Dealing With Death in Custody: Psychosocial Consequences for Correctional Staff.

This study investigated experiences of trauma and psychosocial mediators in correctional staff who had dealt with a death in custody within the previous year. A total of 211 participants completed the Trauma Symptom Index as well as measures of self-efficacy, optimism, problem-solving style, social support, and growth. The data showed that around 32% of participants were exhibiting symptoms at a clinical level. Prior experience with suicide and level of involvement in the incident were direct predictors of symptom level. Support, optimism, self-efficacy, and confidence in problem-solving seemed to be potential protective factors and were also predictive of trauma-related growth. Although the study was cross sectional, the data suggest that it may be possible to predict factors that are protective and therefore offer some hope in terms of developing preventive strategies.

Predation and Risk Behaviors of Free-Roaming Owned Cats in Auckland, New Zealand via the Use of Animal-Borne Cameras.

Free-roaming cats are at increased risk of injuring themselves as well as other domestic and fauna species, yet relatively little is known about the frequency at which risk and predation behaviors occur in a typical day. In this study, cat risk, and predation behavioral information was collected using animal-borne video cameras and global positioning system (GPS) units that were attached to break-free cat collars. The observation period was one to three consecutive days for 37 convenience sampled free-roaming owned cats in Auckland, New Zealand. Video footage was manually reviewed and all predation and risk behavior events were recorded. These included stalking, pursuing, and seizing prey as well as altercations with other cats, ingesting harmful substances, and venturing into hazardous locations such as roads and storm drains. During the observation period, 23 of the 37 cats (62.2%) engaged in a total of 121 predation events. Of these, 40 resulted in successful prey capture with 18 of the 40 captures involving New Zealand native fauna species. Invertebrates were the most common taxa preyed upon (n = 55; 46%), followed by skinks (n = 8; 7%). No mammalian, avian or amphibian prey were captured and no cat took prey back to their residence. A total of 326 risk behaviors were observed for 32 out of the 37 cats (86.5%) with the most common being cats venturing onto the road (n = 132; 41%). Younger cats (aged 1-6 six years) engaged in significantly more predation and risk behaviors than older cats (aged 7 years and above). Sex, breed, number of cats in a household, and geographic location were not found to be predictors of cats' participation in predation or risk behaviors. Given the high frequency of predation and risk behaviors in free-roaming owned cats, it may be beneficial to educate owners about strategies to minimize risk such as housing them indoors, containing them to their properties or monitoring their time spent outdoors.

Personalised telehealth intervention for chronic disease management: A pilot randomised controlled trial.

INTRODUCTION: The aim of this study was to assess the impact of home-based telehealth monitoring on health outcomes, quality of life and costs over 12 months for patients with diabetes and/or chronic obstructive pulmonary disease (COPD) who were identified as being at high risk of readmission to hospital. METHODS: This pilot study was a randomised controlled trial combined with an economic analysis to examine the outcomes of standard care versus home-based telehealth for people with diabetes and/or COPD who were at risk of hospital readmission within one year. The primary outcomes were (i) hospital admission and length of stay (LOS); and (ii) health-related quality of life (HRQOL); and the secondary outcomes were (i) health-related clinical outcomes; (ii) anxiety and depression scores; and (iii) health literacy. The costs of the intervention and hospitalisations were included. RESULTS: A total of 86 and 85 participants were randomised to the intervention and control groups respectively. The difference between groups in hospital LOS was -3.89 (95% confidence interval (CI): -9.40, 1.62) days, and for HRQOL, 0.09 (95% CI: 0.05, 0.14) in favour of the telehealth monitoring group. There was a saving of AUD$6553 (95% CI: -12145, -961) in the cost of hospitalisation over 12 months, which offset the increased cost of tele-monitoring. The intervention group showed an improvement in anxiety, depression and health literacy at 12 months, and in the diabetes group, a reduction in microalbuminuria. DISCUSSION: The telehealth monitoring intervention improved patient's health outcomes and quality of life at no additional cost.

A Survey of Public Opinion on Cat (Felis catus) Predation and the Future Direction of Cat Management in New Zealand.

Cat predation is a prominent issue in New Zealand that provokes strong and opposing views. We explored, via 1011 face-to-face questionnaires, public opinion on (a) support for a National Cat Management Strategy (78% support); (b) concern regarding predation of wildlife by owned and un-owned cats (managed stray, unmanaged stray, and feral cats); (c) the acceptability of management techniques for owned cats; and (d) the acceptability of population management techniques for un-owned cats. The highest concern was expressed regarding the predation of non-native and native wildlife by feral cats (60 and 86% repectively), followed by unmanaged stray cats (59 and 86% respectively), managed stray cats (54 and 82% respectively), and finally owned cats (38 and 69% repectively). Limits to the number of cats owned and cat restriction zones received high levels of support (>65%), and compulsory microchipping, Council registration, and de-sexing were supported by the majority (>58%). Public support of population control methods for unowned cats was explored, and the influence of participant demographic variables on responses is described. These findings provide insight into public opinion regarding the management of cats in New Zealand, which should be considered during the development of legislation in this area.

Effects of home-based primary care on Medicare costs in high-risk elders.

