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We experienced an emergency room (ER) shutdown related to an accidental exposure to a patient with COVID-19 who had not been isolated. To prevent in-hospital transmission of the disease, we subsequently isolated patients with suspected symptoms, relevant radiographic findings, or epidemiology. The SARS-CoV-2 reverse-transcriptase polymerase chain reaction was performed in most patients requiring hospitalization. Universal mask policy and comprehensive use of personal protective equipment (PPE) were implemented.
Materials and Methods:
The effect of the interventions was analyzed in a 635-bed, tertiary-care hospital in Daegu, South Korea.
From the pre-shutdown (February 10 to 25) to the post-shutdown (February 28 to March 16, 2020) period, the mean hourly turnaround time (23:31±6:43 versus 9:27±3:41, P<0.001) was shortened, which increased the proportions of the patients tested (5.8% [N=1,037] versus 64.6% [N=690], P<0.001) and the average number of tests per day (3.8±4.3 versus 24.7±5.0, P<0.001). All 23 patients with COVID-19 in the post-shutdown period were isolated in the ER without any problematic accidental exposure or in-hospital transmission. From the pre- to the post-shutdown period, the median duration of stay in the ER among hospitalized patients (4:30 hr [2:17-9:48] versus 14:33 hr (6:55-24:50), P<0.001), rates of intensive care unit admissions (1.4% versus 2.9%, P=0.023), and mortality (0.9% versus 3.0%, P=0.001) increased.
Problematic accidental exposure and in-hospital transmission of COVID-19 can be successfully prevented through active isolation and surveillance policy and comprehensive PPE use despite longer ER stays and the presence of more severely ill patients during an explosive COVID-19 outbreak.
UK clinical guidelines recommend treatment of attention-deficit hyperactivity disorder (ADHD) in adults by suitably qualified clinical teams. However, young people with ADHD attempting the transition from children's to adults’ services experience considerable difficulties in accessing care.
To map the mental health services in the UK for adults who have ADHD and compare the reports of key stakeholders (people with ADHD and their carers, health workers, service commissioners).
A survey about the existence and extent of service provision for adults with ADHD was distributed online and via national organisations (e.g. Royal College of Psychiatrists, the ADHD Foundation). Freedom of information requests were sent to commissioners. Descriptive analysis was used to compare reports from the different stakeholders.
A total of 294 unique services were identified by 2686 respondents. Of these, 44 (15%) were dedicated adult ADHD services and 99 (34%) were generic adult mental health services. Only 12 dedicated services (27%) provided the full range of treatments recommended by the National Institute for Health and Care Excellence. Only half of the dedicated services (55%) and a minority of other services (7%) were reported by all stakeholder groups (P < 0.001, Fisher's exact test).
There is geographical variation in the provision of NHS services for adults with ADHD across the UK, as well as limited availability of treatments in the available services. Differences between stakeholder reports raise questions about equitable access. With increasing numbers of young people with ADHD graduating from children's services, developing evidence-based accessible models of care for adults with ADHD remains an urgent policy and commissioning priority.
The prevalence of mental health conditions and national suicide rates are increasing in many countries. Lithium is widely and effectively used in pharmacological doses for the treatment and prevention of manic/depressive episodes, stabilising mood and reducing the risk of suicide. Since the 1990s, several ecological studies have tested the hypothesis that trace doses of naturally occurring lithium in drinking water may have a protective effect against suicide in the general population.
To synthesise the global evidence on the association between lithium levels in drinking water and suicide mortality rates.
The MEDLINE, Embase, Web of Science and PsycINFO databases were searched to identify eligible ecological studies published between 1 January 1946 and 10 September 2018. Standardised regression coefficients for total (i.e. both genders combined), male and female suicide mortality rates were extracted and pooled using random-effects meta-analysis. The study was registered with PROSPERO (CRD42016041375).
