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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.icarus.2007.09.031 Byline: Robert J. Lillis (a), Stephen W. Bougher (b), David L. Mitchell (a), David A. Brain (a), Robert P. Lin (a), Mario H. AcuA[+ or -]a (c) Keywords: Mars; Magnetic fields; Mars; atmosphere Abstract: Details are presented of an improved technique to use atmospheric absorption of magnetically reflecting solar wind electrons to constrain neutral mass densities in the nightside martian upper thermosphere. The helical motion of electrons on converging magnetic field lines, through an extended neutral atmosphere, is modeled to enable prediction of loss cone pitch angle distributions measured by the Magnetometer/Electron Reflectometer (MAG/ER) experiment on Mars Global Surveyor at 400 km altitude. Over the small fraction of Mars' southern hemisphere ([approximately equal to]2.5%) where the permanent crustal magnetic fields are both open to the solar wind and sufficiently strong as to dominate the variable induced martian magnetotail field, spherical harmonic expansions of the crustal fields are used to prescribe the magnetic field along the electron's path, allowing least-squares fitting of measured loss cones, in order to solve for parameters describing the vertical neutral atmospheric mass density profile from 160 to 230 km. Results are presented of mass densities in the southern hemisphere at 2 a.m. LST at the mean altitude of greatest sensitivity, 180 km, continuously over four martian years. Seasonal variability in densities is largely explained by orbital and latitudinal changes in dayside insolation that impacts the nightside through the resulting thermospheric circulation. However, the physical processes behind repeatable rapid, late autumnal cooling at mid-latitudes and near-aphelion warming at equatorial latitudes is not fully clear. Southern winter polar warming is generally weak or nonexistent over several Mars years, in basic agreement with MGS and MRO accelerometer observations. The puzzling response of mid-latitude densities from 160[degrees] to 200[degrees] E to the 2001 global dust storm suggests unanticipated localized nightside upper thermospheric lateral and vertical circulation patterns may accompany such storms. The downturn of the 11-year cycle of solar EUV flux is likely responsible for lower aphelion densities in 2004 and 2006 (Mars years 27 and 28). Author Affiliation: (a) UC Berkeley Space Sciences Laboratory, 7 Gauss Way, Berkeley, CA 94720, USA (b) University of Michigan Department of Atmospheric, Oceanic and Space Sciences, 2455 Hayward St., Ann Arbor, MI 48109-2143, USA (c) NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA Article History: Received 21 February 2007; Revised 15 September 2007

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.icarus.2005.09.023 Byline: David A. Brain, David L. Mitchell, Jasper S. Halekas Keywords: Mars; Magnetic fields; Ionospheres; Solar wind Abstract: Using more than five years of data from the magnetometer and electron reflectometer (MAG/ER) on Mars Global Surveyor (MGS), we derive the draping direction of the magnetic field above a given latitude band in the northern hemisphere. The draping direction varies on timescales associated with the orbital period of Mars and with the solar rotation period. We find that there is a strongly preferred draping direction when Mars is in one solar wind sector, but the opposite direction is not preferred as strongly for the other solar wind sector. This asymmetry occurs at or below the magnetic pileup boundary (MPB), is observed preferentially on field lines that connect to the collisional ionosphere, and is independent of planetary longitude. The observations could be explained by a hemispherical asymmetry in the access of field lines to the low-altitude ionosphere, or possibly from global modification of the low-altitude solar wind interaction by crustal magnetic fields. We show that the draping direction affects both the penetration of sheath plasma to 400 km altitudes on the martian dayside and the radial component of the magnetic field on the planetary night side. Author Affiliation: UC Berkeley Space Sciences Laboratory, 7 Gauss Way, Berkeley, CA 94720, USA Article History: Received 12 April 2005; Revised 19 September 2005

