scholarly journals A complex intervention to improve intercultural communication and Aboriginal patient outcomes: which components worked?

2020 ◽  
Author(s):  
Anna P Ralph ◽  
Vicki Kerrigan ◽  
Craig Castillon ◽  
Vincent Mithen ◽  
Elise O'Connor ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Aboriginal People ◽  
Discharge Rate ◽  
Baseline Period ◽  
Sudden Increase ◽  
Inverse Association ◽  
Full Time ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Interpreter Use

Abstract Background Aboriginal language interpreters are under-utilised in healthcare in northern Australia. Self-discharge from hospital is an adverse outcome occurring at high rates among Aboriginal people, with poor communication thought to be a contributor. We previously reported increased Aboriginal interpreter uptake and decreased rates of self-discharge during implementation of a 12-month hospital-based intervention. Interrupted time-series analysis showed sudden increase and up-trending improvement in interpreter use, and a corresponding decrease in self-discharge rates, during a 12-month intervention period (April 2018 - March 2019) compared with a 24-month baseline period (April 2016 – March 2018). This paper aims to explore reasons for these outcomes, and further explore the likelihood of a causal association between study activities and outcomes. Methods We used the ‘Template for Intervention Description and Replication’ (TIDieR) as a framework to describe intervention components and evaluate their relative importance. Information on intercurrent activities that may have contaminated study findings was reviewed. The relationship between proportion of hospital separations among Aboriginal people ending in self-discharge and numbers of Aboriginal interpreter bookings made during April 2016-March 2019 was tested using linear regression. Results One full-time Aboriginal Interpreter Coordinator was employed for the intervention period who identified language needs, promoted interpreter use and mentored interpreters. The intervention period start date corresponded with commencement of this role. Three ‘Working with Interpreter’ training sessions were held during the intervention period reaching 83 clinicians, and three medical officers volunteered as champions of interpreter use in hospital practice. Employment of the Aboriginal Interpreter Coordinator was deemed the most important component of the intervention, based on reach compared to the other components and timing of the changes in outcomes. There was an inverse association between interpreter bookings and self-discharge rate among Aboriginal inpatients (p = 0.02). This association, the timing of changes and assessment of intercurrent activities at the hospital indicated that the study intervention was likely to be casually related to the measured outcomes. Conclusions Communication in healthcare can be improved through targeted strategies, with associated improvements in patient outcomes. Health services with high interpreter needs would benefit from employing an interpreter coordinator.

scholarly journals A Complex Intervention to Improve Intercultural Communication and Aboriginal Patient Outcomes: Which Components Worked?

2020 ◽  
Author(s):  
Anna P Ralph ◽  
Vicki Kerrigan ◽  
Craig Castillon ◽  
Vincent Mithen ◽  
Elise O'Connor ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Aboriginal People ◽  
Discharge Rate ◽  
Baseline Period ◽  
Sudden Increase ◽  
Inverse Association ◽  
Full Time ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Interpreter Use

Abstract BackgroundAboriginal language interpreters are under-utilised in healthcare in northern Australia. Self-discharge from hospital is an adverse outcome occurring at high rates among Aboriginal people, with poor communication thought to be a contributor. We previously reported increased Aboriginal interpreter uptake and decreased rates of self-discharge during implementation of a 12-month hospital-based intervention. Interrupted time-series analysis showed sudden increase and up-trending improvement in interpreter use, and a corresponding decrease in self-discharge rates, during a 12-month intervention period (April 2018 - March 2019) compared with a 24-month baseline period (April 2016 – March 2018). This paper aims to explore reasons for these outcomes, and further explore the likelihood of a causal association between study activities and outcomes. MethodsWe used the ‘Template for Intervention Description and Replication’ (TIDieR) as a framework to describe intervention components and evaluate their relative importance. Information on intercurrent activities that may have contaminated study findings was reviewed. The relationship between proportion of hospital separations among Aboriginal people ending in self-discharge and numbers of Aboriginal interpreter bookings made during April 2016-March 2019 was tested using linear regression. ResultsOne full-time Aboriginal Interpreter Coordinator was employed for the intervention period who identified language needs, promoted interpreter use and mentored interpreters. The intervention period start date corresponded with commencement of this role. Three ‘Working with Interpreter’ training sessions were held during the intervention period reaching 83 clinicians, and three medical officers volunteered as champions of interpreter use in hospital practice. Employment of the Aboriginal Interpreter Coordinator was deemed the most important component of the intervention, based on reach compared to the other components and timing of the changes in outcomes. There was an inverse association between interpreter bookings and self-discharge rate among Aboriginal inpatients (p=0.02). This association, the timing of changes and assessment of intercurrent activities at the hospital indicated that the study intervention was likely to be casually related to the measured outcomes. ConclusionsCommunication in healthcare can be improved through targeted strategies, with associated improvements in patient outcomes. Health services with high interpreter needs would benefit from employing an interpreter coordinator.

