This book explores the personalities, leadership styles, and decision-making of the NASA senior executives in the first decade of spaceflight and follows how those individuals created a culture that ...can take on seemingly insurmountable challenges, that can recover from tragedy and adversity, that continues to attract the best and brightest.
•High resolution imagery are used to link landscape indicators with water quality.•Imagery at 5 m resolution was optimal for assessing impervious surfaces.•Dissolved oxygen and fecal coliform were ...well explained by indicators.•Configurational indicators at riparian zone level were important.
Urban streams are subject to a myriad of complex stressors associated with impervious surfaces, which impact delivery of pollutants. Landscape indicators (e.g. the amount and arrangement of land cover) are widely used to help monitor water quality, yet their application in highly urbanized settings remains poorly understood. Here, we explored the utility of landscape indicators for explaining water chemistry and bacterial concentrations in streams throughout the Greater Vancouver Regional District, British Columbia, Canada. First, we compared high and moderate spatial resolution imagery to evaluate their relative efficacy in characterizing impervious surfaces. Second, we linked a suite of landscape indicators to major chemical properties and pollutants (e.g. dissolved oxygen, nitrate, turbidity, fecal coliform, E. Coli.) using a series of comparative statistical models. Land cover at 30-m resolution often over-estimated the proportional area of impervious surface by 0.10–0.30, sometimes doubling the amount detected using finer resolution imagery. Finer 5- and 2-m resolution imagery demonstrated little difference in estimating impervious cover. Therefore, 5-m resolution imagery was adopted for spatial analysis in the study region. Watershed-level landscape indicators explained nearly 50% of the variability in wet season concentrations of dissolved oxygen and fecal coliform. When considering the spatial configuration of impervious areas, edge density within the riparian zone explained more than 30% of the variability in fecal coliform and E. Coli. Our approach is potentially transferable to many cities worldwide facing similar challenges in monitoring urban streams.
Promoting Smoking Cessation Larzelere, Michele M., PhD; Williams, Dave E., MD
American family physician,
03/2012, Letnik:
85, Številka:
6
Journal Article
Recenzirano
Cigarette smoking causes significant morbidity and mortality in the United States. Physicians can use the five A's framework (ask, advise, assess, assist, arrange) to promote smoking cessation. All ...patients should be asked about tobacco use and assessed for motivation to quit at every clinical encounter. Physicians should strongly advise patients to quit smoking, and use motivational interviewing techniques for patients who are not yet willing to stop smoking. Clinical contacts with unmotivated patients should emphasize the rewards and relevance of quitting, as well as the risks of smoking and anticipated barriers to abstinence. These messages should be repeated at every opportunity. Appropriate patients should be offered pharmacologic assistance in quitting, such as nicotine replacement therapies, bupropion, and varenicline. Use of pharmacologic support during smoking cessation can double the rate of successful abstinence. Using more than one type of nicotine replacement therapy (“patch plus” method) and combining these therapies with bupropion provide additional benefit. However, special populations pose unique challenges in pharmacotherapy for smoking cessation. Nicotine replacement therapies increase the risk of birth defects and should not be used during pregnancy. They are usually safe in patients with cardiovascular conditions, except for those with unstable angina or within two weeks of a coronary event. Varenicline may increase the risk of coronary events. Nicotine replacement therapies are safe for use in adolescents; however, they are less effective than in adults. Physicians also should arrange to have repeated contact with smokers around their quit date to reinforce cessation messages.
Many early attempts at tallgrass prairie reconstruction failed to achieve the high species diversity of remnant prairies, and instead consist primarily of C₄ grasses. We hypothesized that frequent ...mowing of established prairie grasses could create sufficient gaps in the aboveground and belowground environment to allow for the establishment of native forbs from seed. We studied forb seedling establishment in a 25-year-old prairie planting in northern Iowa that was dominated by native warm-season grasses. In winter 1999, 23 species of native forbs were broadcast into the recently burned sod at a rate of 350 viable seeds/m². Treatment plots were mowed weekly for either one or two growing seasons, and control plots were unmowed. Mowed plots had greater light availability than controls, especially when warm-season grasses began to flower. Overwinter seedling mortality was 3% in mowed treatments compared to 29% in the controls. Forbs in mowed plots had significantly greater root and shoot mass than those in control plots in the first and second growing seasons but were not significantly more abundant. By the fourth growing season, however, forbs were twice as abundant in the mowed treatments. No lasting negative impacts of frequent mowing on the grass population were observed. Mowing a second year influenced species composition but did not change total seedling establishment. Experimental evidence is consistent with the idea that mowing reduced competition for light from large established grasses, allowing forb seedlings the opportunity to reach sufficient size to establish, survive, and flower in the second and subsequent years.
