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Fibrinolysis is an acceptable treatment for acute ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) cannot be performed within 120 minutes. The American Heart Association has recommended Emergency Medical Services (EMS) interventions such as prehospital fibrinolysis (PHF), prehospital electrocardiogram (ECG), and hospital bypass direct to PCI center. Nova Scotia, Canada has incorporated these interventions into a unique province-wide approach to STEMI care. A retrospective cohort analysis comparing the primary outcome of 30-day mortality for patients receiving either prehospital or emergency department (ED) fibrinolysis (EDF) to patients transported directly by EMS from community or regional ED for primary PCI was conducted.
This retrospective, population-based cohort study included all STEMI patients in Nova Scotia who survived to hospital admission from July 2011 through July 2013. Three provincial databases were used to collect demographic, 30-day mortality, hospital readmission, and rescue PCI data. The results were grouped and compared according to reperfusion strategy received: PHF, EDF, patients brought by ambulance via EMS direct to PCI (EMS to PCI), and ED to PCI (ED to PCI).
There were 1,071 STEMI patients included with 145 PHF, 606 EDF, 98 EMS to PCI, and 222 ED to PCI. There were no significant differences in 30-day mortality across groups (n, %): PHF 5(3); EDF 36(6); EHS to PCI <5(2); and ED to PCI 10(4); P = .28. There was no significant difference in patients receiving fibrinolysis who underwent rescue PCI.
Prehospital fibrinolysis incorporated into a province-wide approach to STEMI treatment is feasible with no observed difference in patient 30-day mortality outcomes observed.
Research suggests an increased prevalence of callous-unemotional (CU) traits in children with autism spectrum disorder (ASD), and a similar impairment in fear recognition to that reported in non-ASD populations. However, past work has used measures not specifically designed to measure CU traits and has not examined whether decreased attention to the eyes reported in non-ASD populations is also present in individuals with ASD. The current paper uses a measure specifically designed to measure CU traits to estimate prevalence in a large community-based ASD sample. Parents of 189 adolescents with ASD completed questionnaires assessing CU traits, and emotional and behavioral problems. A subset of participants completed a novel emotion recognition task (n = 46). Accuracy, reaction time, total looking time, and number of fixations to the eyes and mouth were measured. Twenty-two percent of youth with ASD scored above a cut-off expected to identify the top 6% of CU scores. CU traits were associated with longer reaction times to identify fear and fewer fixations to the eyes relative to the mouth during the viewing of fearful faces. No associations were found with accuracy or total looking time. Results suggest the mechanisms that underpin CU traits may be similar between ASD and non-ASD populations.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
Electron microscopy is uniquely suited for atomic-resolution imaging of heterogeneous and complex materials, where composition, physical, and electronic structure need to be analyzed simultaneously. Historically, the technique has demonstrated optimal performance at room temperature, since practical aspects such as vibration, drift, and contamination limit exploration at extreme temperature regimes. Conversely, quantum materials that exhibit exotic physical properties directly tied to the quantum mechanical nature of electrons are best studied (and often only exist) at extremely low temperatures. As a result, emergent phenomena, such as superconductivity, are typically studied using scanning probe-based techniques that can provide exquisite structural and electronic characterization, but are necessarily limited to surfaces. In this article, we focus not on the various methods that have been used to examine quantum materials at extremely low temperatures, but on what could be accomplished in the field of quantum materials if the power of electron microscopy to provide structural analysis at the atomic scale was extended to extremely low temperatures.
We use apatite fission track ages from sediments recovered by the International Ocean Discovery Program in the Laxmi Basin, Arabian Sea, to constrain exhumation rates in the western Himalaya and Karakoram since 15.5 Ma. With the exception of a Triassic population in the youngest 0.93 Ma samples supplied from western Peninsular India, apatite fission track ages are overwhelmingly Cenozoic, largely <25 Ma, consistent with both a Himalaya–Karakoram source and rapid erosion. Comparison of the minimum cooling age of each sample with depositional age (lag time) indicates an acceleration in exhumation between 7.8 and 7.0 Ma, with lag times shortening from ∼6.0 Myr at 8.5–7.8 Ma to being within error of zero between 7.0 and 5.7 Ma. Sediment supply at 7.0–5.7 Ma was largely from the Karakoram, and to a lesser extent the Himalaya, based on U–Pb zircon ages from the same samples. This time coincides with a period of drying in the Himalayan foreland caused by weaker summer monsoons and Westerly winds. It also correlates with a shift of erosion away from the Karakoram, Kohistan and the Tethyan Himalaya towards more erosion of the Lesser and Greater Himalaya and Nanga Parbat, as shown by zircon U–Pb provenance data, and especially after 5.7 Ma based on Nd isotope data. Samples younger than 5.7 Ma have lag times of ∼4.5 Myr, similar to Holocene Indus delta sediments.
