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Currently no national guidelines exist for the management of scabies outbreaks in residential or nursing care homes for the elderly in the United Kingdom. In this setting, diagnosis and treatment of scabies outbreaks is often delayed and optimal drug treatment, environmental control measures and even outcome measures are unclear. We undertook a systematic review to establish the efficacy of outbreak management interventions and determine evidence-based recommendations. Four electronic databases were searched for relevant studies, which were assessed using a quality assessment tool drawing on STROBE guidelines to describe the quality of observational data. Nineteen outbreak reports were identified, describing both drug treatment and environmental management measures. The quality of data was poor; none reported all outcome measures and only four described symptom relief measures. We were unable to make definitive evidence-based recommendations. We draw on the results to propose a framework for data collection in future observational studies of scabies outbreaks. While high-quality randomised controlled trials are needed to determine optimal drug treatment, evidence on environmental measures will need augmentation through other literature studies. The quality assessment tool designed is a useful resource for reporting of outcome measures including patient-reported measures in future outbreaks.
Space Infrared Telescope for Cosmology and Astrophysics (SPICA), the cryogenic infrared space telescope recently pre-selected for a ‘Phase A’ concept study as one of the three remaining candidates for European Space Agency (ESA's) fifth medium class (M5) mission, is foreseen to include a far-infrared polarimetric imager [SPICA-POL, now called B-fields with BOlometers and Polarizers (B-BOP)], which would offer a unique opportunity to resolve major issues in our understanding of the nearby, cold magnetised Universe. This paper presents an overview of the main science drivers for B-BOP, including high dynamic range polarimetric imaging of the cold interstellar medium (ISM) in both our Milky Way and nearby galaxies. Thanks to a cooled telescope, B-BOP will deliver wide-field 100–350
m images of linearly polarised dust emission in Stokes Q and U with a resolution, signal-to-noise ratio, and both intensity and spatial dynamic ranges comparable to those achieved by Herschel images of the cold ISM in total intensity (Stokes I). The B-BOP 200
m images will also have a factor
30 higher resolution than Planck polarisation data. This will make B-BOP a unique tool for characterising the statistical properties of the magnetised ISM and probing the role of magnetic fields in the formation and evolution of the interstellar web of dusty molecular filaments giving birth to most stars in our Galaxy. B-BOP will also be a powerful instrument for studying the magnetism of nearby galaxies and testing Galactic dynamo models, constraining the physics of dust grain alignment, informing the problem of the interaction of cosmic rays with molecular clouds, tracing magnetic fields in the inner layers of protoplanetary disks, and monitoring accretion bursts in embedded protostars.
In arguing that autistic people are socially motivated, Jaswal & Akhtar miss the opportunity to puncture the notion that social motivation is a prerequisite for humanity. Instead, we contend that some autistic people may indeed find social interactions to be unmotivating and that this doesn't have to be seen as a problem.
We examined the functions of mothers’ speech to infants during two tasks – book-sharing and bead-stringing – in low-income, ethnically diverse families. Mexican, Dominican, and African American mothers and their infants were video-recorded sharing wordless books and toy beads in the home when infants were aged 1;2 and 2;0. Mothers’ utterances were classified into seven categories (labels/descriptions, emotion/state language, attention directives, action directives, prohibitions, questions, and vocal elicitations) which were grouped into three broad language functions: referential language, regulatory language, and vocalization prompts. Mothers’ ethnicity, years of education, years living in the United States, and infant sex and age related to mothers’ language functions. Dominican and Mexican mothers were more likely to use regulatory language than were African American mothers, and African American mothers were more likely to use vocalization prompts than were Latina mothers. Vocalization prompts and referential language increased with mothers’ education and Latina mothers’ years living in the United States. Finally, mothers of boys used more regulatory language than did mothers of girls. Socio-cultural and developmental contexts shape the pragmatics of mothers’ language to infants.
The sound of words has been shown to relate to the meaning that the words denote, an effect that extends beyond morphological properties of the word. Studies of these sound-symbolic relations have described this iconicity in terms of individual phonemes, or alternatively due to acoustic properties (expressed in phonological features) relating to meaning. In this study, we investigated whether individual phonemes or phoneme features best accounted for iconicity effects. We tested 92 participants’ judgements about the appropriateness of 320 nonwords presented in written form, relating to 8 different semantic attributes. For all 8 attributes, individual phonemes fitted participants’ responses better than general phoneme features. These results challenge claims that sound-symbolic effects for visually presented words can access broad, cross-modal associations between sound and meaning, instead the results indicate the operation of individual phoneme to meaning relations. Whether similar effects are found for nonwords presented auditorially remains an open question.
Human Stampedes (HS) occur at religious mass gatherings. Religious events have a higher rate of morbidity and mortality than other events that experience HS. This study is a subset analysis of religious event HS data regarding the physics principles involved in HS, and the associated event morbidity and mortality.
