Previous Encounters Research Articles

Comparative Study on Knowledge About Autism Spectrum Disorder Among Paediatric and Psychiatric Nurses in Public Hospitals in Kumasi, Ghana.

Background:Despite the existence of autism spectrum disorder in Ghana, few studies have provided the necessary information on the phenomenon. These studies have mostly focused on speech and language therapy for children and modification of classroom environment for children with autism spectrum disorder. This approach has resulted in a paucity of knowledge on nurse’s knowledge of autism spectrum disorder in Ghana.Objective:The study sought to assess the knowledge of paediatric and psychiatric on autism spectrum disorder.Method:In this study, 130 paediatric and 93 psychiatric nurses sampled from five public hospitals in the Kumasi Metropolis participated in the survey. The Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaire was employed to assess their knowledge of autism spectrum disorder.Results:It emerged from the study that psychiatric nurses were more knowledgeable on autism spectrum disorder than paediatric nurses in general and specifically on each of the four domains on the KCAHW questionnaire. However, the level of knowledge on autism spectrum disorder among both groups of nurses remains low. Apart from the previous encounter, there were no significant differences between paediatric and psychiatric nurses’ gender, age, marital status, working experience and their knowledge.Conclusion:In view of the findings, it will be appropriate for autism spectrum disorder to be included in the clinical training curriculum as well as the continuous professional education for both paediatric and psychiatric nurses. This will go a long way in helping paediatric and psychiatric nurses to increase their knowledge of autism spectrum disorder.

Is syndromic data from rural poultry farmers a viable poultry disease reporting tool and means of identifying likely farmer responses to poultry disease incursion?

Syndromic surveillance is a well described tool used in developed countries for alerting authorities to livestock disease incursions. However, little work has been done to evaluate whether this could be a viable tool in countries where disease reporting infrastructure and resources is poor. Consequently, a syndrome-based questionnaire study in Eastern Zambia was designed to gather data on previous encounters farmers had with poultry diseases, as well as control measures they use to mitigate them. Descriptive statistics and logistic regression were used to analyse the data.Farmers reported an overall annual disease incidence in rural poultry for eastern Zambia of 31% (90% CI 29–32%). Occurrence of poultry disease in the last 12 months was associated with use of middlemen to purchase poultry products (p = 0.05, OR = 7.87), poultry products sold or given away from the farm (p = 0.01, OR = 1.92), farmers experiencing a period with more trade of poultry and its products (p = 0.04, OR = 1.70), presence of wild birds near the farm or village (p = 0.00, OR = 2.47) and poultry diseases being reported from neighbouring farms or villages (p = 0.00, OR = 3.12). The study also tentatively identified three poultry diseases (Newcastle Disease, Gumboro Disease and Fowl Pox) from the thirty-four disease syndromes provided by farmers. Farmers reported an incidence of 27% for Newcastle Disease in 2014. When compared with the state veterinary services data which reported Newcastle Disease incidence at 9% in 2014, it seems syndromic data obtained from farmers may be more sensitive in identifying disease incursion.Thirty-six remedies and strategies farmers use to treat and control these diseases were revealed. The main control strategy for identified diseases was vaccination and the main treatment was unspecified herbs, which warrants further investigation and presents an opportunity for further research in ethno-veterinary medicine. More still, this study identified chilli, Aloe Vera, garlic onion, moringa, and ash as traditional remedies that are commonly being used in Eastern Zambia, and which are also used to treat poultry diseases in Zimbabwe and Botswana. Only fourteen remedies described are conventionally accepted by veterinarians as remedies and disease control measures for poultry diseases.This study shows that syndromic data obtained from farmers is a useful disease reporting tool and could be used as an effective means of alerting authorities to disease incursion. In addition, it shows that these data may give a more accurate estimate of incidence for certain diseases than current surveillance methods and could be useful in assessing significant risk factors associated with disease occurrence.

