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The development and conceptual relationship of the constructs of threat appraisal (TA) and intolerance of uncertainty (IU) are explored in the context of anxiety disorders. A narrative review tracking the development of these constructs and their relationship is undertaken. There is some evidence to suggest that the interaction between the components of threat appraisal (probability × cost) may partially account for or provide a theoretical framework which explains presenting levels of anxiety. Furthermore, research suggested that IU is a construct which contributes to a broad range of anxiety disorders. It was concluded that distinctive cognitive biases linked with IU – such as interpreting ambiguous and uncertain (both positive and negative) information as highly concerning – suggests that IU is interpreted negatively independent of threat appraisal. These findings mean a number of issues remain unclear, including whether IU in anxiety-provoking situations is sufficient in itself – independent of threat appraisal – in eliciting high levels of anxiety. Additionally, it is unclear whether threat appraisal and IU act as independent constructs, or more in an interactive manner in anxiety. To achieve further clarity on these issues, methodological recommendations for future research are made.
Key learning aims
(1)To understand the conceptual foundations of TA and IU in the cognitive model of anxiety.
(2)To understand the empirical evidence supporting the role of both TA and IU in anxiety.
(3)To appreciate the potential relationship between these concepts in anxiety.
The changes in spectra and intensities of the streamwise component of turbulent velocity are calculated in the inflow of a turbine rotor. The flow is initially calculated in the limit when the turbulence is of small scale compared with the rotor diameter. Rapid distortion theory (RDT), Batchelor & Proudman (Q. J. Mech. Appl. Maths, vol. 7 (1), 1954, pp. 83–103) (BP), for small-scale turbulence is combined with the effect of the fluctuating potential flow field on the turbulence caused by the direct interaction of the incident turbulence with the rotor as a sheet of resistance. A second computation is then carried out for turbulence of larger length scale. The results of the calculations are compared with velocity measurements in the inflow of both a commercial wind turbine and a tidal turbine rotor.
Introduction: Although use of point of care ultrasound (PoCUS) protocols for patients with undifferentiated hypotension in the Emergency Department (ED) is widespread, our previously reported SHoC-ED study showed no clear survival or length of stay benefit for patients assessed with PoCUS. In this analysis, we examine if the use of PoCUS changed fluid administration and rates of other emergency interventions between patients with different shock types. The primary comparison was between cardiogenic and non-cardiogenic shock types. Methods: A post-hoc analysis was completed on the database from an RCT of 273 patients who presented to the ED with undifferentiated hypotension (SBP <100 or shock index > 1) and who had been randomized to receive standard care with or without PoCUS in 6 centres in Canada and South Africa. PoCUS-trained physicians performed scans after initial assessment. Shock categories and diagnoses recorded at 60 minutes after ED presentation, were used to allocate patients into subcategories of shock for analysis of treatment. We analyzed actual care delivered including initial IV fluid bolus volumes (mL), rates of inotrope use and major procedures. Standard statistical tests were employed. Sample size was powered at 0.80 (α:0.05) for a moderate difference. Results: Although there were expected differences in the mean fluid bolus volume between patients with non-cardiogenic and cardiogenic shock, there was no difference in fluid bolus volume between the control and PoCUS groups (non-cardiogenic control 1878 mL (95% CI 1550 – 2206 mL) vs. non-cardiogenic PoCUS 1687 mL (1458 – 1916 mL); and cardiogenic control 768 mL (194 – 1341 mL) vs. cardiogenic PoCUS 981 mL (341 – 1620 mL). Likewise there were no differences in rates of inotrope administration, or major procedures for any of the subcategories of shock between the control group and PoCUS group patients. The most common subcategory of shock was distributive. Conclusion: Despite differences in care delivered by subcategory of shock, we did not find any significant difference in actual care delivered between patients who were examined using PoCUS and those who were not. This may help to explain the previously reported lack of outcome difference between groups.
