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Attachment theory and research : new directions and emerging themes
\"This volume showcases the latest theoretical and empirical work from some of the top scholars in attachment. Extending classic themes and describing important new applications, the book examines several ways in which attachment processes help explain how people think, feel, and behave in different situations and at different stages in the life cycle. Topics include the effects of early experiences on adult relationships; new developments in neuroscience and genetics; attachment orientations and parenting; connections between attachment and psychopathology, as well as health outcomes; and the relationship of attachment theory and processes to clinical interventions. Key Words/Subject Areas: attachment research, attachment security, attachment theory, couple interventions, developmental psychology, dyadic regulation process, emotion, parenting, psychopathology, relationships, romantic functioning, romantic attachment Audience: Researchers and students in social, developmental, personality, and clinical psychology. Serves as a primary or supplemental text in advanced undergraduate or graduate courses on attachment, close relationships, interpersonal processes, and family relationships \"-- Provided by publisher.
Book
Essays to My Daughter on Our Relationship With the Natural World
What do fishing with an otter, sitting atop a mountain at dawn
with eighty Taiwanese backpackers, and driving home from Aldo
Leopold's Shack have to say about the evolution of a personal
environmental philosophy? Essays to My Daughter on Our
Relationship With the Natural World provides a series of
reflections by an environmental educator about lessons learned from
time spent in nature. Originally conceived as personal letters to
the author's daughter, this collection presents ethical questions
outdoor enthusiasts regularly face as they work and play in the
natural world.
The essays in this book explore environmentalism in a modern-day
context, with topics including sustainability education, the
current relevance of environmental writers from the past, and the
uncertainty of what is meant by words like \"naturalist,\"
\"solitude,\" and \"wilderness.\" There is no attempt to direct readers
to any particular environmental philosophy. Instead, Simpson
encourages readers to articulate their own perspective based on
personal experiences in nature. Though Essays to My
Daughter is written by a father to his daughter, the insights
within the volume-and the questions they provoke-are valuable to
all members of the next generation as they grapple with their own
relationship to the natural world.
eBook
Cross-site transportability of an explainable artificial intelligence model for acute kidney injury prediction
Artificial intelligence (AI) has demonstrated promise in predicting acute kidney injury (AKI), however, clinical adoption of these models requires interpretability and transportability. Non-interoperable data across hospitals is a major barrier to model transportability. Here, we leverage the US PCORnet platform to develop an AKI prediction model and assess its transportability across six independent health systems. Our work demonstrates that cross-site performance deterioration is likely and reveals heterogeneity of risk factors across populations to be the cause. Therefore, no matter how accurate an AI model is trained at the source hospital, whether it can be adopted at target hospitals is an unanswered question. To fill the research gap, we derive a method to predict the transportability of AI models which can accelerate the adaptation process of external AI models in hospitals.
Artificial intelligence (AI) has demonstrated promise in predicting acutekidney injury (AKI), however, clinical adoption of these models requires interpretability and transportability across sites. Here, the authors develop an AKI prediction model and a measure for model transportability across six independent health systems.
Journal Article
Nutrition, ecology and nutritional ecology: toward an integrated framework
1. The science of nutritional ecology spans a wide range of fields, including ecology, nutrition, behaviour, morphology, physiology, life history and evolutionary biology. But does nutritional ecology have a unique theoretical framework and research program and thus qualify as a field of research in its own right? 2. We suggest that the distinctive feature of nutritional ecology is its integrative nature, and that the field would benefit from more attention to formalizing a theoretical and quantitative framework for developing this. 3. Such a framework, we propose, should satisfy three minimal requirements: it should be nutritionally explicit, organismally explicit, and ecologically explicit. 4. We evaluate against these criteria four existing frameworks (Optimal Foraging Theory, Classical Insect Nutritional Ecology, the Geometric Framework for nutrition, and Ecological Stoichiometry), and conclude that each needs development with respect to at least one criterion. 5. We end with an initial attempt at assessing the expansion of our own contribution, the Geometric Framework, to better satisfy the criterion of ecological explicitness.
Journal Article
The Surviving Sepsis Campaign bundles and outcome: results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study)
Introduction
Despite evidence demonstrating the value of performance initiatives, marked differences remain between hospitals in the delivery of care for patients with sepsis. The aims of this study were to improve our understanding of how compliance with the 3-h and 6-h Surviving Sepsis Campaign (SSC) bundles are used in different geographic areas, and how this relates to outcome.
Methods
This was a global, prospective, observational, quality improvement study of compliance with the SSC bundles in patients with either severe sepsis or septic shock.
