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Cardiac strangulation is a rare and potentially deadly complication of epicardial pacemaker implantation. A young boy presenting with chest pain and tiredness almost 7 years after pacemaker implantation was found to have cardiac strangulation. Literature review revealed 22 cases reported to date with a worrying rise in the number of reports over the past 3 years. Strangulation is associated with implantation of leads at a young age and appears to be related to somatic growth. Serial assessment with chest X-ray and echocardiogram is recommended, at least until full adult growth is attained with further coronary artery imaging reserved for symptoms or suspicious echocardiographic findings. If cardiac strangulation is diagnosed prompt replacement of the offending system is needed.
Advanced imaging techniques are enhancing research capacity focussed on the developmental origins of adult health and disease (DOHaD) hypothesis, and consequently increasing awareness of future health risks across various subareas of DOHaD research themes. Understanding how these advanced imaging techniques in animal models and human population studies can be both additively and synergistically used alongside traditional techniques in DOHaD-focussed laboratories is therefore of great interest. Global experts in advanced imaging techniques congregated at the advanced imaging workshop at the 2019 DOHaD World Congress in Melbourne, Australia. This review summarizes the presentations of new imaging modalities and novel applications to DOHaD research and discussions had by DOHaD researchers that are currently utilizing advanced imaging techniques including MRI, hyperpolarized MRI, ultrasound, and synchrotron-based techniques to aid their DOHaD research focus.
Additive Manufacturing (AM) offers the potential to increase the ability to customise large-scale plastic components. However, a substantial amount of manual work is still required during the customisation process, both in design and manufacturing.
This paper looks into how the additive manufacturing of mass customised large-scale products can be supported. Data was collected through interaction with industrial partners and potential customers in a case study regarding the customisation of kayaks.
As a result, the paper proposes a model-based methodology which combines design automation with a user interface.
The results point to the benefit of the proposed methodology in terms of design efficiency, as well as in terms of displaying results to the end user in an understandable format.
This article considers the evolving relationship between Protestant children, pedagogy and the missionary movement across the British world. From the 1840s, children were a central focus of missionary society philanthropy. By the time of the 1910 World Missionary Conference, missionary and denominational thinkers were consistently highlighting their strategic importance and the need for clear policy that was focused on children's education. This article traces the ways in which this emphasis developed, and the impact that it had among the children involved. It argues that the children's missionary movement was educational at heart, wherein philanthropy and pedagogy went hand in hand. In particular, over the long nineteenth century all the players consistently emphasized the importance of nurturing a ‘missionary spirit’, a notion that was primarily religious in intent but which in practice moved from pragmatic philanthropy to a more formalized emphasis on education and identity formation. The article introduces representative ways by which this was articulated, drawing on examples from a range of British world contexts in which different communities of Protestant children were engaged educationally and philanthropically in very similar ways.
To date no studies have explored the effectiveness of written cognitive–behavioural therapy (CBT) resources for low mood and stress delivered via a course of self-help classes in a community setting.
To assess the effectiveness of an 8-week community-based CBT self-help group classes on symptoms of depression, anxiety and social function at 6 months (trial registration: ISRCTN86292664).
In total, 142 participants were randomly allocated to immediate (n = 71) or delayed access to a low-intensity CBT intervention (n = 71). Measures of depression, anxiety and social function were collected at baseline and 6 months.
There was a significant improvement for the primary outcome of Patient Health Questionnaire-9 (PHQ-9) score (mean between-group difference: –3.64, 95% CI –6.06 to –1.23; P = 0.004). The percentage of participants reducing their PHQ-9 score between baseline and 6 months by 50% or more was 17.9% for the delayed access group and 43.8% for the immediate access group. Secondary outcomes also improved including anxiety and social function. The intervention was cost neutral. The probabilities of a net benefit at willingness to pay thresholds of £20 000, £25 000 or £30 000 were 0.928, 0.944 and 0.955, respectively.
Low-intensity class-based CBT delivered within a community setting is effective for reducing depression, anxiety and impaired social function at little additional cost.
