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Immersion of patients in a body bag filled with ice and water is recommended as prehospital management of severe hyperthermia. Experienced paramedics have raised a number of concerns about the use of this technique; particularly, whether cardiac monitoring equipment would remain functional once immersed. This test showed that monitoring equipment does remain functional and provides advice about safety considerations. The test should reassure practitioners that such an approach is feasible.
Extending previous research that has examined the relationship between long-term memory and second language (L2) development with a primary focus on accuracy in L2 outcomes, the current study explores the relationship between declarative and procedural memory and accuracy and automatization during L2 practice. Adult English native speakers had learned an artificial language over two weeks (Morgan-Short, Faretta-Stutenberg, Brill-Schuetz, Carpenter & Wong, 2014), producing four sessions of practice data that had not been analyzed previously. Mixed-effects models analyses revealed that declarative memory was positively related to accuracy during comprehension practice. No other relationships were evidenced for accuracy. For automatization, measured by the coefficient of variation (Segalowitz, 2010), the model revealed a positive relationship with procedural memory that became stronger over practice for learners with higher declarative memory but weaker for learners with lower declarative memory. These results provide further insight into the role that long-term memory plays during L2 development.
This article discusses annotations to some eighty surviving copies of William Caxton's “Golden Legend.” It assesses reactions from male and female readers across the religious spectrum, exploring the varied ways in which early modern readers engaged with a book that quickly became—and has remained—a shorthand for medieval religion. It seeks to contribute to the history of the “Legend” itself, to historical understanding of annotation, and to the history of reading during the Reformation.
We conducted a survey in the major row-crop production regions of Texas to determine the response of waterhemp to glyphosate (5-enolpyruvylshikimate-3-phosphate synthase [EPSPS] inhibitor), atrazine (photosystem II [PSII] inhibitor), pyrithiobac (acetolactate synthase [ALS] inhibitor), tembotrione (hydroxyphenylpyruvate dioxygenase [HPPD] inhibitor), fomesafen (protoporphyrinogen oxidase [PPO] inhibitor), and dicamba (synthetic auxin). We evaluated 127 accessions for these herbicides. Resistance was confirmed on the basis of plant survival within an accession, and the injury ratings of surviving plants were used to categorize each accession as resistant (<50% injury) or less sensitive (50% to 89% injury). For glyphosate, approximately 27% of all tested accessions were resistant and 20% were less sensitive. The Gulf Coast region had the most glyphosate-resistant accessions (46% of the accessions from this region), followed by the Blacklands region (9%). A dose-response assay of the most resistant waterhemp accession (TX-25) exhibited 17-fold resistance to glyphosate when compared with a susceptible standard. Waterhemp resistance to atrazine also was common in the Gulf Coast region. The accession with the greatest atrazine resistance (TX-31) exhibited 47- and 68-fold resistance to this herbicide when applied POST and PRE, respectively. Widespread resistance to pyrithiobac was observed in waterhemp accessions throughout the Blacklands and Gulf Coast regions. The most resistant accession identified in this study was 61-fold resistant compared with a susceptible standard. No high-level resistance was detected for tembotrione, dicamba, or fomesafen, but high variability in sensitivity to tembotrione and dicamba was observed. One waterhemp accession exhibited reduced sensitivity to fomesafen; the rest were sensitive. Overall, at least two accessions exhibited resistance or reduced sensitivity to herbicides with five different sites of action. The study illustrates the prevalence of multiple herbicide resistance in waterhemp accessions in Texas and emphasizes the need to implement diversified management tactics.
Risk prediction algorithms have long been used in health research and practice (e.g. prediction of cardiovascular disease and diabetes). However, similar tools have not been developed for mental health. For example, for psychotic disorders, attempts to sum environmental risk are rare, unsystematic and dictated by available data. In light of this, we sought to develop a valid, easy to use measure of the aggregate environmental risk score (ERS) for psychotic disorders.
We reviewed the literature to identify well-replicated and validated environmental risk factors for psychosis that combine a significant effect and large-enough prevalence. Pooled estimates of relative risks were taken from the largest available meta-analyses. We devised a method of scoring the level of exposure to each risk factor to estimate ERS. Relative risks were rounded as, due to the heterogeneity of the original studies, risk effects are imprecisely measured.
Six risk factors (ethnic minority status, urbanicity, high paternal age, obstetric complications, cannabis use and childhood adversity) were used to generate the ERS. A distribution for different levels of risk based on simulated data showed that most of the population would be at low/moderate risk with a small minority at increased environmental risk for psychosis.
This is the first systematic approach to develop an aggregate measure of environmental risk for psychoses in asymptomatic individuals. This can be used as a continuous measure of liability to disease; mostly relevant to areas where the original studies took place. Its predictive ability will improve with the collection of additional, population-specific data.
Cardiac catheterisation in patients on extracorporeal membrane oxygenation (ECMO) may reveal new information leading to modification of a therapeutic plan and correction of newly recognised or residual lesions. Complications associated with cardiac catheterisation during ECMO are not uncommon and often related to the access site. We report a straightforward technique for accessing the ECMO circuit to perform an emergent cardiac catheterisation in two patients with hypoplastic left heart syndrome decompensated after Norwood I, due to presumed systemic-to-pulmonary artery shunt obstruction.