Impulsivity and compulsivity have been implicated as important transdiagnostic dimensional phenotypes with potential relevance to addiction. We aimed to develop a model that conceptualizes these constructs as overlapping dimensional phenotypes and test whether different components of this model explain the co-occurrence of addictive and related behaviors.
A large sample of adults (N = 487) was recruited through Amazon’s Mechanical Turk and completed self-report questionnaires measuring impulsivity, intolerance of uncertainty, obsessive beliefs, and the severity of 6 addictive and related behaviors. Hierarchical clustering was used to organize addictive behaviors into homogenous groups reflecting their co-occurrence. Structural equation modeling was used to evaluate fit of the hypothesized bifactor model of impulsivity and compulsivity and determine the proportion of variance explained in the co-occurrence of addictive and related behaviors by each component of the model.
Addictive and related behaviors clustered into 2 distinct groups: Impulse-Control Problems, consisting of harmful alcohol use, pathological gambling, and compulsive buying, and Obsessive-Compulsive-Related Problems, consisting of obsessive-compulsive symptoms, binge eating, and internet addiction. The hypothesized bifactor model of impulsivity and compulsivity provided the best empirical fit, with 3 uncorrelated factors corresponding to a general Disinhibition dimension, and specific Impulsivity and Compulsivity dimensions. These dimensional phenotypes uniquely and additively explained 39.9% and 68.7% of the total variance in Impulse-Control Problems and Obsessive-Compulsive-Related Problems.
A model of impulsivity and compulsivity that represents these constructs as overlapping dimensional phenotypes has important implications for understanding addictive and related behaviors in terms of shared etiology, comorbidity, and potential transdiagnostic treatments.
The churchmen who adhered to the established Church in Scotland during the years from 1661 to 1689, the last period in which it had bishops, have been overlooked by historians in favour of laymen and presbyterian dissenters. This article breaks new ground by examining the episcopalian clergy's attitude to the royal supremacy. To do so, it explores how Scottish episcopalians used the early Church under the Roman empire to illustrate their ideal relationship between Church and monarch. Three phases are evident in their approach. First, it was argued that conformists were, like early Christians, living in proper obedience, while presbyterians were seeking to create a separate jurisdiction in conflict with the king's. Later, Bishop Andrew Honeyman of Orkney tried to put some limitations on the royal supremacy over the Church, arguing that church courts had an independent power of discipline. This became politically unacceptable after the 1669 Act of Supremacy gave the king complete power over the Church, and, in the final phase, the history of the early Church was used to undermine the power of the church courts. The Church under the Roman empire, much like the royal supremacy itself, changed from an instrument to encourage conformity to a means of delegitimizing any clerical opposition to royal policy.
Transient storage and erosion of valley fills, or sediment buffering, is a fundamental but poorly quantified process that may significantly bias fluvial sediment budgets and marine archives used for paleoclimatic and tectonic reconstructions. Prolific sediment buffering is now recognized to occur within the mountainous upper Indus River headwaters and is quantified here for the first time using optically stimulated luminescence dating, petrography, detrital zircon U-Pb geochronology, and morphometric analysis to define the timing, provenance, and volumes of prominent valley fills. This study finds that climatically modulated sediment buffering occurs over 103–104 yr time scales and results in biases in sediment compositions and volumes. Increased sediment storage coincides with strong phases of summer monsoon and winter westerlies precipitation over the late Pleistocene (32–25 ka) and mid-Holocene (~8–6 ka), followed by incision and erosion with monsoon weakening. Glacial erosion and periglacial frost-cracking drive sediment production, and monsoonal precipitation mediates sediment evacuation, in contrast to the arid Transhimalaya and monsoonal frontal Himalaya. Plateau interior basins, although volumetrically large, lack transport capacity and are consequently isolated from the modern Indus River drainage. Marginal plateau catchments that both efficiently produce and evacuate sediment may regulate the overall compositions and volumes of exported sediment from the Himalayan rain shadow.
Gurga Chiya and Tepe Marani are small, adjacent mounds located close to the town of Halabja in the southern part of the Shahrizor Plain, one of the most fertile regions of Iraqi Kurdistan. Survey and excavation at these previously unexplored sites is beginning to produce evidence for human settlement spanning the sixth to the fourth millennia, c. 5600–3300 cal. b.c. In Mesopotamian chronology this corresponds to the Late Neolithic through to Chalcolithic periods; the Halaf, Ubaid, and Uruk phases of conventional culture history. In Iraqi Kurdistan, documentation of these periods—which witnessed many important transformations in prehistoric village life—is currently very thin. Here we offer a preliminary report on the emerging results from the Shahrizor Plain, with a particular focus on the description of material culture (ceramic and lithic assemblages), in order to establish a benchmark for further research. We also provide a detailed report on botanical remains and accompanying radiocarbon dates, which allow us to place this new evidence in a wider comparative framework. A further, brief account is given of Late Bronze Age material culture from the upper layers at Gurga Chiya. We conclude with observations on the significance of the Shahrizor Plain for wider research into the later prehistory of the Middle East, and the importance of preserving and investigating its archaeological record.