Introduction: Point of care ultrasound has been reported to improve diagnosis in non-traumatic hypotensive ED patients. We compared diagnostic performance of physicians with and without PoCUS in undifferentiated hypotensive patients as part of an international prospective randomized controlled study. The primary outcome was diagnostic performance of PoCUS for cardiogenic vs. non-cardiogenic shock. Methods: SHoC-ED recruited hypotensive patients (SBP < 100 mmHg or shock index > 1) in 6 centres in Canada and South Africa. We describe previously unreported secondary outcomes relating to diagnostic accuracy. Patients were randomized to standard clinical assessment (No PoCUS) or PoCUS groups. PoCUS-trained physicians performed scans after initial assessment. Demographics, clinical details and findings were collected prospectively. Initial and secondary diagnoses including shock category were recorded at 0 and 60 minutes. Final diagnosis was determined by independent blinded chart review. Standard statistical tests were employed. Sample size was powered at 0.80 (α:0.05) for a moderate difference. Results: 273 patients were enrolled with follow-up for primary outcome completed for 270. Baseline demographics and perceived category of shock were similar between groups. 11% of patients were determined to have cardiogenic shock. PoCUS had a sensitivity of 80.0% (95% CI 54.8 to 93.0%), specificity 95.5% (90.0 to 98.1%), LR+ve 17.9 (7.34 to 43.8), LR-ve 0.21 (0.08 to 0.58), Diagnostic OR 85.6 (18.2 to 403.6) and accuracy 93.7% (88.0 to 97.2%) for cardiogenic shock. Standard assessment without PoCUS had a sensitivity of 91.7% (64.6 to 98.5%), specificity 93.8% (87.8 to 97.0%), LR+ve 14.8 (7.1 to 30.9), LR- of 0.09 (0.01 to 0.58), Diagnostic OR 166.6 (18.7 to 1481) and accuracy of 93.6% (87.8 to 97.2%). There was no significant difference in sensitivity (-11.7% (-37.8 to 18.3%)) or specificity (1.73% (-4.67 to 8.29%)). Diagnostic performance was also similar between other shock subcategories. Conclusion: As reported in other studies, PoCUS based assessment performed well diagnostically in undifferentiated hypotensive patients, especially as a rule-in test. However performance was similar to standard (non-PoCUS) assessment, which was excellent in this study.
Perceptual dimensions underlying timbre and sound-source identification have received considerable scientific attention. While these scholarly insights help us in understanding the nature of sound within a multidimensional timbral space, they carry little meaning for the majority of musicians. To help address this, we conducted two experiments to establish listeners’ perceptual thresholds (PT) for changes in sound using a staircase-procedure. Unlike most timbre perception research, these changes were sonic manipulations that are common in synthesisers, audio processors and instruments familiar to musicians and producers, and occurred within continuous sounds (rather than between discrete pairs of sounds). In experiment 1, two sounds (variants of a sawtooth oscillation) both with the same fundamental frequency (F1: 80 Hz, 240 Hz or 600 Hz) were played with no intervening gap. In each trial, the two sounds’ partials differed in amplitudes or frequencies to produce a timbre change. The sonic manipulations were varied in size to detect thresholds for the perceived timbre change – listeners were instructed to indicate whether or not they perceived a change within the sound. In experiment 2, we modified stimulus presentation to introduce the factor of transition time (TT). Rather than occurring instantaneously (as in experiment 1), the timbre manipulations were introduced gradually over the course of a 100 ms or a 1000 ms TT. Results revealed that PTs were significantly affected by the manipulations in experiment 1, and additionally by TT in experiment 2. Importantly, the data revealed an interaction between the F1 and the timbre manipulations, such that there were differential effects of timbre changes on the perceptual system depending on pitch height. Musicians (n=11) showed significantly smaller PTs compared to non-musicians (n=10). However, PTs for musicians and non-musicians were highly correlated (r=.83) across different sonic manipulations, indicating similar perceptual patterns in both. We hope that by establishing PTs for commonly used timbre manipulations, we can provide musicians with a general perceptual unit, for each manipulation, that can guide music composition and assessment.
Towards a comprehensive revision of Gesneriaceae in Sri Lanka, 12 names are here typified, of which 11 are lectotypifications, including one second-step lectotypification, and the other is a neotypification.