The almost universally-occurring aggregated distributions of helminth burdens in host populations have major significance for parasite population ecology and evolutionary biology, but the mechanisms generating heterogeneity remain poorly understood. For the direct life cycle monogenean Discocotyle sagittata infecting rainbow trout, Oncorhynchus mykiss, variables potentially influencing aggregation can be analysed individually. This study was based at a fish farm where every host individual becomes infected by D. sagittata during each annual transmission period. Worm burdens were examined in one trout population maintained in isolation for 9 years, exposed to self-contained transmission. After this year-on-year recruitment, prevalence was 100% with intensities 10–2628, mean 576, worms per host. Parasite distribution, amongst hosts with the same age and environmental experience, was highly aggregated with variance to mean ratio 834 and negative binomial parameter, k, 0.64. The most heavily infected 20% of fish carried around 80% of the total adult parasite population. Aggregation develops within the first weeks post-infection; hosts typically carried intensities of successive age-specific cohorts that were consistent for that individual, such that heavily-infected individuals carried high numbers of all parasite age classes. Results suggest that host factors alone, operating post-infection, are sufficient to generate strongly overdispersed parasite distributions, rather than heterogeneity in exposure and initial invasion.
This study analyses the interplay between classical acoustic modes and intrinsic thermoacoustic (ITA) modes in a simple thermoacoustic system. The analysis is performed using a frequency-domain low-order network model as well as a time-domain spatially discretised model. Anti-correlated modal sensitivities are found to arise due to a pairwise interplay between acoustic and ITA modes. The magnitude of the sensitivities increases as the interplay between the modes grows stronger. The results show a global behaviour of the modes linked to the presence of exceptional points in the spectrum. The time-domain analysis results in a delay-differential equation and allows the investigation of non-normal behaviour and its consequences. Pseudospectral analysis reveals that energy amplification is crucially linked to an interplay between acoustic and ITA modes. While higher non-orthogonality between two modes is correlated with peaks in modal sensitivity, transient energy growth does not necessarily involve the most sensitive modes. In particular, growth estimates based on the Kreiss constant demonstrate that transient amplification relies critically on the proximity of the non-normal modes to the imaginary axis. The time scale for transient amplification is identified as the flame time delay, which is further corroborated by determining the optimal initial conditions responsible for the bulk of the non-modal energy growth. The flame is identified as an active and dominant contributor to energy gain. The frequency of the optimal perturbation matches the acoustic time scale, once more confirming an interplay between acoustic and ITA structures. Flame-based amplification factors of two to five are found, which are significant when feeding into the acoustic dynamics and eventually triggering nonlinear limit-cycle behaviour.
The spread of the Zika virus (ZIKV) in the Americas led to large outbreaks across the region and most of the Southern hemisphere. Of greatest concern were complications following acute infection during pregnancy. At the beginning of the outbreak, the risk to unborn babies and their clinical presentation was unclear. This report describes the methods and results of the UK surveillance response to assess the risk of ZIKV to children born to returning travellers. Established surveillance systems operating within the UK – the paediatric and obstetric surveillance units for rare diseases, and national laboratory monitoring – enabled rapid assessment of this emerging public health threat. A combined total of 11 women experiencing adverse pregnancy outcomes after possible ZIKV exposure were reported by the three surveillance systems; five miscarriages, two intrauterine deaths and four children with clinical presentations potentially associated with ZIKV infection. Sixteen women were diagnosed with ZIKV during pregnancy in the UK. Amongst the offspring of these women, there was unequivocal laboratory evidence of infection in only one child. In the UK, the number and risk of congenital ZIKV infection for travellers returning from ZIKV-affected countries is very small.
Field trials were conducted near Lubbock, TX, in 2013, 2014, and 2015 to evaluate non–2,4-D–resistant cotton response to low rates of glyphosate plus 2,4-D choline. Cotton was treated with five rates of glyphosate plus 2,4-D choline (0.0183, 0.183, 1.83, 18.3, and 183 g ae ha−1) at two application timings (nine leaf and first bloom). These rates correspond to contamination rates of 0.0008%, 0.008%, 0.08%, 0.8%, and 8%, respectively. Visual cotton injury, boll retention, lint yield, and fiber properties were recorded. When averaged over contamination rates, visual injury after applications made to nine-leaf cotton was greater than for first-bloom cotton in three of 3 yr and yield loss was greater when applications were made to nine-leaf cotton when compared with first-bloom cotton in two of 3 yr. Averaged over application timing, lint yield in 2013, 2014, and 2015 after glyphosate plus 2,4-D choline contamination rates of 0.0008% and 0.008% were not different than that of the nontreated control, whereas contamination rates of 0.08%, 0.8%, and 8% decreased yield by 3% to 20%, 45% to 58%, and 80% to 96%, respectively. Contamination rates of 0.0008%, 0.008%, 0.08%, and 0.8% rarely affected fiber quality; however, a contamination rate of 8% frequently decreased micronaire, fiber length, fiber length uniformity, and fiber strength. This decrease in fiber quality also resulted in a reduction in cotton loan value and potential financial return. Although decreases in fiber quality parameters were not observed with the 0.8% contamination rate, significant reductions in financial return occurred due to yield loss caused by injury from glyphosate plus 2,4-D choline.