The literature search identified 415 articles; of these, 15 ecological studies were included in the synthesis. The random-effects meta-analysis showed a consistent protective (or inverse) association between lithium levels/concentration in publicly available drinking water and total (pooled β = −0.27, 95% CI −0.47 to −0.08; P = 0.006, I2 = 83.3%), male (pooled β = −0.26, 95% CI −0.56 to 0.03; P = 0.08, I2 = 91.9%) and female (pooled β = −0.13, 95% CI −0.24 to −0.02; P = 0.03, I2 = 28.5%) suicide mortality rates. A similar protective association was observed in the six studies included in the narrative synthesis, and subgroup meta-analyses based on the higher/lower suicide mortality rates and lithium levels/concentration.
This synthesis of ecological studies, which are subject to the ecological fallacy/bias, supports the hypothesis that there is a protective (or inverse) association between lithium intakes from public drinking water and suicide mortality at the population level. Naturally occurring lithium in drinking water may have the potential to reduce the risk of suicide and may possibly help in mood stabilisation, particularly in populations with relatively high suicide rates and geographical areas with a greater range of lithium concentration in the drinking water. All the available evidence suggests that randomised community trials of lithium supplementation of the water supply might be a means of testing the hypothesis, particularly in communities (or settings) with demonstrated high prevalence of mental health conditions, violent criminal behaviour, chronic substance misuse and risk of suicide.
In face of the ongoing discrepancy between the number of political science PhD graduates and the availability of permanent academic positions, in this article we consider attitudes of faculty members towards options to address this issue. Based on a survey of faculty members in PhD-granting political science programs at English-speaking Canadian universities, we find considerable support for both reducing the number of PhD students admitted and reforming curriculum to ensure graduates cultivate skills transferable to non-academic environments. At the same time, faculty members are inclined to believe that PhD students themselves should shoulder the greatest responsibility for career preparation.
Field studies were conducted in 2018 and 2019 in Arkansas, Indiana, Illinois, Missouri, and Tennessee to determine if cover crop residue interfered with herbicides that provide residual control of Palmer amaranth and waterhemp in no−till soybean. The experiments were established in the fall with planting of cover crops (cereal rye plus hairy vetch). Herbicide treatments consisted of a nontreated or no residual, acetochlor, dimethenamid−P, flumioxazin, −pyroxasulfone + flumioxazin, pendimethalin, metribuzin and pyroxasulfone and S−metolachlor. Palmer amaranth took 18 d and waterhemp took 24 d in the cover crop alone (nontreated) treatment to reach a height of 10 cm. Compared with this treatment, all herbicides except metribuzin increased the number of days (d) until 10 cm Palmer amaranth was present. Flumioxazin applied alone or in a mixture with pyroxasulfone were the best at delaying Palmer amaranth growing to a height of 10 cm (35 and 33 d). The herbicides that resulted in the lowest Palmer amaranth density (1.5 to 4x less) integrated with a cover crop were pyroxasulfone + flumioxazin, flumioxazin, pyroxasulfone, and acetochlor. Those four herbicide treatments also delayed Palmer amaranth emergence for the longest period (27 to 34 d). Waterhemp density was 7 to 14 times less with acetochlor than all the other herbicides present. Yield differences were observed for locations with waterhemp. This research agrees with previous research that utilizing soil residual herbicides along with cover crop benefits control of Palmer amaranth and/or waterhemp.
Anthocyanins and bromelain have gained significant attention due to their antioxidative and anti-inflammatory properties. Both have been shown to improve endothelial function, blood pressure (BP), and oxygen utility capacity in humans, however the combination of these two and the impacts on endothelial function, BP, total antioxidant capacity (TAC), and oxygen utility capacity have not been previously investigated. The purpose of this study was to investigate the impacts of a combined anthocyanins and bromelain supplement (BE) on endothelial function, BP, TAC, oxygen utility capacity, and fatigability in healthy adults. Healthy adults (n=18, age 24±4) received BE or placebo in a randomized crossover design. Brachial artery flow-mediated dilation (FMD), BP, TAC, resting heart rate, oxygen utility capacity, and fatigability were measured pre-and post-BE and placebo intake. The BE group showed significantly increased FMD, reduced systolic BP, and improved oxygen utility capacity compared placebo group (p<0.05). Tissue saturation and oxygenated hemoglobin significantly increased following BE intake while deoxygenated hemoglobin significantly decreased (p<0.05) during exercise. Additionally, TAC was significantly increased following BE intake (p<0.05). There were no significant differences for resting heart rate, diastolic BP, or fatigability index. These results suggest that BE intake is an effective nutritional therapy for improving endothelial function, BP TAC, and oxygen utility capacity, which may be beneficial to support vascular health in humans.