• Experienced registered nurses who are employed as nurse navigators provide effective co-ordinated care to people living with multiple chronic conditions. • Nurse navigators effectively use value-based care to help reconnect patients who have lost trust in the health service, to reconnect with their interdisciplinary teams. • Nurse navigators provide individualized, authentic care, which is more than the sum of hospital avoidance. Nurse navigators are an emerging workforce providing care to people with multiple chronic conditions. The role of the navigators is to identify patients requiring support in negotiating their health care. A critical discourse analysis was used to examine qualitative data collected from nurse navigators and consenting navigated patients to identify key indicators of how nurse navigators do their work and where the success of their work is most evident. Nurse navigators help patients who have lost trust in the health system to re-engage with their interdisciplinary health care team. This re-engagement is the final step in a journey of addressing unmet needs, essential to hospital avoidance. Nurse navigators provide a continuum of authentic and holistic care. To acknowledge the true value of nurse navigators, their performance indicators need to embrace the value-added care they provide. [ABSTRACT FROM AUTHOR]

Objective: To conduct a systematic review and meta-analysis and estimate the economic costs attributable to child and adolescent bullying victimization in Australia.Method: The costs of bullying victimization were measured from a societal perspective that accounted for costs associated with health care, education resources, and productivity losses. A prevalence-based approach was used to estimate the annual costs for Australians who experienced bullying victimization in childhood and adolescence. This study updated a previous systematic review summarizing the association between bullying victimization and health and nonhealth outcomes. Costs were estimated by calculating population attributable fractions to determine the effects of bullying victimization on increased risk of adverse health outcomes, such as anxiety disorders, depressive disorders, intentional self-harm, and tobacco use. A top-down approach to cost estimation was taken for all outcomes of interest except for costs incurred by educational institutions and productivity losses of victims' caregivers, for which a bottom-up cost estimation was applied.Results: Annual costs in Australian dollars (AUD) in 2016 on health and nonhealth outcomes attributable to child and adolescent bullying victimization were estimated at AUD $763 million: AUD $750 million for health system costs with AUD $147 million for anxiety disorders, AUD $322 million for depressive disorders, AUD $57 million for intentional self-harm, and AUD $224 million for tobacco use; AUD $7.5 million for productivity losses of victims' caregivers; and AUD $6 million for educational services.Conclusion: The findings from this study suggest a substantial annual cost to Australian society as a result of bullying victimization with more than 8% of annual mental health expenditure in Australia estimated to be attributable to bullying victimization. [ABSTRACT FROM AUTHOR]

There is a paucity of high-quality evidence based on clinical endpoints for routine cleaning of shared medical equipment. We assessed the effect of enhanced cleaning and disinfection of shared medical equipment on health-care-associated infections (HAIs) in hospitalised patients. We conducted a stepped-wedge, cluster randomised, controlled trial in ten wards of a single hospital located on the central coast of New South Wales, Australia. Hospitals were eligible for inclusion if they were classified as public acute group A according to the Australian Institute of Health and Welfare, were located in New South Wales, had an intensive care unit, had a minimum of ten wards, and provided care for patients aged 18 years or older. Each cluster consisted of two randomly allocated wards (by use of simple randomisation), with a new cluster beginning the intervention every 6 weeks. Wards were informed of their allocation 2 weeks before commencement of intervention exposure, and the researcher collecting primary outcome data and audit data was masked to treatment sequence allocation. In the control phase, there was no change to environmental cleaning practices. In the intervention phase, a multimodal cleaning bundle included an additional 3 h per weekday for the dedicated cleaning and disinfection of shared medical equipment by 21 dedicated cleaning staff, with ongoing education, audit, and feedback. The primary outcome was the number of confirmed cases of HAI, as assessed by a fortnightly point prevalence survey and measured in all patients admitted to the wards during the study period. The completed trial is registered with Australia New Zealand Clinical Trials Registry (ACTRN12622001143718). The hospital was recruited on July 31, 2022, and the study was conducted between March 20 and Nov 24, 2023. We assessed 220 hospitals for eligibility, of which five were invited to participate, and the first hospital to formally respond was enrolled. 5002 patients were included in the study (2524 [50·5%] women and 2478 [49·5%] men). In unadjusted results, 433 confirmed HAI cases occurred in 2497 patients (17·3%, 95% CI 15·9 to 18·8) in the control phase and 301 confirmed HAI cases occurred in 2508 patients (12·0%, 10·7 to 13·3) in the intervention phase. In adjusted results, there was a relative reduction of –34·5% (–50·3 to –17·5) in HAIs following the intervention (odds ratio 0·62, 95% CI 0·45 to 0·80; p=0·0006), corresponding to an absolute reduction equal to –5·2% (–8·2 to –2·3). No adverse effects were reported. Improving the cleaning and disinfection of shared medical equipment significantly reduced HAIs, underscoring the crucial role of cleaning in improving patient outcomes. Findings emphasise the need for dedicated approaches for cleaning shared equipment. National Health and Medical Research Council. [ABSTRACT FROM AUTHOR]