Refugees are confronted with the task of adapting to the long-term erosion of psychosocial systems and institutions that in stable societies support psychological well-being and mental health. We provide an overview of the theoretical principles and practical steps taken to develop a novel psychotherapeutic approach, Integrative Adapt Therapy (IAT), which aims to assist refugees to adapt to these changes. This paper offers the background informing ongoing trials of IAT amongst refugees from Myanmar.
A systematic process was followed in formulating the therapy and devising a treatment manual consistent with the principles of the Adaptation and Development After Persecution and Trauma (ADAPT) model. The process of development and refinement was based on qualitative research amongst 70 refugees (ten from West Papua and 60 Rohingya from Myanmar). The therapeutic process was then piloted by trained interventionists amongst a purposively selected sample of 20 Rohingya refugees in Malaysia.
The final formulation of IAT represented an integration of the principles of the ADAPT model and evidence-based techniques of modern therapies in the field, including a transdiagnostic approach and the selective use of cognitive behavioural treatment elements such as problem-solving and emotional regulation techniques. The steps outlined in refining the manual are outlined in relation to work amongst West Papuan refugees, and the process of cultural and contextual modifications described during early piloting with Rohingya refugees in Malaysia.
IAT integrates universal principles of the ADAPT model with the particularities of the culture, history of conflict and living context of each refugee community; this synthesis of knowledge forms the basis for participants gaining insights into their personal patterns of psychosocial adaptation to the refugee experience. Participants then apply evidence-based techniques to improve their capacity to adapt to the serial psychosocial changes they have encountered in their lives as refugees. The overarching goal of IAT is to provide refugees with a coherent framework that assists in making sense of their experiences and their emotional and interpersonal reactions to the challenges they confront within the family and community context. As such, the principles of a general model (ADAPT) are used as a springboard for making concrete, manageable and meaningful life changes at the individual level, a potentially novel approach for psychosocial interventions in the field.
The prevalence of common mental disorders has not declined in high-income countries despite substantial increases in service provision. A possible reason for this lack of improvement is that greater willingness to disclose mental disorders might have led to increased reporting of psychiatric symptoms, thus masking reductions in prevalence. This masking hypothesis was tested using data from two trials of interventions that increased willingness to disclose and that also measured symptoms. Both interventions involved Mental Health First Aid (MHFA) training, which is known to reduce stigma, including unwillingness to disclose a mental health problem.
A cross-lagged panel analysis was carried out on data from two large Australian randomised controlled trials of MHFA training. The first trial involved 1643 high school students in Year 10 (mean age 15.87 years), who were randomised to receive either teen MHFA training or physical first aid training as the control. The second trial involved 608 Australia public servants who were randomised to receive either eLearning MHFA, blended eLearning MHFA or eLearning physical first aid as the control. In both trials, willingness to disclose a mental disorder as described in vignettes and psychiatric symptoms (K6 scale) were measured pre-training, post-training and at 12-month follow-up.
Both trials found that MHFA training increased willingness to disclose. However, a cross-lagged panel analysis showed no effect of this change on psychiatric symptom scores.
Greater willingness to disclose did not affect psychiatric symptom scores. Because the trials increased willingness to disclose through a randomly assigned intervention, they provide a strong causal test of the masking hypothesis. It is therefore unlikely that changes in willingness to disclose are masking reductions in prevalence in the population.
To determine the baseline individual characteristics that predicted symptom recovery and functional recovery at 10-years following the first episode of psychosis.
AESOP-10 is a 10-year follow up of an epidemiological, naturalistic population-based cohort of individuals recruited at the time of their first episode of psychosis in two areas in the UK (South East London and Nottingham). Detailed information on demographic, clinical, and social factors was examined to identify which factors predicted symptom and functional remission and recovery over 10-year follow-up. The study included 557 individuals with a first episode psychosis. The main study outcomes were symptom recovery and functional recovery at 10-year follow-up.
At 10 years, 46.2% (n = 140 of 303) of patients achieved symptom recovery and 40.9% (n = 117) achieved functional recovery. The strongest predictor of symptom recovery at 10 years was symptom remission at 12 weeks (adj OR 4.47; CI 2.60–7.67); followed by a diagnosis of depression with psychotic symptoms (adj OR 2.68; CI 1.02–7.05). Symptom remission at 12 weeks was also a strong predictor of functional recovery at 10 years (adj OR 2.75; CI 1.23–6.11), together with being from Nottingham study centre (adj OR 3.23; CI 1.25–8.30) and having a diagnosis of mania (adj OR 8.17; CI 1.61–41.42).
Symptom remission at 12 weeks is an important predictor of both symptom and functional recovery at 10 years, with implications for illness management. The concepts of clinical and functional recovery overlap but should be considered separately.