The chapter examines the impact of Brexit on transnational solidarity. It explains how Brexit was triggered, in part, by concerns as to the impact of EU membership, both in terms of the UK’s identity as a member of the EU and the impact of migration. This negative impact on transnational solidarity will only continue post Brexit, particularly if the UK were to leave the EU with no deal concerning its future relationship. Some of these issues would be mitigated were the UK to leave under the terms of the current Withdrawal Agreement. Nevertheless, the chapter argues that some of the benefits of EU membership will continue post Brexit, particularly as concerns the impact of the UK’s membership of the EU on the UK constitution.
There is a need for accurate, inexpensive and field-friendly methods to assess body composition in children. Bioelectrical impedance analyzer (BIA) is a promising approach; however, there has been limited validation and use among young children in resource poor settings. We aim to develop and validate population-specific prediction equations for estimating total fat mass (FM), fat free-mass (FFM), and percent body fat (PBF) in Vietnamese children (4-7 years) using reactance and resistance from BIA, anthropometric variables and demographic information. We conducted a cross-sectional survey of 120 children. Body composition was measured using dual energy x-ray absorptiometry (DXA), BIA and anthropometry. To develop prediction equations, we split all data into development (70%) and validation datasets (30%). The model performance was evaluated using PRESS (Predicted residual error sum of squares), RMSE (Root mean squared error), MEA (Mean absolute error) and R2. We identified a top performing model with the least number of parameters (age, sex, weight and resistance index or resistance and height), low RMSE (FM 0.70, FFM 0.74, PBF 3.10), low MAE (FM 0.55, FFM 0.62, PBF 2.49), high R2 (FM 0.95, FFM 0.92, PBF 0.82), and the least difference between predicted values and actual values from DEXA (FM 0.03kg or 0.01SD, FFM 0.06kg or 0.02SD, PBF 0.27% or 0.04SD). In conclusion, we developed the first valid and highly predictive equations to estimate FM, FFM and PBF in Vietnamese children using BIA. These findings have important implications for future research on the double burden of disease and risks associated with overweight and obesity in young children.
This study compares the investigated water vapor diffusion coefficient in the neat polyurethane (PU) membrane, the silica–PU nanocomposite membrane, and two surface-modified silica–PU nanocomposite membranes. The silane first surface modifier is with an amine functional group known as N-[3-(trimethoxysilyl)propyl]ethylenediamine, while the second one is with an aniline functional group known as N-[3-(trimethoxysilyl)propyl]aniline. The enhancement of water vapor diffusivity values through the polymer nanocomposite is desirable for the membrane air dehumidification application. The diffusivities were calculated via molecular dynamics simulations at the temperature of 298.15 K. The Einstein's relationship known as the mean square displacement method was used to obtain the diffusivity for the membranes. The results showed a significant effect on the diffusivity of water vapor for the surface-modified silica–PU nanocomposite membrane as compared with the neat PU and the unmodified silica–PU nanocomposite membranes. For the amine-modified silica, the diffusion coefficient increased by 80.3% compared with the unmodified silica–PU nanocomposite membrane. On the other hand, the aniline-modified silica outperformed the amine-modified one in terms of the diffusion coefficient by 22.4%.