The second year of life is a period of nutritional vulnerability. We aimed to investigate the dietary patterns and nutrient intakes from 1 to 2 years of age during the 12-month follow-up period of the Growing Up Milk – Lite (GUMLi) trial. The GUMLi trial was a multi-centre, double-blinded, randomised controlled trial of 160 healthy 1-year-old children in Auckland, New Zealand and Brisbane, Australia. Dietary intakes were collected at baseline, 3, 6, 9 and 12 months post-randomisation, using a validated FFQ. Dietary patterns were identified using principal component analysis of the frequency of food item consumption per d. The effect of the intervention on dietary patterns and intake of eleven nutrients over the duration of the trial were investigated using random effects mixed models. A total of three dietary patterns were identified at baseline: ‘junk/snack foods’, ‘healthy/guideline foods’ and ‘breast milk/formula’. A significant group difference was observed in ‘breast milk/formula’ dietary pattern z scores at 12 months post-randomisation, where those in the GUMLi group loaded more positively on this pattern, suggesting more frequent consumption of breast milk. No difference was seen in the other two dietary patterns. Significant intervention effects were seen on nutrient intake between the GUMLi (intervention) and cows’ milk (control) groups, with lower protein and vitamin B12, and higher Fe, vitamin D, vitamin C and Zn intake in the GUMLi (intervention) group. The consumption of GUMLi did not affect dietary patterns, however, GUMLi participants had lower protein intake and higher Fe, vitamins D and C and Zn intake at 2 years of age.
This study reports the fabrication of high mass loading (32 mg/cm2) electrodes of niobium pentoxide (Nb2O5) nanoparticles and carbon nanotubes (CNTs) using a facile procedure. The as-obtained Nb2O5 nanoparticles by microwave-assisted hydrothermal synthesis presented pseudohexagonal (TT) phase, and when exposed to the thermal treatment, the Nb2O5 nanoparticles changed to orthorhombic (T) phase. Distinct morphologies were obtained, which exhibited a specific surface area of 216 m2/g and 47 m2/g to pseudohexagonal and orthorhombic phases, respectively. Cyclic voltammetry and electrochemical impedance spectroscopy techniques were performed in a three-electrode system using 1 M Li2SO4 as electrolyte with a potential window of 0–0.9 V (versus standard calomel electrode). Both materials showed capacitive behavior with a specific capacitance of 0.11 F/cm2 and 0.09 F/cm2 to nanocomposites CNT + TT-Nb2O5 and CNT + T-Nb2O5 at 2 mV/s, respectively. Thus, an efficient, simple, and promising process to produce electrodes for supercapacitors was demonstrated.
In experimental and clinical studies, green or black tea consumption has been shown to reduce oxidative stress. However, these studies involved high levels of tea consumption and may not reflect patterns in the general population. Here, we examined the association between black or green tea consumption and oxidative stress in a cross-sectional study of 889 premenopausal US women aged 35–54 years. Tea consumption was measured using the Block-98 FFQ. Urinary 8-iso-PGF2α (F2-IsoP) and 2,3-dinor-5,6-dihydro-15-F2t-isoprostane (15-F2t-IsoP-M) were used as biomarkers of oxidative stress. These compounds were measured by MS and normalised to creatinine. Linear regression was used to calculate the geometric mean differences (GMD) and 95% CI for log-transformed urinary F2-IsoP or 15-F2t-IsoP-M in relation to black or green tea consumption. We further examined whether adjusting for caffeine impacted associations between tea and oxidative stress. Geometric means of urinary F2-IsoP and 15-F2t-IsoP-M were 1·44 (95% CI 1·39, 1·49) and 0·71 (95% CI 0·69, 0·73) ng/mg creatinine, respectively. Overall, green tea consumption was not associated with urinary F2-IsoP or 15-F2t-IsoP-M. High-level black tea consumption (≥5 cups/week compared with 0) was associated with higher 15-F2t-IsoP-M concentrations (adjusted GMD=0·10, 95 % CI 0·02–0.19) but not F2-IsoP. Adjusting for caffeine nullified the association between black tea and 15-F2t-IsoP-M. Our findings do not support the hypothesis that dietary tea consumption is inversely associated with oxidative stress.
This study will evaluate radiation medicine professionals’ perceptions of clinical and professional risks and benefits, and the evolving roles and responsibilities with artificial intelligence (AI).
Radiation oncologists (ROs), medical physicists (MPs), treatment planners (TP-RTTs) and treatment delivery radiation therapists (TD-RTTs) at a cancer centre in preliminary stages of implementing an AI-enabled treatment planning system were invited to participate in uniprofessional focus groups. Semi-structured scripts addressed the perceptions of AI, including thoughts regarding changing roles and competencies. Sessions were audiorecorded, transcribed and coded thematically through consensus-building.