scholarly journals Does improved interpreter uptake reduce self-discharge rates in hospitalised patients? A successful hospital intervention explained

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0257825
Author(s):  
Elise O’Connor ◽  
Vicki Kerrigan ◽  
Robyn Aitken ◽  
Craig Castillon ◽  
Vincent Mithen ◽  
...  
Keyword(s):  
Online Survey ◽  
Aboriginal People ◽  
Sudden Increase ◽  
Inverse Association ◽  
Northern Australia ◽  
Intervention Period ◽  
Interpreter Use ◽  
Discharge Rates ◽  
Hospitalised Patients ◽  
Study Intervention

Background Aboriginal language interpreters are under-utilised in healthcare in northern Australia. Self-discharge from hospital is an adverse outcome occurring at high rates among Aboriginal people, with poor communication thought to be a contributor. We previously reported increased Aboriginal interpreter uptake and decreased rates of self-discharge during implementation of a 12-month hospital-based intervention. Interrupted time-series analysis showed sudden increase and up-trending improvement in interpreter use, and a corresponding decrease in self-discharge rates, during a 12-month intervention period (April 2018—March 2019) compared with a 24-month baseline period (April 2016 –March 2018). This paper aims to investigate reasons for these outcomes and explore a potential causal association between study activities and outcomes. Methods The study was implemented at the tertiary referral hospital in northern Australia. We used the Template for Intervention Description and Replication (TIDieR) as a framework to describe intervention components according to what, how, where, when, how much, tailoring, modifications and reach. Components of the study intervention were: employment of an Aboriginal Interpreter Coordinator, ‘Working with Interpreters’ training for healthcare providers, and championing of interpreter use by doctors. We evaluated the relative importance of intervention components according to TIDieR descriptors in relation to outcomes. Activities independent of the study that may have affected study findings were reviewed. The relationship between proportion of hospital separations among Aboriginal people ending in self-discharge and numbers of Aboriginal interpreter bookings made during April 2016-March 2019 was tested using linear regression. ‘Working with Interpreters’ training sessions were undertaken at a regional hospital as well as the tertiary hospital. Training evaluation comprised an anonymous online survey before the training, immediately after and then at six to eight months. Survey data from the sites were pooled for analysis. Results Employment of the Aboriginal Interpreter Coordinator was deemed the most important component of the intervention, based on reach compared to the other components, and timing of the changes in outcomes in relation to the employment period of the coordinator. There was an inverse association between interpreter bookings and self-discharge rate among Aboriginal inpatients throughout the baseline and intervention period (p = 0.02). This association, the timing of changes and assessment of intercurrent activities at the hospital indicated that the study intervention was likely to be casually related to the measured outcomes. Conclusions Communication in healthcare can be improved through targeted strategies, with associated improvements in patient outcomes. Health services with high interpreter needs would benefit from employing an interpreter coordinator.