Mee-Soo was a good student in North Korea. She came to South Korea in her early teens, and South Korean state policy for North Korean defectors enabled her to gain entry into a decent university in Seoul. She majored in Business Management and, when she had to choose her sub-major, she chose Accounting over Marketing and Human Resources because she thought she could avoid English. Achieving CPA (Certified Public Accountant) status was the goal for Accounting majors. Passing a score of 700 in the Test of English for International Communication (TOEIC) was a requirement to take the CPA exam. Mee-Soo worked hard studying for TOEIC and took the test ten times. Her score rose from the 400s to the 600s, but she could not pass the 700 threshold and was left behind while other South Korean students passed the English requirement. She could not even begin to study for the CPA exam itself. She once sighed and told me (one of the authors), ‘I wish I could have a life without English.’ I responded, ‘I didn't think English would be so important to North Koreans in South Korea.’ To this, Mee-Soo exclaimed, ‘It is a matter of survival.’
Given there have now been over 70 years of separation between North and South Korea since the Korean War, it is unquestionable that North Korean migrants face and struggle with a variety of troubles in their attempts to settle into South Korean society. In this context, why does English constitute a ‘matter of survival’ for North Koreans when there are so many other critical issues for these individuals, who crossed several borders at the risk of their lives? This phenomena, that ‘English’ represents a major difficulty for North Korean defectors in their process of settling in South Korea (Jung & Lim, 2009), constitutes an interesting linguistic phenomena in an intra-ethnic contact. However, by itself, this statement somewhat simplifies how English actually affects the migrant group. Instead, its influence works in a surprisingly diverse number of ways across different ranges and layers within the North Korean population, depending on their regional and social background, age, time of migration, and possibly many other factors. A meaningful pattern we discuss here is the changing relations between English and North Korean migrants according to age; it is the North Korean young adults who seem to be particularly affected by English and disproportionately in need of English teaching. We also note, though, that this pattern itself is changing, as we are seeing the recent increase of children of North Korean migrants born and educated in South Korea or in China.
Korea is probably one of the few countries, if not the only one, that observes a holiday in honor of the national language's alphabet. Hangulnal, which falls on October 9, is the Korean Alphabet Day. Each year, the government hosts events to celebrate one of the most prized possessions of the country, Hangul – the writing system of the national language. Created by King Sejong and his Royal Academy Scholars in the 15th century, Hangul is recognized as one of ‘the world's most scientific writing systems ever created by man’ (Sohn, 2001: 13). To outsiders, such pride may appear somewhat overblown, but Koreans do take great pride in Hangul.
Even in cases with complexity, simple techniques can be useful to target a specific symptom. Intrusive mental images are highly disruptive, drive emotion, and contribute to maintaining psychopathology. Cognitive science suggests that we might target intrusive images using competing tasks.
We describe an imagery competing task technique within cognitive behavioural therapy (CBT) with a patient with bipolar disorder and post-traumatic stress disorder (PTSD) symptoms. The intervention – including Tetris computer game-play – was used (1) to target a specific image within one therapy session, and (2) to manage multiple images in daily life.
A single case (AB) design was used. (1) To target a specific image, the patient brought the image to mind and, after mental rotation instructions and game-play practice, played Tetris for 10 minutes. Outcomes, pre- and post-technique, were: vividness/distress ratings when the image was brought to mind; reported intrusion frequency over a week. (2) To manage multiple images, the patient used the intervention after an intrusive image occurred. Outcomes were weekly measures of: (a) imagery characteristics; (b) symptoms of PTSD, anxiety, depression and mania.
(1) For the target image, there were reductions in vividness (80% to 40%), distress (70% to 0%), and intrusion frequency (daily to twice/week). (2) For multiple images, there were reductions from baseline to follow-up in (a) imagery vividness (38%), realness (66%) and compellingness (23%), and (b) PTSD symptoms (Impact of Events Scale-Revised score 26.33 to 4.83).
This low-intensity intervention aiming to directly target intrusive mental imagery may offer an additional, complementary tool in CBT.