OBJECTIVES: To determine the effect of home-based primary care (HBPC) on Medicare costs and mortality in frail elders. DESIGN: Case-control concurrent study using Medicare administrative data. SETTING: HBPC practice in Washington, District of Columbia. PARTICIPANTS: HBPC cases (n = 722) and controls (n = 2,161) matched for sex, age bands, race, Medicare buy-in status (whether Medicaid covers Part B premiums), long-term nursing home status, cognitive impairment, and frailty. Cases were eligible if enrolled in MedStar Washington Hospital Center's HBPC program during 2004 to 2008. Controls were selected from Washington, District of Columbia, and urban counties in Virginia, Maryland, and Pennsylvania. INTERVENTION: HBPC clinical service. MEASUREMENTS: Medicare costs, utilization events, mortality. RESULTS: Mean age was 83.7 for cases and 82.0 for controls (P < .001). A majority of both groups was female (77%) and African American (90%). During a mean 2-year follow-up, in univariate analysis, cases had lower Medicare ($44,455 vs $50,977, P = .01), hospital ($17,805 vs $22,096, P = .003), and skilled nursing facility care ($4,821 vs $6,098, P = .001) costs, and higher home health ($6,579 vs $4,169; P < .001) and hospice ($3,144 vs. $1,505; P = .005) costs. Cases had 23% fewer subspecialist visits (P = .001) and 105% more generalist visits (P < .001). In a multivariate model, cases had 17% lower Medicare costs, averaging $8,477 less per beneficiary (P = .003) over 2 years of follow-up. There was no difference between cases and controls in mortality (40% vs 36%, hazard ratio = 1.06, P = .44) or in average time to death (16.2 vs 16.8 months, P = .30). CONCLUSION: HBPC reduces Medicare costs for ill elders, with similar survival outcomes in cases and controls.

Local provision of percutaneous coronary intervention increases stenting rates and reduces length of hospital stay in remote regional centre.

INTRODUCTION: An early invasive strategy with follow-on percutaneous coronary intervention (PCI) is recommended in the management of high risk acute coronary syndromes (ACS). This article aimed to assess the impact of a new PCI service in a remote population. METHOD: The study compared patient treatment pre- and post-introduction of the PCI service in a remote regional centre. Patients were identified using ICD discharge code during two 12 week periods ('pre' and 'post' introduction of the new PCI service). Further data was obtained from a catheter laboratory database, electronic patient management systems and clinical notes. Non-parametric statistical tests were used. RESULTS: There were 182 patients in the pre-PCI group and 204 in the post-PCI group. There were no demographic differences between the groups. Patients admitted post service introduction who required active treatment were more likely to have PCI rather than an angiogram only (p = 0.046). Furthermore, patients admitted after the introduction of the PCI service had a shorter period of time from admission to PCI (p = 0.002), were less likely to be transferred to another hospital (p < 0.001), and on average had a shorter hospital stay (p = 0.017). CONCLUSION: A local PCI service in a remote regional centre increased efficiency in the management of patients with ACS with increased rates of PCI, shorter waiting times, reduced requirement for hospital transfer, and shorter length of stay. Nevertheless, many patients still required transfer to other centres. Therefore, maintaining links with other regional centres with clear patient pathways are necessary to provide optimal ACS care to all patients in a rural area.

A statistical model for under- or overdispersed clustered and longitudinal count data.

We propose a likelihood-based model for correlated count data that display under- or overdispersion within units (e.g. subjects). The model is capable of handling correlation due to clustering and/or serial correlation, in the presence of unbalanced, missing or unequally spaced data. A family of distributions based on birth-event processes is used to model within-subject underdispersion. A computational approach is given to overcome a parameterization difficulty with this family, and this allows use of common Markov Chain Monte Carlo software (e.g. WinBUGS) for estimation. Application of the model to daily counts of asthma inhaler use by children shows substantial within-subject underdispersion, between-subject heterogeneity and correlation due to both clustering of measurements within subjects and serial correlation of longitudinal measurements. The model provides a major improvement over Poisson longitudinal models, and diagnostics show that the model fits well.

Age-related impairments in the revision of syntactic misanalyses: effects of prosody.

Two experiments examined whether young and older adults differ in comprehending sentences that contain temporary syntactic closure ambiguities. Experiment 1 examined age-related differences using the Auditory Moving Window (AMW) task, in which sentences were presented in a segment-by-segment self-paced fashion. Experiment 2 examined age-related differences using a sentence recall task, in which sentences were presented in their entirety. Sentences were constructed to have cooperating prosody (i.e., where prosody is consistent with the syntactic boundaries), baseline prosody (i.e., where prosody is ambiguous in the syntactically ambiguous region), and conflicting prosody (i.e., where cross-splicing relocates the prosodic phrase break at a misleading point in syntactic structure). The results showed that both young and older adults make comparable use of prosodic information to interpret temporary syntactic ambiguities, although younger adults may make use of this information more quickly than older adults. In addition, older adults appeared to be less able than young adults to revise initial syntactic misinterpretations caused by conflicting prosodic information. These results are interpreted with respect to age-related impairments in the allocation of working memory resources and inefficient inhibitory function during spoken language processing.