To analyze reports of religious HS to determine the initiating physics principles and associated morbidity and mortality.
Thirty-four reports of religious HS were analyzed to find shared variables. Thirty-three (97.1%) were written media reports with photographic, drawn, or video documentation. 29 (85.3%) cited footage/photographs and 1 (2.9%) was not associated with visual evidence. Descriptive phrases associated with physics principles contributing to the onset of HS and morbidity data were extracted and analyzed to evaluate frequency before, during, and after events.
34 (39.1%) reports of HS found in the literature review were associated with religious HS. Of these, 83% were found to take place in an open space, and 82.3% were associated with population density changes. 82.3% of events were associated with architectural nozzles (small streets, alleys, etc). 100% were found to have loss of XY-axis motion and 89% reached an average velocity of zero. 100% had loss of proxemics and 91% had associated Z-axis displacement (falls). Minimum reported attendance for a religious HS was 3000. 100% of religious HS had reported mortality at the event and 56% with further associated morbidity.
HS are deadly events at religious mass gatherings. Religious events are often recurring, planned gatherings in specific geographic locations. They are frequently associated with an increase in population density, loss of proxemics and velocity, followed by Z-axis displacements, leading to injury and death. This is frequently due to architectural nozzles, which those organizing religious mass gatherings can predict and utilize to mitigate future events.
Introduction: Emergency hospital admissions are a growing concern for patients and health systems, globally. The objective of this study was to systematically review the evidence for diagnostic, medical, and surgical interventions that reduce emergency hospital admissions. Methods: We conducted a systematic review of systematic reviews by searching MEDLINE, PubMED, the Cochrane Database of Systematic Reviews, Google Scholar, and grey literature. Systematic reviews of any diagnostic, surgical, or medical interventions examining the effect on emergency hospital admissions among adults were included. The quality of reviews was assessed using AMSTAR and the quality of evidence was assessed using GRADE. The subsequent analysis was restricted to interventions with moderate or high-quality evidence only. Results: 13 051 titles and abstracts and 1 791 full-text articles were screened from which 42 systematic reviews were included. The reviews included an underlying evidence base of 215 randomized controlled trials with 135 282 patients. Of 20 unique diagnostic, medical, and surgical interventions identified, four had moderate (n = 4) or high (n = 0) quality evidence for significant reductions in hospital admissions in five patient populations. These were: cardiac resynchronization therapy for heart failure and atrial fibrillation, percutaneous aspiration for pneumothorax, early/routine coronary angiography for acute coronary syndrome (alone or comorbid with chronic kidney disease), and natriuretic peptide guided therapy for heart failure. Conclusion: We identified four interventions across five populations that when optimized, may lead to reductions in emergency hospital admissions. These finding can therefore help guide the development of quality indicators, standards, or practice guidelines.
Opioid overdose deaths in the United States are increasing. Time to restoration of ventilation is critical. Rapid bystander administration of opioid antidote (naloxone) is an effective interim response but is historically constrained by legal restrictions.
To review and contextualize development of legislation facilitating layperson administration of naloxone across the United States.
Publicly accessible databases (1,2) were searched for legislation relevant to naloxone administration between January 2001 and July 2017.
All 51 jurisdictions implemented naloxone access laws between 2001 and 2017; 45 of these between 2012 and 2017. Nationwide mortality from opioid overdose increased from 3.3 per 100,000 population in 2001 to 13.3 in 2016, 42, and 35 jurisdictions enacted laws giving prescribers immunity from criminal prosecution, civil liability, and professional sanctions, respectively. 36, 41, and 35 jurisdictions implemented laws allowing dispensers immunity in the same domains. 38 and 46 jurisdictions gave laypeople administering naloxone immunity from criminal and civil liability. Forty-seven jurisdictions implemented laws allowing prescription of naloxone to third parties. All jurisdictions except Nebraska allowed pharmacists to dispense naloxone without a patient-specific prescription. Fifteen jurisdictions removed criminal liability for possession of non-prescribed naloxone. The 10 states with highest average rates of opioid overdose-related mortality had not legislated in a higher number of domains compared to the 10 lowest states and the average of all jurisdictions (3.4 vs 2.9 vs 2.7, respectively).
Effective involvement of bystanders in early recognition and reversal of opioid overdose requires removal of legal deterrents to prescription, dispensing, distribution, and administration of naloxone. Jurisdictions have varied in degree and speed of creating this legal environment. Understanding the integration of legislation into epidemic response may inform the response to this and future public health crises.