Microbiome Medicine: This Changes Everything

Microbiome Medicine: This Changes Everything

‘What Was I Thinking?!’ Rhetorical Questions as a Technique to Identify and Explore Impasses in Therapy

Rhetorical questions emerging spontaneously in consultations can be used as a tool for developing self‐reflexivity and exploring the therapeutic alliance in the process of therapy with couples and families. This paper presents a technique based on the enunciation of rhetorical questions, which can point to an impasse in the process of therapy and contain a key to its resolution. The technique focuses on the distinctive feature of rhetorical questions as convening a paradoxical injunction: a question not intended as a question, while uttered as such. The technique in four steps is illustrated by examples from therapy, supervision, consultation, and self‐supervision. Its focus is the interlink between the therapeutic relationship and the process of therapy and it is informed by a second‐order cybernetics approach, dialogical practice, and the systemic literature on emotion. The technique can help develop curiosity in working with families, lead to unforeseen developments, and touch on prejudices not made explicit in previous therapeutic encounters. Whether we are acting as supervisors, therapists, or clients, the creation of a ‘secure enough’ context for rhetorical questions becomes critical to allow freeform exploration.

Parietal control network activation during memory tasks may be associated with the co-occurrence of externally and internally directed cognition: A cross-function meta-analysis

Functional neuroimaging studies on episodic memory retrieval consistently indicated the activation of the precuneus (PCU), mid-cingulate cortex (MCC), and lateral intraparietal sulcus (latIPS) regions. Although studies typically interpreted these activations in terms of memory retrieval processes, resting-state functional connectivity data indicate that these regions are part of the frontoparietal control network, suggesting a more general, cross-functional role. In this regard, this study proposes a novel hypothesis which suggests that the parietal control network plays a strong role in accommodating the co-occurrence of externally directed cognition (EDC) and internally directed cognition (IDC), which are typically antagonistic to each other. To evaluate how well this dual cognitive processes hypothesis can account for parietal activation patterns during memory tasks, this study provides a cross-function meta-analysis involving 3 different memory paradigms, namely, retrieval success (hit > correct rejection), repetition enhancement (repeated > novel), and subsequent forgetting (forgotten > remembered). Common to these paradigms is that the target condition may involve both EDC (stimulus processing and motor responding) and IDC (intentional remembering, involuntary awareness of previous encounter, or task-unrelated thoughts) strongly, whereas the reference condition may involve EDC to a greater extent, but IDC to a lesser extent. Thus, the dual cognitive processes hypothesis predicts that each of these paradigms will activate similar, overlapping PCU, MCC, and latIPS regions. The results were fully consistent with the prediction, supporting the dual cognitive processes hypothesis. Evidence from relevant prior studies suggests that the dual cognitive processes hypothesis may also apply to non-memory domain tasks.

Diving dolphins are master planners

Slipping beneath the surface of the water in pursuit of food sets the timer ticking for hungry dolphins; the pressure is on to locate food and make it back to the surface before they run out of oxygen. So what strategies might a peckish dolphin use to forage efficiently on a tight time budget? ‘Lab experiments that test the memory of animals for the location of food show that they have a similar ability to that of humans’, says Patricia Arranz from the University of St Andrews, UK: which suggests that some foraging animals may plan ahead. However, it was unclear whether animals that are actively foraging in their natural surroundings would adjust their hunting strategy in response to the conditions that they encountered before and during a dive. Knowing that Risso's dolphins dive down several hundred metres to dine on shoals of squid, Arranz, Peter Tyack, also from St Andrews, Brandon Southall from the University of California, Santa Cruz, USA, and Kelly Benoit-Bird from the Monterey Bay Aquarium Research Institute, USA, decided to find out whether these mammals plan their submarine sorties.However, tracking the activities of wild animals is extremely challenging. ‘It is really difficult to approach them and attach something to their backs; you need to be very patient!’ says Arranz. She recalls how John Calambokidis from the Cascadia Research Collective, USA, and Ari Friedlaender from the Marine Mammal Institute, USA, cautiously observed the animals while carefully manoeuvring into place, before gently attaching the data loggers – which tracked the animals’ depths and movements, and the sounds they emitted – with a 5 m-long pole. Then, Benoit-Bird and Southall tracked the location of shoals of squid beneath the surface with echosounders mounted on remotely operated underwater robots while the dolphins searched for food. ‘In one of the experiments, we were extremely lucky as the group that the tagged animal was in stayed in the same area, allowing us to track the dolphin every time it was at the surface and observe the prey with the echosounder right where and when the dolphin was foraging’, says Arranz.Back in the lab, Arranz and Benoit-Bird analysed the recordings from 37 dolphin dives while tracking the location of the squid prey and realised that the dolphins began echolocating soon after leaving the surface, ‘Probably to gain information on the depth distribution and availability of prey and to respond swiftly to rapid changes in habitat structure at different depths’, says Arranz. And the descending dolphins seemed to match their echolocation range to the depth at which they had encountered the most squid during their previous dive, ‘Which can be interpreted as dolphins recalling information to plan the next foraging dive’, says Arranz. The team also noticed that the dolphins continued echolocating as they returned to the surface, even though they were no longer hunting, as if they were planning ahead and scouting out the best location for their next dive. And the animals seemed to be able to tailor their diving strategy as the conditions changed, sometimes targeting a shallow layer of squid at the outset, but shifting their attention to deeper, more plentiful squid patches later in the dive.The dolphins were definitely planning ahead, pulling together information that they had gleaned during previous encounters and combining it with their present experience to optimise their dives and ensure that they made the most of each precious lungful of air while submerged.