Declaration of interest
C.W. is president of British Association for Behavioural & Cognitive Psychotherapies (BABCP) – the lead body for CBT in the UK. He is also author of a range of CBT-based resources available commercially. He is developer of the LLTTF classes evaluated in this study. He receives royalty, and is shareholder and director of a company that commercialises these resources.
We investigated the potential for human-mediated range expansion of an exotic beech leaf-mining weevil, Orchestes fagi (Linnaeus) (Coleoptera: Curculionidae: Curculioninae: Rhamphini) (formerly known as Rhynchaenus fagi) on timber or firewood, which for eight to nine months of the year may harbour adults in diapause. In both relatively low-density and high-density populations, adults were found on the base, middle, and upper boles of the primary host, American beech (Fagus grandifolia Ehrhart; Fagaceae), as well as red maple (Acer rubrum Linnaeus; Sapindaceae) and red spruce (Picea rubens Sargent; Pinaceae) in the vicinity. Comparatively few individuals were found on tree branches, or in the moss, duff, or soil collected beneath beech trees. Overwintering adults appeared to favour parts of trees with relatively high bark roughness. Our study suggests that, between the months of July through May, any woody stems near areas having O. fagi outbreaks are likely to harbour adults. Moreover, as all of the trees studied are common sources of timber or firewood, the harvest and transport of wood from these areas may facilitate outbreak spread; this may explain the multiple, distantly distributed populations of O. fagi that have been reported in eastern Nova Scotia, Canada in recent years.
Here we report on the photocurrent response of two-dimensional (2D) heterostructures of sputtered MoS2 on boron nitride (BN) deposited on (001)-oriented Si substrates. The steady state photocurrent (Iph) measurements used a continuous laser of λ = 658 nm (E = 1.88 eV) over a broad range of laser intensities, P (∼1 μW < P < 10 μW), and indicate that Iph obtained from MoS2 layers with the 80 nm BN under layer was ∼4 times higher than that obtained from MoS2 layers with the 30 nm BN under layer. We also found super linear dependence of Iph on P (Iph ∝ Pγ, with γ > 1) in both the samples. The responsivities obtained over the range of laser intensity studied were in the order of mA/W (∼12 and ∼2.7 mA/W with 80 nm BN and 30 nm BN under layers, respectively). These investigations provide crucial insight into the optical activity of MoS2 on BN, which could be useful for developing a variety of optoelectronic applications with MoS2 or other 2D transition metal dichalcogenide heterostructures.
Research suggests that the way in which cognitive therapy is delivered is an important factor in determining outcomes. We test the hypotheses in which the development of a shared problem list, use of case formulation, homework tasks and active intervention strategies will act as process variables.
Presence of these components during therapy is taken from therapist notes. The direct and indirect effect of the intervention is estimated by an instrumental variable analysis.
A significant decrease in the symptom score for case formulation (coefficient =–23, 95% CI –44 to –1.7, P = 0.036) and homework (coefficient =–0.26, 95% CI –0.51 to –0.001, P = 0.049) is found. Improvement with the inclusion of active change strategies is of borderline significance (coefficient =–0.23, 95% CI –0.47 to 0.005, P = 0.056).
There is a greater treatment effect if formulation and homework are involved in therapy. However, high correlation between components means that these may be indicators of overall treatment fidelity.
Internalised stigma in young people meeting criteria for at-risk mental states (ARMS) has been highlighted as an important issue, and it has been suggested that provision of cognitive therapy may increase such stigma.
To investigate the effects of cognitive therapy on internalised stigma using a secondary analysis of data from the EDIE-2 trial.
Participants meeting criteria for ARMS were recruited as part of a multisite randomised controlled trial of cognitive therapy for prevention and amelioration of psychosis. Participants were assessed at baseline and at 6, 12, 18 and 24 months using measures of psychotic experiences, symptoms and internalised stigma.
Negative appraisals of experiences were significantly reduced in the group assigned to cognitive therapy (estimated difference at 12 months was −1.36 (95% Cl −2.69 to −0.02), P = 0.047). There was no difference in social acceptability of experiences (estimated difference at 12 months was 0.46, 95% Cl −0.05 to 0.98, P = 0.079).