Results
A total of 1794 patients from 62 countries were enrolled in the study with either severe sepsis or septic shock. Overall compliance with all the 3-h bundle metrics was 19 %. This was associated with lower hospital mortality than non-compliance (20 vs. 31 %,
p
< 0.001). Overall compliance with all the 6-h bundle metrics was 36 %. This was associated with lower hospital mortality than non-compliance (22 vs. 32 %,
p
< 0.001). After adjusting the crude mortality differences for ICU admission, sepsis status (severe sepsis or septic shock), location of diagnosis, APACHE II score and country, compliance remained independently associated with improvements in hospital mortality for both the 3-h bundle (OR = 0.64 (95 % CI 0.47−0.87),
p
= 0.004)) and 6-h bundle (OR = 0.71 (95 % CI 0.56−0.90),
p
= 0.005)).
Discussion
Compliance with all of the evidence-based bundle metrics was not high. Patients whose care included compliance with all of these metrics had a 40 % reduction in the odds of dying in hospital with the 3-h bundle and 36 % for the 6-h bundle.
Journal Article
Sepsis Guidelines
This interactive feature about the initial management of suspected sepsis offers a case vignette, accompanied by essays that either support or discourage the implementation of a 1-hour bundle for the management of sepsis and septic shock.
Journal Article
Clinical factors associated with rapid treatment of sepsis
To understand what clinical presenting features of sepsis patients are historically associated with rapid treatment involving antibiotics and fluids, as appropriate.
This was a retrospective, observational cohort study using a machine-learning model with an embedded feature selection mechanism (gradient boosting machine).
For adult patients (age ≥ 18 years) who were admitted through Emergency Department (ED) meeting clinical criteria of severe sepsis from 11/2007 to 05/2018 at an urban tertiary academic medical center, we developed gradient boosting models (GBMs) using a total of 760 original and derived variables, including demographic variables, laboratory values, vital signs, infection diagnosis present on admission, and historical comorbidities. We identified the most impactful factors having strong association with rapid treatment, and further applied the Shapley Additive exPlanation (SHAP) values to examine the marginal effects for each factor.
For the subgroups with or without fluid bolus treatment component, the models achieved high accuracy of area-under-receiver-operating-curve of 0.91 [95% CI, 0.86-0.95] and 0.84 [95% CI, 0.81-0.86], and sensitivity of 0.81[95% CI, 0.72-0.87] and 0.91 [95% CI, 0.81-0.97], respectively. We identified the 20 most impactful factors associated with rapid treatment for each subgroup. In the non-hypotensive subgroup, initial physiological values were the most impactful to the model, while in the fluid bolus subgroup, value minima and maxima tended to be the most impactful.
These machine learning methods identified factors associated with rapid treatment of severe sepsis patients from a large volume of high-dimensional clinical data. The results provide insight into differences in the rapid provision of treatment among patients with sepsis.
Journal Article
The role of telehealth in sepsis care in rural emergency departments: A qualitative study of emergency department sepsis telehealth user perspectives
Sepsis is a leading cause of hospitalization and death in the United States, and rural patients are at particularly high risk. Telehealth has been proposed as one strategy to narrow rural-urban disparities. The objective of this study was to understand why rural emergency department (ED) staff use provider-to-provider telehealth (tele-ED) and how tele-ED care changes the care for rural patients with sepsis.
We conducted a qualitative interview study between February 15, 2022, and May 22, 2023, with participants from upper Midwest rural EDs and tele-ED hub physicians in a single tele-ED network that delivers provider-to-provider consultation for sepsis patients. One interviewer conducted individual telephone interviews, then we used standard qualitative methods based on modified grounded theory to identify themes and domains.
We interviewed 27 participants, and from the interviews we identified nine themes within three domains. Participants largely felt tele-ED for sepsis was valuable in their practice. We identified that telehealth was consulted to facilitate interhospital transfer, provide surge capacity for small teams, to adhere with provider scope-of-practice policies, for inexperienced providers, and for patients with increased severity of illness or complex comorbidities. Barriers to tele-ED use and impact included increased sepsis care standardization, provider reluctance, and sepsis diagnostic uncertainty. Additionally, we identified that real-time education and training were important secondary benefits identified from tele-ED use.
Tele-ED care was used by rural providers for sepsis treatment, but many barriers existed that may have limited potential benefits to its use.
Journal Article
Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to ProCESS, ProMISe, and ARISE
Prior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar outcome benefits have been reported in over 70 observational and randomized controlled studies comprising over 70,000 patients. As a result, early goal-directed therapy was largely incorporated into the first 6 hours of sepsis management (resuscitation bundle) adopted by the Surviving Sepsis Campaign and disseminated internationally as the standard of care for early sepsis management. Recently a trio of trials (ProCESS, ARISE, and ProMISe), while reporting an all-time low sepsis mortality, question the continued need for all of the elements of early goal-directed therapy or the need for protocolized care for patients with severe and septic shock. A review of the early hemodynamic pathogenesis, historical development, and definition of early goal-directed therapy, comparing trial conduction methodology and the changing landscape of sepsis mortality, are essential for an appropriate interpretation of these trials and their conclusions.
Journal Article