A total of 24 participants (four ROs, five MPs, seven TP-RTTs and eight TD-RTTs) were engaged in four focus groups of 58 minutes average duration (range 54–61 minutes). Emergent themes addressed AI’s impact on quality of care, changing professional tasks and changing competency requirements. Time-consuming repetitive tasks such as delineating targets, generating treatment plans and quality assurance were thought conducive to offloading to AI. Outcomes data and adaptive planning would be incorporated into clinical decision-making. Changing workload would necessitate changing skills, prioritising plan evaluation over generation and increasing interprofessional communication. All groups discussed AI reducing the need for TP-RTTs, though displacement was thought more likely than replacement.
It is important to consider how professionals perceive AI to be proactive in informing change, as gains in quality and efficiency will require new workflows, skills and education.
Hip fracture rehabilitation has two streams: high tolerance short duration (HTSD) and low tolerance long duration (LTLD). This study examined patient characteristics and outcomes in HTSD and LTLD associated with length of stay (LOS) and discharge destination. We retrospectively examined patients’ medical charts following hip fracture surgery and collected demographic, functional, and health characteristics. A statistical analysis was done to describe the differences between HTSD (n = 73) and LTLD (n = 57) patient characteristics and their relationship with LOS and discharge destination. Those in LTLD were significantly older, less independent with prefracture bathing and instrumental activities of daily living, had lower Functional Independence Measure (FIM) admission scores, and more co-morbidities. Higher FIM motor score on admission in HTSD and greater change in FIM total score in LTLD was significantly correlated with discharge home. Diabetes in LTLD and lower total admission FIM in HTSD was significantly associated with increased LOS.
Recent developments have led the UK government to deem clinical supervision ‘essential’ to a safe and effective national health service. Cognitive behavioural therapy (CBT) supervision has been increasingly operationalized and manualized, but there are few psychometrically sound observational instruments with which to measure CBT supervision. This paper reports the factor analysis of a promising 23-item instrument for observing competence in CBT supervision (Supervision: Adherence and Guidance Evaluation: SAGE). N =115 qualified mental health practitioners (supervisors and their supervisees) rated the same supervision session by completing SAGE. A principal components analysis indicated that a two-factor solution, identified as the ‘Supervision Cycle’ and the ‘Supervisee Cycle’ components, accounted for 52.8% of the scale variance and also demonstrated high internal reliability (α = .91 and α = .81, respectively). These findings provide the basis for a shorter, 14-item version of SAGE, clarify the factor structure of SAGE, ease implementation, and afford more succinct feedback. Short-SAGE also improves implementation yield, taking half the time to complete as the original 23-item scale. These conceptual and practical improvements strengthen the role of SAGE as a promising observational instrument for evaluating CBT supervision, complementing self-report assessments of competent CBT supervision with an instrument that can fulfil the distinctive functions that are provided through direct observation.
Introduction: Patients with chronic diseases are known to benefit from exercise. Such patients often visit the emergency department (ED). There are few studies examining prescribing exercise in the ED. We wished to study if exercise prescription in the ED is feasible and effective. Methods: In this pilot prospective block randomized trial, patients in the control group received routine care, whereas the intervention group received a combined written and verbal prescription for moderate exercise (150 minutes/week). Both groups were followed up by phone at 2 months. The primary outcome was achieving 150 min of exercise per week. Secondary outcomes included change in exercise, and differences in reported median weekly exercise. Comparisons were made by Mann-Whitney and Fishers tests (GraphPad). Results: Follow-up was completed for 22 patients (11 Control; 11 Intervention). Baseline reported median (with IQR) weekly exercise was similar between groups; Control 0(0-0)min; Intervention 0(0-45)min. There was no difference between groups for the primary outcome of 150 min/week at 2 months (Control 3/11; Intervention 4/11, RR 1.33 (95%CI 0.38-4.6;p=1.0). There was a significant increase in median exercise from baseline in both groups, but no difference between the groups (Control 75(10-225)min; Intervention 120(52.5-150)min;NS). 3 control patients actually received exercise prescription as part of routine care. A post-hoc comparison of patients receiving intervention vs. no intervention, revealed an increase in patients meeting the primary target of 150min/week (No intervention 0/8; Intervention 7/14, RR 2.0 (95%CI 1.2-3.4);p=0.023). Conclusion: Recruitment was feasible, however our study was underpowered to quantify an estimated effect size. As a significant proportion of the control group received the intervention (as part of standard care), any potential measurable effect was diluted. The improvement seen in patients receiving intervention and the increase in reported exercise in both groups (possible Hawthorne effect) suggests that exercise prescription for ED patients may be beneficial.