ObjectiveAn ageing population and rising healthcare costs place healthcare systems at risk of failure. Our goal was to develop a technology that would identify illness early, initiate action and ...therein improve patient care, outcomes and save healthcare resources.DesignThis was a prospective interventional quality improvement study.SettingA 40 bed medical floor in a 300 bed Canadian tertiary care regional referral hospital.ParticipantsGeneral ward patients randomly assigned to control or treatment groups. There was no cross-over or loss to follow-up.InterventionWe designed an algorithm and software programme capable of detecting the sentinel change in a deteriorating patient’s clinical condition and once detected direct early investigation and care. Study duration was 1 year.Main outcome measuresPrimary outcome was patient transfer from the general medical ward to the intensive care unit (ICU). The secondary outcome was the time needed to (1) order investigations (2) contact senior medical staff and (3) senior medical staff intervention.ResultsWe identified a decrease in the transfer of patients from the medical ward to the ICU. Over the course of the study including 273 patients (110 in the control group and 163 in the treatment group), transfers dropped from 14 to 3 with a relative risk reduction of 85.54% (95% CI 84.96 to 86.1), a number needed to treat of 9.19 (95% CI 9.01 to 9.36) and a absolute risk reduction of 10.89% (95% CI 10.7 to 11.1). We also found a statistically significant reduction in the time required to order investigations (p=0.049), contact senior medical staff (p=0.040) and senior medical staff intervention (p=0.045).ConclusionA novel algorithm and software in the hands of nursing staff identified acute illness with adequate sensitivity and specificity to dramatically reduce ICU transfers and time to clinical intervention on a medical ward.
Attention-deficit/hyperactivity disorder (ADHD) is associated with significant impairment in multiple functional domains. This trial evaluated efficacy in ADHD symptoms and functional outcomes in ...young adults treated with atomoxetine.
Young adults (18-30 years old) with ADHD were randomized to 12 weeks of double-blind treatment with atomoxetine (n = 220) or placebo (n = 225). The primary efficacy measure of ADHD symptom change was Conners' Adult ADHD Rating Scale (CAARS): Investigator-Rated: Screening Version Total ADHD Symptoms score with adult prompts. Secondary outcomes scales included the Adult ADHD Quality of Life-29, Clinical Global Impression-ADHD-Severity, Patient Global Impression-Improvement, CAARS Self-Report, Behavior Rating Inventory of Executive Function-Adult Version Self-Report, and assessments of depression, anxiety, sleepiness, driving behaviors, social adaptation, and substance use.
Atomoxetine was superior to placebo on CAARS: Investigator-Rated: Screening Version (atomoxetine least-squares mean ± SE, -13.6 ± 0.8 vs placebo -9.3 ± 0.8, 95% confidence interval -6.35 to -2.37, P < 0.001), Clinical Global Impression-ADHD-Severity (atomoxetine -1.1 ± 0.1 vs placebo -0.7 ± 0.1, 95% confidence interval -0.63 to -0.24, P < 0.001), and CAARS Self-Report (atomoxetine -11.9 ± 0.8 vs placebo -7.8 ± 0.7, 95% confidence interval -5.94 to -2.15, P < 0.001) but not on Patient Global Impression-Improvement. In addition, atomoxetine was superior to placebo on Adult ADHD Quality of Life-29 and Behavior Rating Inventory of Executive Function-Adult Version Self-Report. Additional assessments failed to detect significant differences (P ≥ 0.05) between atomoxetine and placebo. The adverse event profile was similar to that observed in other atomoxetine studies. Nausea, decreased appetite, insomnia, dry mouth, irritability, dizziness, and dyspepsia were reported significantly more often with atomoxetine than with placebo.
Atomoxetine reduced ADHD symptoms and improved quality of life and executive functioning deficits in young adults compared with placebo. Atomoxetine was also generally well tolerated.
While a wealth of literature exists on the topic of fostering, limited research has been published on the experiences of the biological children of foster-carers (Younes and Harp, 2007; Sutton and ...Stack, 2013). Literature that exists identifies increased recognition of the importance of birth children’s contribution to successful foster-care placements and the prevention of placement breakdown (Kalland and Sinkonnen, 2001; Hojer et al., 2013). This paper reports findings from an interpretivist study that explored the retrospective experiences of fifteen adult birth children of foster-carers (aged between eighteen and twenty-eight years) in Ireland. Using semi-structured interviews, birth children’s experiences of fostering processes and their interactions with fostering professionals are explored. Findings indicate that birth children are not passive observers in how fostering influences their daily lives. Instead they use strategies to influence fostering processes, in particular to protect their parents and birth siblings, while also having feelings of responsibility for their foster siblings. Findings suggest that, despite the complexity of the fostering task, professionals should recognise and acknowledge the input of birth children to fostering. The study also suggests the value of training that encourages foster-carers to continually include the opinions of their own children in fostering decisions.