Impact of Ultraviolet Germicidal Irradiation for No-Touch Terminal Room Disinfection on Clostridium difficile Infection Incidence Among Hematology-Oncology Patients

2016 ◽  
Vol 38 (1) ◽  
pp. 39-44 ◽  
Author(s):  
David A. Pegues ◽  
Jennifer Han ◽  
Cheryl Gilmar ◽  
Brooke McDonnell ◽  
Steven Gaynes
Keyword(s):  
Patient Flow ◽  
Tertiary Care ◽  
Substantial Reduction ◽  
Baseline Period ◽  
Incidence Rates ◽  
Control Measures ◽  
Care Hospital ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
The Impact

OBJECTIVETo evaluate the impact of no-touch terminal room no-touch disinfection using ultraviolet wavelength C germicidal irradiation (UVGI) on C. difficile infection (CDI) rates on inpatient units with persistently high rates of CDI despite infection control measures.DESIGNInterrupted time-series analysis with a comparison arm.SETTING3 adult hematology-oncology units in a large, tertiary-care hospital.METHODSWe conducted a 12-month prospective valuation of UVGI. Rooms of patients with CDI or on contact precautions were targeted for UVGI upon discharge using an electronic patient flow system. Incidence rates of healthcare-onset CDI were compared for the baseline period (January 2013–December 2013) and intervention period (February 2014–January 2015) on study units and non–study units using a mixed-effects Poisson regression model with random effects for unit and time in months.RESULTSDuring a 52-week intervention period, UVGI was deployed for 542 of 2,569 of all patient discharges (21.1%) on the 3 study units. The CDI rate declined 25% on study units and increased 16% on non-study units during the intervention compared to the baseline period. We detected a significant association between UVGI and decrease in CDI incidence (incidence rate ratio [IRR], 0.49; 95% confidence interval [CI], 0.26–0.94; P=.03) on the study units but not on the non-study units. The impact of UVGI use on average room-cleaning time and turnaround time was negligible compared to the baseline period.CONCLUSIONSTargeted deployment of UVGI to rooms of high-risk patients at discharge resulted in a substantial reduction of CDI incidence without adversely impacting room turnaround.Infect Control Hosp Epidemiol 2016;1–6

Oxygen radicals participate in alloxan-induced pulmonary EDEMA

1990 ◽  
Vol 48 (3) ◽  
pp. 298-299
Author(s):  
Tomoo Kawada ◽  
Michio Arakawa ◽  
Kenjiro Kambara ◽  
Takashi Segawa ◽  
Fumio Ando ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
Oxygen Radicals ◽  
Bolus Injection ◽  
Physiological Saline ◽  
Baseline Period ◽  
Alveolar Epithelial Cells ◽  
Control Group ◽  
Intervention Period ◽  
Lung Water ◽  
Electron Microscopic

We know that alloxan causes increased-permeability pulmonary edema and that alloxan generates oxygen radicals (H2O2, O2−, ·OH) in blood. Therefore, we hypothesize that alloxan-generated oxygen radicals damage pulmonary capillary endothelial cells, and, possibly, alveolar epithelial cells as well. We examined whether oxygen radical scavengers, such as catalase or dimethylsulfoxide (DMSO), protected against alloxaninduced pulmonary edema.Five dogs in each following group were anesthetized: control group: physiological saline (20ml/kg/h); alloxan group: physiological saline + alloxan (75mg/kg) bolus injection at the beginning of the experiment; catalase group: physiological saline + catalase (150,000u/kg) bolus injection before injection of alloxan; DMSO group: physiological saline + DMSO (0.4mg/kg) bolus injection before alloxan. All dogs had 30-min baseline period and 3-h intervention period. Hemodynamics and circulating substances were measured at the specific points of time. At the end of intervention period, the dogs were killed and had the lungs removed for electron microscopic study and lung water measurement with direct destructive method.

scholarly journals 1214. Microbiological and Clinical Effectiveness of Pulsed-Xenon Ultraviolet Disinfection of the Patient Room in the ICU

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S436-S437
Author(s):  
Keita Morikane ◽  
Shoko Suzuki ◽  
Jun Yoshioka ◽  
Jun Yakuwa ◽  
Masaki Nakane
Keyword(s):  
Clinical Effectiveness ◽  
Healthcare Setting ◽  
Baseline Period ◽  
University Hospital ◽  
Intervention Period ◽  
Tertiary Referral Hospital ◽  
Contact Precautions ◽  
Healthcare Settings ◽  
Route Of Transmission ◽  
The Us