Current knowledge of the potential nutrient supply that can be derived from indigenous and sown pasture is described and related to classically derived nutrient requirements. From this information, nutrient deficits can be identified for specific times in the ewe's cycle of production. Whilst nutrient deficits have been clearly identified in late pregnancy and early lactation, responses to nutrients and nutrient supply from autumn pasture have not yet been adequately described for the ewe over the mating period.
Nutrient deficits can be met by a combination of tissue catabolism and the provision of supplementary feeding. The dearth of knowledge of the factors influencing tissue catabolism and of the effects of supplementary feeding on herbage intake limits quantification of the amount and type of supplementary feeding to offer.
The principles concerning supplementary feeding in late pregnancy in some circumstances still require elucidation because of the interactions between mid- and late-pregnancy nutrition and this will be illustrated with reference to sheep grazing a predominantly heather hill. However, the principles governing supplementary feeding in early lactation are relatively well understood in relation to sown pastures below 4 cm in sward surface height and these are outlined. Information on the relative importance of milk and herbage in the diet of the lamb to weaning is discussed. The dependence of one part of the annual cycle on the nutrition in other parts of the cycle is stressed.
To test the hypothesis that more frequent consumption of sugar-sweetened soft drinks would be associated with increased risk of obesity-related cancers. Associations for artificially sweetened soft drinks were assessed for comparison.
Prospective cohort study with cancers identified by linkage to cancer registries. At baseline, participants completed a 121-item FFQ including separate questions about the number of times in the past year they had consumed sugar-sweetened or artificially sweetened soft drinks. Anthropometric measurements, including waist circumference, were taken and questions about smoking, leisure-time physical activity and intake of alcoholic beverages were completed.
The Melbourne Collaborative Cohort Study (MCCS) is a prospective cohort study which recruited 41 514 men and women aged 40–69 years between 1990 and 1994. A second wave of data collection occurred in 2003–2007.
Data for 35 593 participants who developed 3283 incident obesity-related cancers were included in the main analysis.
Increasing frequency of consumption of both sugar-sweetened and artificially sweetened soft drinks was associated with greater waist circumference at baseline. For sugar-sweetened soft drinks, the hazard ratio (HR) for obesity-related cancers increased as frequency of consumption increased (HR for consumption >1/d v. <1/month=1·18; 95 % CI 0·97, 1·45; P-trend=0·007). For artificially sweetened soft drinks, the HR for obesity-related cancers was not associated with consumption (HR for consumption >1/d v. <1/month=1·00; 95 % CI 0·79, 1·27; P-trend=0·61).
Our results add to the justification to minimise intake of sugar-sweetened soft drinks.
Metallic silver nanoparticles were synthesized using a hydrothermal route for use in high throughput biosensing applications. Particle shape was engineered by varying polyvinyl pyrollidone (PVP) concentration in the precursor mixture, resulting in the emergence of flat triangular shaped nanoparticles with increasing PVP content. The hydrothermal method was found to yield particles with better particle size distribution and longer shelf life relative to polyol synthesis particles.
Students, young and old, find the existence of extraterrestrial life one of the most intriguing of all science topics. The theme of searching for life in the universe lends itself naturally to the integration of many scientific disciplines for thematic science education. Based upon the search for extraterrestrial intelligence (SETI), the Life in the Universe (LITU) curriculum project at the SETI Institute developed a series of six teachers guides, with ancillary materials, for use in elementary and middle school classrooms, grades 3 through 9. Lessons address topics such as the formation of planetary systems, the origin and nature of life, the rise of intelligence and culture, spectroscopy, scales of distance and size, communication and the search for extraterrestrial intelligence. Each guide is structured to present a challenge as the students work through the lessons. The six LITU teachers guides may be used individually or as a multi-grade curriculum for a school.