Microwave ablation (MWA) has gained attention as a minimally invasive and safe alternative to surgical intervention for patients with small renal masses; however, its cost-effectiveness in Australia remains unclear. This study conducted a cost-effectiveness analysis to evaluate the relative clinical and economic merits of MWA compared to robotic-assisted partial nephrectomy (RA-PN) in the treatment of small renal masses. A Markov state-transition model was constructed to simulate the progression of Australian patients with small renal masses treated with MWA versus RA-PN over a 10-year horizon. Transition probabilities and utility data were sourced from comprehensive literature reviews, and cost data were estimated from the Australian health system perspective. Life-years, quality-adjusted life-years (QALYs), and lifetime costs were estimated. Modelled uncertainty was assessed using both deterministic and probabilistic sensitivity analyses. A willingness-to-pay (WTP) threshold of $50,000 per QALY was adopted. All costs are expressed in 2022 Australian dollars and discounted at 3% annually. To assess the broader applicability of our findings, a validated cost-adaptation method was employed to extend the analysis to 8 other high-income countries. Both the base case and cost-adaptation analyses revealed that MWA dominated RA-PN, producing both lower costs and greater effectiveness over 10 years. The cost-effectiveness outcome was robust across all model parameters. Probabilistic sensitivity analyses confirmed that MWA was dominant in 98.3% of simulations at the designated WTP threshold, underscoring the reliability of the model under varying assumptions. For patients with small renal masses in Australia and comparable healthcare settings, MWA is the preferred strategy to maximize health benefits per dollar, making it a highly cost-effective alternative to RA-PN. [ABSTRACT FROM AUTHOR]

In this study of 638 Australian nurses, compliance to hand hygiene (HH), as defined by the “five moments” recommended by the World Health Organisation (2009), was examined. Hypotheses focused on the extent to which time pressure reduces compliance and safety climate (operationalised in relation to HH using colleagues, manager, and hospital as referents) increases compliance. It also was proposed that HH climate would interact with time pressure, such that the negative effects of time pressure would be less marked when HH climate is high. The extent to which the three HH climate variables would interact among each other, either in the form of boosting or compensatory effects, was tested in an exploratory manner. A prospective research design was used in which time pressure and the HH climate variables were assessed at Time 1 and compliance was assessed by self-report two weeks later. Compliance was high but varied significantly across the 5 HH Moments, suggesting that nurses make distinctions between inherent and elective HH and also seemed to engage in some implicit rationing of HH. Time pressure dominated the utility of HH climate to have its positive impact on compliance. The most conducive workplace for compliance was one low in time pressure and high in HH climate. Colleagues were very influential in determining compliance, more so than the manager and hospital. Manager and hospital support for HH enhanced the positive effects of colleagues on compliance. Providing training and enhancing knowledge was important, not just for compliance, but for safety climate. [ABSTRACT FROM AUTHOR]