These findings suggest that, rather than increasing internalised stigma, cognitive therapy decreases negative appraisals of unusual experiences in young people at risk of psychosis; as such, it is a non-stigmatising intervention for this population.
Research is essential for the development of evidence-based emergency medical services (EMS) systems of care. When resources are scarce and gaps in evidence are large, a national agenda may inform the growth of EMS research in Canada. This mixed methods consensus study explores current barriers and existing strengths within Canadian EMS research, provides recommendations, and suggests EMS topics for future study.
Purposeful sampling was employed to invite EMS research stakeholders from various roles across the country. Study phases consisted of 1) baseline interviews of a subsample, 2) roundtable discussion, and 3) an online Delphi survey, in which participants scored each statement for importance. Consensus was defined a priori and met if 80% scored a statement as “important” or “very important.”
Fifty-three stakeholders participated, representing researchers (37.7%), EMS administrators (24.6%), clinicians/ providers (20.7%), and educators (17.0%). Participation rates were as follows: interviews, 13 of 13 (100%); roundtable, 47 of 53 (89%); survey round 1, 50 of 53 (94%); survey round 2, 47 of 53 (89%); and survey round 3, 40 of 53 (75%). A total of 141 statements were identified as important: 20 barriers, 54 strengths/opportunities, 31 recommendations, and 36 suggested topics for future research. Like statements were synthesized, resulting in barriers (n 5 10), strengths/opportunities (n 5 24), and recommendations (n 5 19), which were categorized as time, opportunities, and funding; education and mentorship; culture of research and collaboration; structure, process, and outcome of research; EMS and paramedic practice; and the future of the EMS Research Agenda.
Consensus-based key messages from this agenda should be considered when designing, funding, and publishing EMS research and will advance EMS research locally, regionally, and nationally.
Background: This study reports the development and revision of the Beliefs about Paranoia Scale (BaPS), a self-report measure to assess metacognitive beliefs about paranoia in non-patients. We aimed to confirm the factor structure of a revised 50-item version of the measure and test the specific hypotheses that positive beliefs about paranoia would predict frequency of paranoia, and that negative beliefs about paranoia would predict distress associated with paranoia. Method: 185 non-patient participants completed questionnaires assessing beliefs about paranoia, thought control, self-consciousness, anxiety, depression and paranoia. Results: The results showed that the original four-factor solution could not be replicated. Instead a three-factor solution comprising Negative Beliefs about Paranoia, Paranoia as a Survival Strategy, and Normalizing Beliefs was developed. The revised 18-item measure showed good internal consistency. Stepwise regression analysis showed that, BaPS-negative beliefs accounted for 34% of the variance with R2 of 0.339, with a multiple R of 0.585 in relation to frequency of paranoia. In relation to distress arising from paranoia, stepwise regression analysis showed that BaPS-negative beliefs accounted for 34% of the variance with R2 of 0.339, with a multiple R of 0.585. In both analyses, BaPS-Survival strategy showed a small but significant incremental increase in the variance accounted for in the overall model. Conclusions: These findings suggest that a metacognitive approach to the conceptualization of paranoia as a strategy for managing interpersonal threat may have some utility. The clinical implications of the findings are also discussed.
We collected midcrown branches of balsam fir, Abies balsamea (L.) Mill. (Pinaceae), at six different sites located in five different plant-hardiness zones, along a north–south transect in New Brunswick, Canada, to evaluate the effect of plant-hardiness zone, crown class (overstory versus understory), and shoot length during the previous 10 years on the annual incidence of gouting by the balsam woolly adelgid, Adelges piceae (Ratzeburg) (Homoptera: Adelgidae). Site, crown class, and their interaction, along with the square of shoot length, explained 78% of the variation in gouting. Variations in gouting attributed to plant-hardiness zone were probably primarily due to variation in mean January temperature: at each site, the mean January temperature was positively and closely related to the mean level of gouting. The level of gouting was consistently higher on trees in the understory than on those in the overstory. Shoot length was parabolically related to the proportion of shoots with gout. The parabolic relationship between shoot size and the level of gouting is similar to that previously reported for galling adelgids, and suggests that gouting by A. piceae may be greatest on trees with an intermediate growth rate.