Evaluation of cellular immunogenicity of recombinant cytochrome p450 cyp141 protein of Mycobacterium tuberculosis in human and mouse model

Mycobacterium tuberculosis (Mtb) is still considered one of the unsolved problems for the World Health Organization Identifying and selecting an immunogenic antigen capable of generating specific immune responses is generally the goal of all studies being carried out in to designing new vaccines. Accordingly, the present study was conducted to evaluate the immunogenicity of a M. tuberculosis recombinant protein which exist in the regions of the bacterium genome and may be an immunogenic protein.Immunogenicity of purified proteins was measured by PBMC and mouse spleen lymphocytes culturing methods using ELISA after an appropriate amount of time of incubation with Recombinant cytochrome P450 CYP141 protein. Cellular immune responses were determined and compared by measuring IFN-γ and IL4 in human, and mouse groups. The results revealed a high level of IFN-γ in PPD + individuals and the mice immunized with protein and adjuvant.Recombinant cytochrome P450 CYP141 protein proved capable of generating an immune response in mice and people with a history of previous encounters with Mycobacterium tuberculosis bacteria. It, could be considered a tuberculosis vaccine candidate in order to induce a specific effective immune response in both mice and humans.

Decision‐making in nursing practice: An integrative literature review

To identify and summarise factors and processes related to registered nurses' patient care decision-making in medical-surgical environments. A secondary goal of this literature review was to determine whether medical-surgical decision-making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM). Decision-making in acute care nursing requires an evaluation of many complex factors. While decision-making research in acute care nursing is prevalent, errors in decision-making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision-making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision-making. PubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data. Key findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision-making; education; understanding patient status; situation awareness; and autonomy. Acute care nurses employ a variety of decision-making factors and processes and informally identify experienced nurses to be important resources for decision-making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision-making nursing research. Experienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision-making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses' decision-making for enhanced patient outcomes.

Age and Influenza-Specific Pre-Vaccination Antibodies Strongly Affect Influenza Vaccine Responses in the Icelandic Population whereas Disease and Medication Have Small Effects.

Influenza vaccination remains the best strategy for the prevention of influenza virus-related disease and reduction of disease severity and mortality. However, there is large individual variation in influenza vaccine responses. In this study, we investigated the effects of gender, age, underlying diseases, and medication on vaccine responses in 1,852 Icelanders of broad age range who received trivalent inactivated influenza virus vaccination in 2012, 2013, or 2015. Hemagglutination inhibition (HAI) and microneutralization (MN) titers were measured in pre- and post-vaccination sera. Of the variables tested, the strongest association was with level of pre-vaccination titer that explained a major part of the variance observed in post-vaccination titers, ranging from 19 to 29%, and from 7 to 21% in fold change (FC), depending on the strain and serological (HAI or MN) analysis performed. Thus, increasing pre-vaccination titer associated with decreasing FC (P = 1.1 × 10−99–8.6 × 10−30) and increasing post-vaccination titer (P = 2.1 × 10−159–1.1 × 10−123). Questionnaires completed by 87% of the participants revealed that post-vaccination HAI titer showed association with repeated previous influenza vaccinations. Gender had no effect on vaccine response whereas age had a strong effect and explained 1.6–3.1% of HAI post-vaccination titer variance and 3.1% of H1N1 MN titer variance. Vaccine response, both fold increase and seroprotection rate (percentage of individuals reaching HAI ≥ 40 or MN ≥ 20), was higher in vaccinees ≤37 years of age (YoA) than all other age groups. Furthermore, a reduction was observed in the H1N1 MN titer in people ≥63 YoA, demonstrating a decreased neutralizing functionality of vaccine-induced antibodies at older age. We tested the effects of underlying autoimmune diseases, asthma and allergic diseases and did not observe significant associations with vaccine responses. Intake of immune modulating medication did not show any association. Taken together, our results show that previous encounter of influenza vaccination or infection, reflected in high HAI and MN pre-vaccination titer has the strongest negative effect on vaccine responses measured as FC and the strongest positive effect on post-vaccination titer. Increasing age had also an effect but not gender, underlying disease or medication.