Previous research identifies the increased exposure of birth children of foster carers to experiences of separation, grief, and loss due to the transient nature of foster care, but little is known ...about how birth children manage this loss. This paper reports findings from a qualitative study that examined the retrospective experiences of 15 adult birth children of foster carers (aged between 18 and 28 years) in Ireland. Findings suggest that birth children experience grief and loss when foster children leave their families. They report experiencing a range of emotional responses such as guilt, blame, and sadness. A reluctance to discuss their emotional responses with either their parents or foster care professionals was also reported. Instead, birth children developed strategies to manage the loss, such as distancing themselves from the foster care process. The study highlights the importance of social workers and foster carers explaining to birth children why foster children are leaving and, where possible, maintaining contact between birth children and foster children. Additionally, findings indicate the need for birth children to have safe nonjudgmental spaces to discuss their emotional reactions to loss.
Settlers crossing the tallgrass prairie in the early 1800s were greeted by a seemingly endless landscape of wildflowers and grasses, one of the most diverse ecosystems on our planet. Today, although ...the tallgrass prairie has been reduced to a tiny percentage of its former expanse, people are working to restore and reconstruct prairie communities. This lavishly illustrated guide to seeds and seedlings, crafted by Tallgrass Prairie Center botanist Dave Williams and illustrator Brent Butler, will insure that everyone from urban gardeners to grassland managers can properly identify and germinate seventy-two species of tallgrass wildflowers and grasses in eastern North Dakota, eastern South Dakota, southwestern Minnesota, southwestern Wisconsin, northern Illinois, northwestern Indiana, Iowa, eastern Nebraska, eastern Kansas, northwestern Missouri, and eastern Oklahoma.
Williams has created a brilliant, nearly foolproof system of identification and verification. Two primary keys lead to eleven secondary keys that link to characteristic groups of tallgrass plants: seven groups for wildflowers and four groups for grasses. To identify a seedling, use the primary key to discover its place in the secondary key, then turn to that characteristic group to find your seedling. Circles on each full seedling photograph correspond to close-up photographs; triangles on these close-ups illustrate information in the text to further pinpoint identification. Drawings of leaves illuminate exact identification, and enlarged photographs of each seed provide yet another way to confirm identification.
Thousands of seeds were sprouted in the Tallgrass Prairie Center's greenhouse to provide seedlings close in size and development to those grown in the field near the end of their first season; research and photography took place over four years. Williams's text for each species includes a thorough description, a comparison of similar species, and guidance for germination and growth. A complete glossary supports the text, which is concise but detailed enough to be accessible to beginning prairie enthusiasts.
Anyone in the Upper Midwest who wishes to preserve the native vegetation of prairie remnants or reconstruct a tallgrass prairie of whatever size-from home gardens to schoolyards to roadsides to large acreages-will benefit from the hundreds of photographs and drawings and the precise text in this meticulously prepared guide.
BackgroundAccurate data on self-harm is crucial to suicide prevention efforts. It has been previously found that around twice as many people who self-harm seek help in primary care than in secondary ...care. Little is known about how contacts for self-harm differ across settings at a population level. This study utilised individual-level linked data across GP, Emergency Departments (ED), outpatients and hospital admissions examining contacts across settings and time by sex for self-harm in 10-24 year olds.
MethodsA whole-population based e-cohort study of routinely collected healthcare data was conducted. Rates of self-harm across settings over time by sex were examined. Individuals were categorised based on the service(s) to which they presented.
ResultsA total of 937,697 individuals aged 10-24 years contributed 5,369,794 person years of data from the 01.01.2003-30.09.2015. There were differences in self-harm contacts by demographic variables particularly with regards to sex and admissions to hospital following ED attendance.
ConclusionThis is the first study to compare self-harm in people aged 10-24 years across primary care, EDs, and hospital settings in the UK. The high rates of self-harm in primary care and for young men in EDs highlight these as important settings for intervention. Understanding patterns of presentation will inform service planning and configuration for follow-up care and could inform tailored support, for example for males in ED. Linked data provides important evidence to support the development of interventions across healthcare settings.
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