Solid oxide fuel cells (SOFCs) efficiently generate electricity, but high operating temperatures (Top > 800 °C) limit their utility. Reducing Top requires mixed ion–electron conducting (MIEC) cathode materials. Density functional theory is used here to investigate the role of potassium substitutions in the MIEC material Sr1−xKxFeO3 (SKFO). We predict that such substitutions are endothermic. SrFeO3 and SKFO have nearly identical metallic electronic structures. Oxygen vacancy formation energies decrease by ~0.2 eV when xK increases from 0 to 0.0625. SKFO is a promising SOFC MIEC cathode material; however, further experimental investigations must assess its long-term stability at the desired operating temperatures.
Impulse control disorders (ICDs) have become a widely recognized non-motor complication of Parkinson's disease (PD) in patients taking dopamine replacement therapy (DRT). There are no current evidence-based recommendations for their treatment, other than reducing their dopaminergic medication.
This study reviews the current literature of the treatment of ICDs including pharmacological treatments, deep brain stimulation, and psychotherapeutic interventions.
Dopamine agonist withdrawal is the most common and effective treatment, but may lead to an aversive withdrawal syndrome or motor symptom degeneration in some individuals. There is insufficient evidence for all other pharmacological treatments in treating ICDs in PD, including amantadine, serotonin selective reuptake inhibitors, antipsychotics, anticonvulsants, and opioid antagonists (e.g. naltrexone). Large randomized control trials need to be performed before these drugs can be routinely used for the treatment of ICDs in PD. Deep brain stimulation remains equivocal because ICD symptoms resolve in some patients after surgery but may appear de novo in others. Cognitive behavioral therapy has been shown to improve ICD symptoms in the only published study, although further research is urgently needed.
Further research will allow for the development of evidence-based guidelines for the management of ICDs in PD.
I much prefer the audience not to know that there's a director. That's my general thesis in regard to directing.
Delmer Daves is the property of those who can enjoy stylistic conviction in an intellectual vacuum. The movies of Delmer Daves are fun of a very special kind. Call it Camp or call it Corn. The director does not so much transcend his material as mingle with it.
Andrew Sarris, The American Cinema
American critics have never taken Delmer Daves seriously, and the way things look, they probably never will.
Jean-Pierre Coursodon, American Directors
It is tempting, in introducing a book of this nature, to declare at the outset something like, “Delmer Daves is the best filmmaker you've never heard of!” Alas, we cannot resort to such rhetoric—not because Delmer Daves is not a great, critically overlooked filmmaker, but because you likely have heard of him. Daves is remembered principally as a maker of Westerns, and of two Westerns in particular: Broken Arrow (1950) and 3:10 to Yuma (1957). The former, about an Army scout who brokers a peace treaty between the American government and the Chiricahua Apache, offered viewers a comparatively nuanced, sympathetic depiction of Native American culture, and in so doing helped to transform how American Indians are represented in cinema. The latter, a stylish, psychological frontier drama about a poor farmer who agrees to help escort a dangerous outlaw to the train that will take him to prison, is frequently considered among the best Westerns of the 1950s, and was even subject to a high-profile remake in 2007. As these synopses suggest, however, Broken Arrow and 3:10 to Yuma are quite different films, and are remembered for different reasons: the former for its sociocultural significance, the latter for its style. This perceived difference, it turns out, matters a great deal.
Making the jump from discussing individual films to discussing filmmakers normally requires us to detect consistency, not difference. Identifying recurring features of style or theme across multiple films implies the underlying presence of an impelling, organizing personality: an artist who imbues his work with his own vision of the world.
As the first comprehensive study of Daves's career, this collection of essays seeks to deepen our understanding of his work, and also to problematize existing conceptions of him as a competent, conventional and even naïve studio man.
A gap between research and management exists in numerous natural resource fields. This can lead to management actions that are based on experience rather than evidence and may be less effective as a result. The gap may be partly attributable to research not being relevant, timely or accessible for managers. Editorial boards of peer-reviewed journals are responsible for determining the relevance of submitted manuscripts for a journal's readership. Limited representation of natural resource managers on editorial boards may make it more difficult for journals to identify the topics and findings of most relevance for management, thus contributing to the research–management gap. We quantified the representation of natural resource managers on the editorial boards of 79 conservation and applied natural resource journals. We found that 65% of editors were affiliated with universities, 13% with research institutions, 12% with government agencies and 3% with NGOs. On average, 9% of editors were affiliated with an agency or organization responsible for managing or regulating natural resources. The proportion of managers on editorial boards did not differ significantly between natural resource fields or with journal impact factor. Potential benefits of greater integration of managers into the research and publishing process include selection of research topics with greater relevance for management, clearer statements of the management implications of research studies, and more frequent publication of research evaluating the effectiveness of management interventions. Further study is needed to evaluate whether greater participation of managers in the editorial review process may contribute to achieving these benefits.