Detecting Flooding Attack and Accommodating Burst Traffic in Delay-Tolerant Networks

Delay-tolerant network (DTN) is developed to cope with intermittent connectivity and long delay in wireless networks. Due to limited connectivity, DTN is vulnerable to flooding attack in which malicious nodes flood the network with superfluous data to deplete the network resources. Existing works mitigate internal flooding attacks by rate limit to constrain the number of messages that nodes can generate per time slot. However, rate limit cannot flexibly accommodate burst traffic in which nodes may have sending demands higher than the rate limit for a short period. In this paper, we propose flooding detection based on encounter records (FDER) to detect flooding attack and yet allow legitimate burst traffic simultaneously. Nodes exchange their histories of encounter records (ER), which record the sent messages during their previous encounters. The ER history is used to infer a node's new message transmission rate over time and the number of forwarded replicas per message. The adversary nodes that send too many messages or replicas can thus be detected. Since ERs serve as useful tools for monitoring the sending behavior of nodes over a long time period, FDER could detect the burst traffic violation efficiently. We also design fairness policy (FP)—a fairness forwarding policy to ensure fairness in the delivery performance fairness between nodes with normal traffic and those with burst traffic. FP uses ER information to observe nodes’ rate of new message generation and adjust their forwarding priorities accordingly. Simulation results show that FDER can detect flooding attack at a higher accuracy and a lower delay compared to a state-of-the-art scheme with affordable overhead. Moreover, FP could mitigate the smart flooding attack and still provide the performance fairness to support bursty traffic scenario.

Attitude of orthopaedic surgeons to the e-patient: Experience from a developing country

Background: Increasingly, more patients are obtaining medical information from the Internet with which they are confronting their physicians. Very few studies have been reported from developing countries concerning physician's attitude to such patients, and to our knowledge, none has been reported from Sub-Saharan Africa. This study looked at the attitude of Nigerian orthopaedic surgeons to such patients. Methods: This was a questionnaire-based interview of orthopaedic surgeons and their trainees at the 2013 annual conference of the Nigerian Orthopaedic Association in Lokoja, Nigeria. It was supplemented by an online Google form survey. Results: One hundred and twelve questionnaires were returned, and seven were incompletely filled and were discarded, leaving 105 for analysis. About 94.3% of the respondents have had previous encounters with e-patients. The mean attitude score was high (3.64 ± 0.46, the highest obtainable was 5.0). Consultants and orthopaedists in semi-urban settings scored higher than other categories. The physician's self-esteem and efficacy of using the Internet correlated highly with their attitude to e-patients. Similarly, self-esteem, the frequency of using the Internet and the experience of the way e-patients have been presenting their information (print, verbal or electronic) were the significant predictors of physicians' attitude to e-patients. Conclusion: Orthopaedic surgeons and their trainees practising in Nigeria frequently encounter patients with Internet-based medical information at consultations. Most of them have high positive attitudes towards these patients. There is a need for these doctors to become skilled in online information handling to become better at guiding such patients.