Abstract Background Contact precautions do not necessarily control transmission of MDROs as other route of transmission such as patient environment may be significant. No-touch environmental disinfection has been highlighted in the past several years to control transmission of MDROs. The effectiveness of portable Pulsed Xenon Ultraviolet (PX-UV) device has been examined and demonstrated in US healthcare settings. However, its effectiveness outside the US healthcare setting is seldom reported. Methods This study was conducted in the intensive care unit (ICU) of Yamagata University Hospital, a 637-bed tertiary referral hospital. The ICU has six rooms and beds. In the baseline period (August 2016 to January 2018), all rooms were manually cleaned after every patient transfer/discharge. In the intervention period (February 2018 to February 2019), PX-UV disinfection was added after the manual cleaning. In both periods, all patients were screened for MRSA and two drug-resistant Acinetobacter baumannii (2DRA) to detect acquisition of those pathogens in the ICU. For microbiological evaluation, surfaces were selected for sampling by contact plates before/after manual cleaning and after PX-UV. After overnight incubation, colonies on the plates were counted. Results The incidence of newly acquired MRSA declined over time (1.40 per 1,000 patient-days in the baseline period to 0.95 in the intervention period, relative risk (RR): 0.68, 95% confidence interval (CI): 0.12–3.70). The incidence of newly acquired 2DRA further declined (4.91 to 1.90, RR: 0.39, 95% CI: 0.13–1.18). Notably, no new acquisition of 2DRA was observed since August 2018 for more than 7 months, not only in the ICU but also throughout the hospital. The total count of colonies in the sampling of 140 sites after 17 patient discharges were 3,540 (before manual cleaning), 669 (after manual cleaning, before PX-UV) and 261 (after PX-UV). The percent reduction of microbiological burden by manual cleaning was 81%, but a further 61% reduction was achieved by PX-UV. Conclusion PX-UV is effective in further reducing the microbial burden even after through manual cleaning, which presumably led to termination of transmission of 2DRA in our hospital. The effectiveness of PX-UV in controlling MDROs in the non-US healthcare settings is suggested. Disclosures All authors: No reported disclosures.

scholarly journals The effectiveness of semantic intervention for word-finding difficulties in college-aged students (16–19 years) with persistent Language Disorder

2019 ◽  
Vol 4 ◽  
pp. 239694151987078 ◽  
Author(s):  
Lisa Campbell ◽  
Hilary Nicoll ◽  
Susan H Ebbels
Keyword(s):  
Language Disorder ◽  
Baseline Period ◽  
Equal Length ◽  
Age Group ◽  
Intervention Period ◽  
Speech And Language ◽  
Language Therapy ◽  
Baseline Design ◽  
Word Finding ◽  
College Aged Students

Background and aims Little evidence exists for the effectiveness of intervention for older adolescents and young adults with language disorders, particularly for those over 16 years. This study involves college-aged students aged 16–19 years with Language Disorder and Word-Finding Difficulties and investigates whether progress in word finding following 1:1 semantic intervention is greater than progress during a baseline period as measured by a standardised test. Methods Twenty-five college-aged students (20 males and 5 females) with Language Disorder and Word-Finding Difficulties (aged 16;4–18;4 years) participated in a single baseline design study comparing progress on the Test of Adolescent and Adult Word Finding during an intervention period with progress during a baseline period of equal length. Intervention was focused on semantics of different words from those in the Test of Adolescent and Adult Word Finding and was delivered 1:1 by the participants’ usual Speech and Language Therapist, 30 minutes per week, for eight weeks. Results The participants made significant progress in raw score on the Test of Adolescent and Adult Word Finding during both the baseline ( d = 1.4) and intervention ( d = 2.5) periods, but progress during the intervention period was significantly greater than during the baseline period ( d = 1.16). Individual data showed reliable change for five participants during the baseline period and for 20 participants during the intervention period. At the start of the study, all participants had standard scores below 85, but after intervention, 10/25 participants scored above 85. Conclusions Four hours of semantic intervention led to significantly greater gains on a standardised test of word finding than during a baseline period of equal length in 16–19 year olds with Language Disorder and Word-Finding Difficulties. The words in the standardised test had not been included in the intervention, indicating generalised gains. Implications This study shows that intervention (at least for Word-Finding Difficulties) can be effective for this older age group of college-aged students with Language Disorder and therefore the effectiveness of Speech and Language Therapy services for this age group in a wider range of areas of language should also be investigated.