An increasing body of genetic and imaging research shows that it is becoming possible to forecast the onset of major psychiatric disorders such as depression and schizophrenia before people become ill with ever improving accuracy. Practical issues such as the optimal combination of clinical and biological variables are being addressed, but the application of predictive algorithms to individuals or in routine clinical settings have yet to be tested. The development of predictive methods in mental health comes with substantial ethical questions, including whether people wish to know their level of risk, as well as individual and societal attitudes to the potential adverse effects of data sharing, early diagnosis and treatment, which so far have been largely ignored. Preliminary data suggests that at least some people think predictive research is valuable and would take part in such studies, and some would welcome knowing the results. Future initiatives should systematically assess opinions and attitudes in conjunction with scientific and technical advances.
Declaration of interest
In the past 3 years, S.M.L. has received personal fees from Otsuaka, Sunovion and Janssen, and research grant support from Janssen and Lundbeck. A.M.M. has received research support from the Sackler Trust, Eli Lilly and Janssen. S.M.L. is part of the PSYSCAN consortium.
Objectives: Fluency is a major problem for individuals with neurodevelopmental disorders, including fluency deficits for academic skills. The aim of this study was to determine neurocognitive predictors of academic fluency within and across domains of reading, writing, and math, in children and adults, with and without spina bifida. In addition to group differences, we expected some neurocognitive predictors (reaction time, inattention) to have similar effects for each academic fluency outcome, and others (dexterity, vocabulary, nonverbal reasoning) to have differential effects across outcomes. Methods: Neurocognitive predictors were reaction time, inattention, dexterity, vocabulary, and nonverbal reasoning; other factors included group (individuals with spina bifida, n=180; and without, n=81), age, and demographic and untimed academic content skill covariates. Univariate and multivariate regressions evaluated hypotheses. Results: Univariate regressions were significant and robust (R2=.78, .70, .73, for reading, writing, and math fluency, respectively), with consistent effects of covariates, age, reaction time, and vocabulary; group and group moderation showed small effect sizes (<2%). Multivariate contrasts showed differential prediction across academic fluency outcomes for reaction time and vocabulary. Conclusions: The novelty of the present work is determining neurocognitive predictors for an important outcome (academic fluency), within and across fluency domains, across population (spina bifida versus typical), over a large developmental span, in the context of well-known covariates. Results offer insight into similarities and differences regarding prediction of different domains of academic fluency, with implications for addressing academic weakness in spina bifida, and for evaluating similar questions in other neurodevelopmental disorders. (JINS, 2019, 25, 249–265)
Bininj Kunwok (BKw), a language spoken in Northern Australia, restricts the degree of anticipatory nasalization, as suggested by previous aerodynamic and acoustic analyses (Butcher 1999). The current study uses aerodynamic measurements of speech to investigate patterns of nasalization and nasal articulation in Bininj Kunwok to compare with Australian languages more generally. The role of nasal coarticulation in ensuring language compre-hensibility a key question in phonetics research today is explored. Nasal aerodynamics is measured in intervocalic, word-medial nasals in the speech of five female speakers of BKw and data are analyzed using Smoothing Spline Analysis of Variance (SSANOVA) and Functional Data Analysis averaging techniques. Results show that in a VNV sequence there is very little anticipatory vowel nasalization with no restriction on carryover nasalization for a following vowel. The maximum peak nasal flow is delayed until the oral release of a nasal for coronal articulations, indicating a delayed velum opening gesture. Patterns of anticipatory nasalization appears similar to nasal airflow in French non-nasalized vowels in oral vowel plus nasal environments (Delvaux et al. 2008). Findings show that Bininj Kunwok speakers use language specific strategies in order to limit anticipatory nasalization, enhancing place of articulation cues at a site of intonational prominence which also is also the location of the majority of place of articulation contrasts within the language. Patterns of airflow suggest enhancement and coarticulatory resistance in prosodically prominent VN and VNC sequences which we interpret as evidence of speakers maintaining a phonological contrast to enhance place of articulation cues.