Negotiating Identity: Israel, Apartheid, and the United Nations, 1949–1952

Abstract Orthodox historiographies on Israel’s early policies in ‘black’ Africa and its relations with ‘white’ South Africa commonly, if disjointedly, assert that the state’s Jewish identity had played, in the early 1960s, a key role in Israel’s participation in the international ‘struggle against apartheid’. Revisiting this assertion, I examine Israel’s involvement in early United Nations debates on South Africa’s race policies. I trace the making of Israel’s position on South Africa’s treatment of persons of Indian origins in preparation for the 1950 General Assembly; present Israel’s voting praxis in that session; and demonstrate the persistence of both position and praxis in the 1952 Assembly session where apartheid first appeared on the UN agenda. Against the grain of existing accounts, I argue first that, on Africa, Israel’s multilateral diplomacy preceded its bilateral diplomacy; Israel’s encounter with Africa began not in the early 1960s but with its 1949 UN admission, compelling its envoys to vote and reflect on African and colonial questions, including apartheid. Secondly, I demonstrate that Israel approached apartheid with equivocation; at the UN, its diplomats devised and acted on a formula allowing them, in their words, ‘to have our cake and eat it’—even if, on the whole, Israel’s diplomatic praxis was far more progressive than that of Western states. Thirdly, I demonstrate how Jewish identity, constructed through the prism of Israel’s foundational ideology, affected such equivocation: it defined Israel’s dilemma on apartheid but, at the same time, also offered a route out of that conundrum. Finally, I illustrate that the elasticity of Jewish identity displayed by Israel’s envoys drew on sensibilities that were often formed in South Africa itself by their own previous encounters with racially-managed society and, later, with apartheid.

A Test of Positive Association for Detecting Heterogeneity in Capture for Capture\u2013Recapture Data

The Cormack–Jolly–Seber (CJS) model assumes that all marked animals have equal recapture probabilities at each sampling occasion, but heterogeneity in capture often occurs and should be taken into account to avoid biases in parameter estimates. Although diagnostic tests are generally used to detect trap-dependence or transience and assess the overall fit of the model, heterogeneity in capture is not routinely tested for. In order to detect and identify this phenomenon in a CJS framework, we propose a test of positive association between previous and future encounters using Goodman–Kruskal’s gamma. This test is based solely on the raw capture histories and makes no assumption on model structure. The development of the test is motivated by a dataset of Sandwich terns (Thalasseus sandvicensis), and we use the test to formally show that they exhibit heterogeneity in capture. We use simulation to assess the performance of the test in the detection of heterogeneity in capture, compared to existing and corrected diagnostic goodness-of-fit tests, Leslie’s test of equal catchability and Carothers’ extension of the Leslie test. The test of positive association is easy to use and produces good results, demonstrating high power to detect heterogeneity in capture. We recommend using this new test prior to model fitting as the outcome will guide the model-building process and help draw more accurate biological conclusions. Supplementary materials accompanying this paper appear online.

Retaliation or selfishness? An rTMS investigation of the role of the dorsolateral prefrontal cortex in prosocial motives

ABSTRACTEquity, fairness and cooperative behavior are crucial for everyday social interactions. Recent neuroimaging studies suggest that the dorsolateral prefrontal cortex (DLPFC) is involved in the evaluation of violations of fairness rules, though difficulties remain to determine its role in implementing retaliating or forgiving responses to unfairness. Accordingly, we applied repetitive transcranial magnetic stimulation (rTMS) to the left and right DLPFC and investigated the impact of the DLPFC on retaliation and selfishness using a sequential neuroeconomic task establishing a role reversal. That is, participants first played an Ultimatum Game (in the role of a recipient) against fair or unfair proposers, followed by a Dictator Game in the role of a proposer. Following inhibition of the right DLPFC, subjects showed an increased punishment rate regarding previously unfair opponents. Surprisingly, previously fair opponents were also treated less fairly after rTMS to the right DLPFC, but not after left or sham rTMS. Previous work suggests that the right DLPFC provides “top-down” cognitive control over prepotent emotional responses to unfairness. Our results indicate, however, that the right DLPFC may be involved in controlling selfish behavior and that its suppression leads to maximization of one’s own benefit, regardless of another’s fairness or unfairness in previous encounters.