scholarly journals 2041. Impact of an Infectious Disease Specialist-led Post-Prescription Carbapenem Intervention in a Large Japanese Tertiary Hospital: A Before–After Cohort Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S686-S687
Author(s):  
Takashi Matono ◽  
Moritsugu Uchida ◽  
Hidenobu Koga ◽  
Naoya Kanatani ◽  
Yoshimi Furuno ◽  
...  
Keyword(s):  
Infectious Disease ◽  
The United States ◽  
Baseline Period ◽  
Tertiary Hospital ◽  
Intervention Period ◽  
Protected Time ◽  
Innovative Solution ◽  
E Mail ◽  
Appropriate Antimicrobial Use

Abstract Background There are fewer board-certified infectious disease (ID) specialists in Japan (n = 1494) than in the United States (n = 8535); therefore, we have insufficient protected time for antimicrobial stewardship activities, and thus, there is a need for an innovative solution. Methods This study compared carbapenem consumption between a 24-month baseline period and a 12-month intervention period at the Iizuka Hospital with 1048 inpatient beds in Japan. During the intervention period, a board-certified ID specialist provided daily feedback to prescribers against prolonged carbapenem use (≥14 days) through conversations and medical records. Additionally, we reported through e-mail the weekly point prevalence surveillance data of the long-term carbapenem users for 7–13 and ≥14 days, which were aggregated by each department. Results We provided a total of 106 feedbacks regarding carbapenem use for ≥14 days during the intervention period. After the initiation of intervention, the trend of monthly carbapenem consumption changed (coefficient: −0.62; 95% CI: −1.15 to −0.087, P = 0.024), and its overall consumption has decreased (coefficient: −0.098; 95% CI: −0.16 to −0.039, P = 0.002, Figure 1) without a change in the in-hospital mortality (P = 0.53) as revealed by segmented regression analysis. Interestingly, the number of monthly carbapenem users, but not the duration of carbapenem use, significantly decreased (coefficient: −3.02; 95% CI: −4.63 to −1.42, P = 0.001, Figure 2). An annual estimated saving after the intervention was $82,266 with a cost reduction of 22%. Conclusion Our ID specialist-led daily intervention in carbapenem prescription and weekly feedback for long-term carbapenem use were effective in reducing this antibiotic’s consumption and consequently the number of carbapenem users. These feedbacks may be useful in changing the behavior of prescribers and promoting appropriate antimicrobial use even in resource-poor settings. Disclosures All authors: No reported disclosures.

Sensory Representation of Temperature in Mosquito Warm and Cold Cells

2005 ◽  
Vol 94 (1) ◽  
pp. 176-185 ◽  
Author(s):  
Ewald Gingl ◽  
Armin Hinterwirth ◽  
Harald Tichy
Keyword(s):  
Radiation Power ◽  
Discharge Rate ◽  
Radiant Heat ◽  
Cell Types ◽  
Sudden Increase ◽  
Change Analysis ◽  
Temperature Changes ◽  
Discharge Rates ◽  
Air Stream ◽  
Instantaneous Values

A pair of antagonistic thermoreceptive cells is associated with each of two peg-in-pit sensilla located on the antennal tip of Aedes aegypti. One, the warm cell, responds to rapid warming with a sudden increase in the rate of discharge. The other, a cold cell, responds to rapid cooling with a sudden increase in the discharge rate. When temperature changes are provided by oscillating changes in the convective heat contained in the stimulating air stream, the oscillating discharge rates of both cell types are in advance of the oscillations in temperature and slightly behind the oscillations in the rate of temperature change. Analysis of these phase relationships shows that both cell types respond not only to the actual temperature at particular instants in time (instantaneous temperature) but also to the rate with which temperature changes. Individual responses are therefore ambiguous and signal tendencies rather than precise instantaneous values. When the temperature oscillations are delivered by changes in radiation power, however, the oscillating discharge rates of the warm and cold cells are in step with the oscillations in temperature. Here, individual responses signal instantaneous values of temperature rather than tendencies. The power of radiant heat required to modulate the discharge rates is relatively high, suggesting that infrared radiation is not a significant cue in distant host location.