In December 2010, a major storm erupted in Saturn’s northern hemisphere near 37° planetographic latitude. This rather surprising event, occurring at an unexpected latitude and time, is the sixth “Great White Spot” (GWS) storm observed over the last century and a half. Such GWS events are extraordinary, planetary-scale atmospheric phenomena that dramatically change the typically bland appearance of the planet. Occurring while the Cassini mission was on orbit at Saturn, the Great Storm of 2010–2011 was well suited for intense scrutiny by the suite of sophisticated instruments onboard the Cassini spacecraft as well by modern instrumentation on ground-based telescopes and onboard the Hubble Space Telescope. This GWS erupted on 5 December close to the peak of a westward jet and generated a major dynamical disturbance that affected the whole latitude band from 25° to 48°N. At the upper cloud level, following the rapid growth of the bright outbreak spot, a blunt aerodynamic-shaped head formed due to interaction of the spot with the westward zonal jet, with the winds reaching velocities of 160 m s−1 along the periphery of the arc. Eastward of the head, the disturbance progressed in the following months forming a turbulent wake or tail with growing vortices, one of them a major enduring anticyclone (called AV) with a size of ~11,000 km. Lightning events were prominent and detected as outbursts and flashes at the head and along the disturbance at both optical and radio wavelengths. The activity of the head ceased after about seven months when AV reached it, leaving the cloud structure and ambient winds perturbed. The tops of the optically dense clouds of the head reached the 300-mbar altitude level (~50 km below tropopause), where a mixture of ices was detected, including (1) a component of water ice lofted over 200 km altitude from its 10-bar condensation level, (2) ammonia ice as the predominant component and (3) a component that might be ammonium hydrogen sulfide ice. The energetics of the frequency and power of lightning, as well as the estimated power generated by the latent heat released in the water-based convection to create the observed dynamical three-dimensional flows, both indicate that the power released for much of the 7-month lifetime of the storm (~1017 Watts) was a significant fraction of Saturn’s total radiated power (~2.2 1017 W). A post-storm depletion of ammonia vapour was also measured in the upper troposphere. The effects of the storm propagated into the stratosphere, forming two warm air masses at the ~0.5- to 5-mbar pressure level altitude that later merged into a so-called “beacon” because of its 80 K temperature excess relative to its surroundings. Related to the stratospheric disturbance, hydrocarbon composition excesses were found, in particular for ethylene (C2H4), in the high stratosphere at the ~0.1- to 0.5-mbar altitude level. Numerical models of the storm dynamics explain the major observed features that essentially result from two processes: (1) a huge and sustained, moist, convective storm at the water clouds (altitude level 10–12 bar, or ~250–275 km below the tropopause) and (2) the interaction of the updraft columns with the ambient winds that generates the turbulent wake consisting of vortices and waves. Model simulations of the GWS require a low vertical shear of the zonal winds and low static stability across the weather layer where the disturbance develops. Its upward propagation into the stratosphere involves Rossby waves and their breaking and energy deposition to form the beacon and induce chemical changes.
The decades-long interval between storms is probably related to the insolation cycle and the long radiative time constant of Saturn’s atmosphere, and several theories for temporarily storing energy have been proposed.
This chapter reviews the state of our knowledge about Saturn’s polar atmosphere that has been revealed through Earth- and space-based observation as well as theoretical and numerical modeling. In particular, the Cassini mission to Saturn, which has been in orbit around the ringed planet since 2004, has revolutionized our understanding of the planet. The current review updates a previous review by Del Genio et al. (2009), written after Cassini’s primary mission phase that ended in 2008, by focusing on the north polar region of Saturn and comparing it to the southern high latitudes. Two prominent features in the northern high latitudes are the northern hexagon and the north polar vortex; we extensively review observational and theoretical investigations to date of both features. We also review the seasonal evolution of the polar regions using the observational data accumulated during the Cassini mission since 2004 (shortly after the northern winter solstice in 2002), through the equinox in 2009, and approaching the next solstice in 2017. We conclude the current review by listing unanswered questions and describing the observations of the polar regions planned for the Grand Finale phase of the Cassini mission between 2016 and 2017.
The longevity of Cassini’s exploration of Saturn’s atmosphere (a third of a Saturnian year) means that we have been able to track the seasonal evolution of atmospheric temperatures, chemistry and cloud opacity over almost every season, from solstice to solstice and from perihelion to aphelion. Cassini has built upon the decades-long ground-based record to observe seasonal shifts in atmospheric temperature, finding a thermal response that lags behind the seasonal insolation with a lag time that increases with depth into the atmosphere, in agreement with radiative climate models. Seasonal hemispheric contrasts are perturbed at smaller scales by atmospheric circulation, such as belt/zone dynamics, the equatorial oscillations and the polar vortices. Temperature asymmetries are largest in the middle stratosphere and become insignificant near the radiative-convective boundary. Cassini has also measured southern-summertime asymmetries in atmospheric composition, including ammonia (the key species forming the topmost clouds), phosphine and para-hydrogen (both disequilibrium species) in the upper troposphere; and hydrocarbons deriving from the UV photolysis of methane in the stratosphere (principally ethane and acetylene). These chemical asymmetries are now altering in subtle ways due to (i) the changing chemical efficiencies with temperature and insolation and (ii) vertical motions associated with large-scale overturning in response to the seasonal temperature contrasts. Similarly, hemispheric contrasts in tropospheric aerosol opacity and coloration that were identified during the earliest phases of Cassini’s exploration have now reversed, suggesting an intricate link between the clouds and the temperatures. Finally, comparisons of observations between Voyager and Cassini (both observing in early northern spring, one Saturn year apart) show tantalizing suggestions of non-seasonal variability. Disentangling the competing effects of radiative balance, chemistry and dynamics in shaping the seasonal evolution of Saturn’s temperatures, clouds and composition remains the key challenge for the next generation of observations and numerical simulations.