Association between surgically diagnosed endometriosis and adverse pregnancy outcomes

To examine the association between surgically diagnosed endometriosis and pregnancy outcomes in subsequent pregnancies. Retrospective cohort study of women who delivered a singleton live birth from 2003 to 2013 in Ottawa, Ontario, Canada. Tertiary level academic center. Pregnant women with surgically diagnosed endometriosis were identified using International Classification of Diseases-10 codes from previous hospital admissions and were compared with pregnant women with no prior admission for endometriosis for the occurrences of adverse pregnancy outcomes. Observational study. Gestational hypertension, preeclampsia, placenta previa, placental abruption, postpartum hemorrhage, preterm birth, low birth weight, small for gestational age, and neonatal intensive care unit admission. Among the 52,202 eligible mother-infant pairs, we identified 469 mothers with surgically diagnosed endometriosis from a previous hospital encounter. Compared with women without endometriosis, women with endometriosis were on average older and were more likely to be primiparous, have lower gravidity, have a history spontaneous abortion, conceive with assisted reproductive technology, and reside in areas with higher neighborhood income and lower proportion of immigrants. Women with endometriosis were found to have an elevated risk of placenta previa (relative risk [RR], 3.30; 95% confidence interval [CI], 1.65-5.40) and cesarean delivery (RR, 1.24; 95% CI, 1.10-1.40). After adjustment for potential confounding factors, women with endometriosis were found to have a significantly elevated risk of placenta previa compared with women without endometriosis (adjusted RR, 2.54; 95% CI, 1.39-4.64). This study identifies baseline demographic differences between women with and without endometriosis and suggests that women affected by endometriosis have an independently elevated risk of placenta previa in pregnancy.

Comparison of Hospital Resource Use and Outcomes Among Hospitalists, Primary Care Physicians, and Other Generalists

A physician's prior experience caring for a patient may be associated with patient outcomes and care patterns during and after hospitalization. To examine differences in the use of health care resources and outcomes among hospitalized patients cared for by hospitalists, their own primary care physicians (PCPs), or other generalists. This retrospective study analyzed admissions for the 20 most common medical diagnoses among elderly fee-for-service Medicare patients from January 1 through December 31, 2013. Patients had at least 1 previous encounter with an outpatient clinician within the 365 days before admission, and diagnoses were restricted to the 20 most common diagnosis related groups. Data were collected from Medicare Parts A and B claims data, and outcomes were analyzed from January 1, 2013, through January 31, 2014. Physician types included hospitalists, PCPs (ie, the physicians who provided a plurality of ambulatory visits in the year preceding admission), or generalists (not the patients' PCPs). Number of in-hospital specialist consultations, length of stay, discharge site, all-cause 7- and 30-day readmission rates, and 30-day mortality. A total of 560 651 admissions were analyzed (41.9% men and 59.1% women; mean [SD] age, 80 [8] years). Patients' physicians were hospitalists in 59.7% of admissions; PCPs, in 14.2%; and other generalists, in 26.1%. Primary care physicians used consultations 3% more (relative risk, 1.03; 95% CI, 1.02-1.05) and other generalists used consultations 6% more (relative risk, 1.06; 95% CI, 1.05-1.07) than hospitalists. Lengths of stay were 12% longer among patients cared for by PCPs (adjusted incidence rate ratio, 1.12; 95% CI, 1.11-1.13) and 6% longer among those cared for by other generalists (adjusted incidence rate ratio, 1.06; 95% CI, 1.05-1.07) compared with patients cared for by hospitalists. However, PCPs were more likely to discharge patients home (adjusted odds ratio [AOR], 1.14; 95% CI, 1.11-1.17), whereas other generalists were less likely to do so (AOR, 0.94; 95% CI, 0.92-0.96). Relative to hospitalists, patients cared for by PCPs had similar readmission rates at 7 days (AOR, 0.98; 95% CI, 0.96-1.01) and 30 days (AOR, 1.02; 95% CI, 0.99-1.04), whereas other generalists' readmission rates were greater than hospitalists' rates at 7 (AOR, 1.05; 95% CI, 1.02-1.07) and 30 (AOR, 1.04; 95% CI, 1.03-1.06) days. Patients cared for by PCPs had lower 30-day mortality than patients of hospitalists (AOR, 0.94; 95% CI, 0.91-0.97), whereas the mortality rate of patients of other generalists was higher (AOR, 1.09; 95% CI, 1.07-1.12). A PCP's prior experience with a patient may be associated with inpatient use of resources and patient outcomes. Patients cared for by their own PCP had slightly longer lengths of stay and were more likely to be discharged home but also were less likely to die within 30 days compared with those cared for by hospitalists or other generalists.

