Extension Agents: A Case Study

Due to the common goal of youth leadership development, there is the opportunity for Cooperative Extension\u27s 4-H clubs and Agricultural Education\u27s FFA chapters to be more effective through cooperation. The qualitative study discussed here used focus groups to explore the level of and perceptions regarding cooperation among agricultural educators and Extension agents. Major themes that positively influenced cooperation were identified as: the relationship between the agricultural educator and Extension agent, the awareness of the other profession, and the understanding and perceptions of cooperation. Findings of this study indicated a lack of collaboration between disciplines

Identifying Tennessee school-based agricultural education student growth and program accountability metrics

Over the years, accountability in education has transformed from the primary focus being the school as a whole to the individual teacher. The purpose of this study was to determine the metrics Tennessee school-based agricultural education teachers perceive as indicators of excellent total programs (classroom instruction, FFA, SAE), and a modified Delphi study was used to seek a consensus. The following nine metrics were retained: (a) pesticide certification, (b) program of activities, (c) number of students participating in CDEs, (d) chapter community service hours, (e) total number of FFA activities, (f) number of CDEs coached, (g) at least one proficiency at regional level, (h) one American degree every 3 years, and (i) percentage of students with SAE. Overall, the metrics agreed upon are narrow in focus and all but one is a record of activity and not direct measures of students’ knowledge or skills. As a result, the measures do not include student growth or value-added scores or authentic assessments of 21st century skills. Additional research is needed to further investigate the metrics that should be used to measure a school-based agricultural education program’s success in Tennessee and across the nation

An anatomical study of the origin, structure and insertion of the medial patellofemoral ligament

Background: Repair and reconstruction of the medial patellofemoral ligament (MPFL) has been undertaken for the treatment of patellar instability. For successful surgery detailed knowledge of the anatomy of the ligament is required. The aim of this study was to describe the origin, structure and insertion of the MPFL. Materials and methods: We studied cadaveric knees from 30 Chinese adults. We studied the origin, course and insertion of the MPFL. Results: We found that the MPFL was composed of two main strands, superficial and deep. We also found that the insertion of the MPFL into the femur had three common patterns. All three were located between the adductor tubercle and the proximal part of superficial medial collateral ligament. Conclusions: We have added to the anatomical knowledge of the structure of the MPFL. Our study has implications for guiding bone tunnel positioning during MPFL reconstruction surgery. (Folia Morphol 2018; 77, 2: 356–361

Light ion isotope identification in space using a pixel detector based single layer telescope

Citation: Kroupa, M., Bahadori, A. A., Campbell-Ricketts, T., George, S. P., Stoffle, N., & Zeitlin, C. (2018). Light ion isotope identification in space using a pixel detector based single layer telescope. Applied Physics Letters, 113(17), 174101. https://doi.org/10.1063/1.5052907It is demonstrated that modern pixel detectors can be utilized as single-layer particle telescopes, offering details of a particle's stopping power evolution surpassing those provided by multi-layer, non-pixelated instruments. For particles that stop in the detector, this advantage arises from repeatably sampling the Bragg curve: we always know which part of the Bragg peak was measured. We can then create a dE/dx1 vs dE/dx2 plot where the stopping power at the beginning and the end of the track is compared. We are able to identify and analyze several fine-grained features on such plots, including several related to particles that stop inside the detector, termed “stopping.” Using data from an instrument aboard the International Space Station, we show that different isotopes of stopping hydrogen can be identified as their stopping powers differ. Other features of the dE/dx1 vs dE/dx2 plot not resolvable in multi-layer particle telescopes are also exhibited, such as nuclear interactions that occur within the sensor active volume

Potential Effects of Managed Competition in Rural Areas

This article assesses the extent to which managed competition could be successful in rural areas. Using 1990 Medicare hospital patient origin data, over 8 million rural residents were found to live in areas potentially without provider choice. Almost all of these areas were served by providers who compete for other segments of their market. Restricting use of out-of-State providers would severely limit opportunities for choice. These findings suggest that most residents of rural States would receive cost benefits from a managed competition system if purchasing alliances are carefully defined, but consideration should be given to boundary issues when forming alliances

Differentiating normal and problem gambling: a grounded theory approach.

A previous study (Ricketts &amp; Macaskill, 2003) delineated a theory of problem gambling based on the experiences of treatment seeking male gamblers and allowed predictions to be made regarding the processes that differentiate between normal and problem gamblers. These predictions are the focus of the present study, which also utilised a grounded theory approach, but with a sample of male high frequency normal gamblers. The findings suggest that there are common aspects of gambling associated with arousal and a sense of achievement. The use of gambling to manage negative emotional states differentiated normal and problem gambling. Perceived self-efficacy , emotion management skills and perceived likelihood of winning money back were intervening variables differentiating problem and normal gamblers.</p

Recognizing and managing a deteriorating patient: a randomised controlled trial investigating the effectiveness of clinical simulation in improving clinical performance in undergraduate nursing students

Aims To report the results of a randomised controlled trial which explored the effectiveness of clinical simulation in improving the clinical performance of recognising and managing an adult deteriorating patient in hospital. Background There is evidence that final year undergraduate nurses may lack the knowledge, clinical skills and situation awareness required to competently manage a deteriorating patient in hospital. The effectiveness of clinical simulation as an educational strategy to teach the skills required to recognise and effectively manage the early signs of clinical deterioration needs to be evaluated. Method This was a two centre, randomised, controlled trial with single blinded assessments. Data were collected in July 2013. Ninety- eight first year nursing students were randomised either into a control group where they received a traditional classroom lecture, or an intervention group where they received simulation training. Participants completed a pre and post- intervention objective structured clinical examination. General Perceived Self Efficacy and Self-Reported Competency scores were measured before and after the intervention. Student satisfaction with teaching was surveyed after the teaching intervention. Results The intervention group performed significantly better in the objective structured clinical examination after their simulation training. General Perceived Self Efficacy and Self-Reported Competency were not correlated with performance. There was no significant difference in the post intervention General Perceived Self Efficacy and Self-Reported Competency scores between the control and intervention group. The intervention group were significantly more satisfied with their teaching method. Conclusion Simulation based education may be an effective educational strategy to teach nurses the necessary skills to effectively recognise and manage a deteriorating patient