scholarly journals Evaluation of a complex intervention to improve primary care prescribing: a phase IV segmented regression interrupted time series analysis

2017 ◽  
Vol 67 (658) ◽  
pp. e352-e360 ◽  
Author(s):  
Sean MacBride-Stewart ◽  
Charis Marwick ◽  
Neil Houston ◽  
Iain Watt ◽  
Andrea Patton ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
High Risk ◽  
Older People ◽  
Secondary Analysis ◽  
Interrupted Time Series ◽  
Segmented Regression ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Primary Analysis

BackgroundIt is uncertain whether improvements in primary care high-risk prescribing seen in research trials can be realised in the real-world setting.AimTo evaluate the impact of a 1-year system-wide phase IV prescribing safety improvement initiative, which included education, feedback, support to identify patients to review, and small financial incentives.Design and settingAn interrupted time series analysis of targeted high-risk prescribing in all 56 general practices in NHS Forth Valley, Scotland, was performed. In 2013–2014, this focused on high-risk non-steroidal anti-inflammatory drugs (NSAIDs) in older people and NSAIDs with oral anticoagulants; in 2014–2015, it focused on antipsychotics in older people.MethodThe primary analysis used segmented regression analysis to estimate impact at the end of the intervention, and 12 months later. The secondary analysis used difference-in-difference methods to compare Forth Valley changes with those in NHS Greater Glasgow and Clyde (GGC).ResultsIn the primary analysis, downward trends for all three NSAID measures that were existent before the intervention statistically significantly steepened following implementation of the intervention. At the end of the intervention period, 1221 fewer patients than expected were prescribed a high-risk NSAID. In contrast, antipsychotic prescribing in older people increased slowly over time, with no intervention-associated change. In the secondary analysis, reductions at the end of the intervention period in all three NSAID measures were statistically significantly greater in NHS Forth Valley than in NHS GGC, but only significantly greater for two of these measures 12 months after the intervention finished.ConclusionThere were substantial and sustained reductions in the high-risk prescribing of NSAIDs, although with some waning of effect 12 months after the intervention ceased. The same intervention had no effect on antipsychotic prescribing in older people.

The effects of changing levels of arousal on the spontaneous activity of cortical neurones II. Relaxation and alarm

1976 ◽  
Vol 194 (1115) ◽  
pp. 239-251 ◽  
Keyword(s):  
Spontaneous Activity ◽  
Temporal Pattern ◽  
Discharge Rate ◽  
Geometric Standard Deviation ◽  
Sudden Increase ◽  
Lateral Cortex ◽  
Infrared Telescope ◽  
Modal Interval ◽  
Log Normal ◽  
Two Parameters

In a previous paper it has been shown that interval distributions derived from the activity of single cortical neurones can be described by log-normal curves. A cell’s temporal pattern of discharge can therefore be defined by the values of two parameters – a modal interval, and a geometric standard deviation (g. s. d.). It has also been shown that the values of both parameters change when an animal falls asleep. The modal interval becomes shorter, and the g. s. d. usually becomes larger. This paper deals with the effects of changes in arousal of animals which are awake; and, in particular, with the effects of the transition from relaxation to alarm. Single unit recordings have been made from neurones in the post-lateral and supra-sylvian gyri of unrestrained cats. In order to eliminate the direct effects of eye-movements, the experiments were carried out in complete darkness, and the animal was observed through an infrared telescope. Alarm was produced by the hiss of compressed air. An animal was said to be alarmed when he stood up abruptly and turned towards the source of the noise. Alarm produced a marked fall in the discharge frequency of those cells in post-lateral cortex which initially showed a low ( < 2 action potentials per second) rate of spontaneous activity. The discharge rate of the remaining neurones (whether in suprasylvian or post-lateral cortex) was unaffected by the sudden increase in arousal. But the temporal pattern of discharge of every cell was altered. The modal interval became longer when the animal was alarmed, and the g. s. d. usually became smaller. Such changes could have been predicted from a knowledge of the neural concomitants of the transition from sleep to wakefulness. These results suggest that the activity of all cortical neurones is affected by the level of arousal of the animal, and that this modulation takes the form of a continuum of possible modal intervals, and possible g.s.ds.

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