Public Demands and Technological Response: Austin Tobin, Leo Beranek and the Advent of Jet Travel

As the Luddite protests in the 19th Century and resistance in the 20th Century to building nuclear power plants illustrate, technological change often generates powerful public opposition. In some instances, however, scientific strategies, joined with sustained pressure from well-placed supporters, can be used to ameliorate the worst effects of technological change - as the case described below illustrates. When Pan Am tried to introduce jet planes for travel in the US and across the Atlantic, it generated a battle that lasted more than two years. The public agency that operated all three major airports in the New York region - the Port Authority - had been designed to encourage its officials to emphasize scientifically based analysis in setting policy; and the agency's leader, Austin Tobin, had developed a strong reputation for political independence and integrity. He also had previous encounters with the airlines, described below, leading him to be suspicious of their assertion that jet planes were not unduly noisy. Therefore, to test jet noise, he recruited the nation's premier acoustical engineer, Leo Beranek, and when Beranek concluded that jets were perceived to be much louder than expected, the aircraft industry fought back, challenging the findings, appealing to federal officials, and alleging that Tobin might be corrupt. After two years of conflict, the airplane industry capitulated, and in a few years the standards developed for the New York airports were embraced by airport managers across the United States and Europe. This paper summarises the battle that ensued between the Port Authority and the airlines, leading to the development of noise limits for operations at the New York airports during the early days of jet travel.

Patient family advisors' perspectives on engagement in health-care quality improvement initiatives: Power and partnership.

BackgroundEngagement of the public in defining and shaping the organization and delivery of health care is increasingly viewed as integral to improving quality and promoting transparent decision making. Meaningful engagement of the public in health‐care reform is predicated on shifting entrenched power imbalances between health‐care systems and those it claims to serve.ObjectivesTo describe the expressions, forms and spaces of power from the perspectives of persons who participated as Patient/Family Advisors (PFAs) in Rapid Process Improvement Workshops (RPIWs) within Saskatchewan, Canada.MethodsUsing a qualitative, interpretive approach, in‐depth interviews were conducted with a purposive sample of 18 PFAs who had participated in at least one RPIW over the past year. Deductive thematic analysis was informed by Gaventa's model of power.ResultsMotivations for serving as a PFA included a sense of obligation to contribute to the improvement of a public system, recognition of their rights as citizens within a publicly funded system and an opportunity to openly express their concerns where previous encounters had been very negative. The invited spaces of the RPIWs were created by policymakers to accord visible power to PFAs. Participation resulted in PFAs gaining new insights into the structure and operations of the system, affirmation of their right to advocate and recognition of the potential to claim spaces of power as consumers. Advisement on specific health‐care initiatives using the vehicle of PFAs shaped and promoted new forms and spaces of power, representing one step in a very long road to full engagement of consumers in health care.

1394P - Previous palliative care encounter is associated with lower total hospital charge and shorter length of stay in patients with metastatic cancer

1394P - Previous palliative care encounter is associated with lower total hospital charge and shorter length of stay in patients with metastatic cancer

Engaging Engineering Students in Geoscience Through Case Studies and Active Learning

ABSTRACTThis study reports on a case study–based curricular intervention designed to help undergraduate engineering students make connections between geoscience and its applications. Teaching through case studies resulted in a measurable and significant improvement in the confidence that students had in their ability to apply geoscience concepts in an engineering context. Before the intervention, students in the Bachelor of Science program in Mining Engineering at Colorado School of Mines struggled to solve problems using geoscience concepts in upper division courses. This motivated faculty to revise the required geoscience courses to better demonstrate how geoscience can be applied to solve engineering problems. There were three elements to the revision: each topic was introduced in an applied context, students gave case study presentations on geoscience in mining, and active learning techniques were employed during lecture sessions. In this paper, teaching materials are presented for a faculty-led case study, associated active learning exercises, and a student case study assignment. Student attitudes toward geoscience were surveyed using a one group pretest–posttest quasiexperimental design. At the beginning of the course, students who had previous encounters with applied geoscience had more positive attitudes toward geoscience (p ≤ 0.05). Comparison of pretest and posttest responses showed significant improvement (p ≤ 0.05) in three areas: students gained exposure to geoscience concepts, had increased confidence that they could provide concrete examples of applied geoscience, and were more willing to convince a friend or colleague that geoscience was important in mining.