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This research seeks to understand the economic and social interaction patterns among dispersed Piedmont Village Tradition communities in the North American Southeast, AD 1200–1600. Piedmont Village Tradition communities lived adjacent to Mississippian societies and have been categorized as a peripheral society because of this spatial relationship. We examine economic behaviors by constructing fall-off curves of local versus nonlocal lithic material proportions at settlement sites and examining the reduction behaviors and tool types at sites. The results support a possible gateway model for the acquisition and distribution of nonlocal materials that linked spatially proximate communities. To examine social interaction patterns, we conducted a Brainerd-Robinson analysis of ceramic attributes from six sites and combined our results with work by Rogers (1993). The results show sites with stylistic similarities are not the same sites that share lithic resources. We conclude that these spatially non-overlapping artifact patterns result from a heterarchical social organization with a high degree of independence between economic and social interactions. Finally, we contextualize our results within the current knowledge of Mississippian and Piedmont Village Tradition societies in the region to broaden the discussion of gateways in reciprocity-based economies, societies traditionally thought of as peripheral to complex societies, and coalescence.
Objectives: Low educational attainment is a risk factor for more rapid cognitive aging, but there is substantial variability in cognitive trajectories within educational groups. The aim of this study was to determine the factors that confer resilience to memory decline within educational strata. Methods: We selected 2573 initially nondemented White, African American, and Hispanic participants from the longitudinal community-based Washington Heights/Inwood Columbia Aging Project who had at least two visits. We estimated initial memory (intercept) and the rate of memory decline (slope) using up to five occasions of measurement. We classified groups according to the educational attainment groups as low (≤5 years), medium (6–11 years), and high (≥12 years). We used a multiple-group latent growth model to identify the baseline predictors of initial memory performance and rate of memory decline across groups. The model specification considered the influence of demographic, socioeconomic, biomedical, and cognitive variables on the intercept and the slope of memory trajectory. Results: Our results indicated that the three educational groups do not benefit from the same factors. When allowed to differ across groups, the predictors were related to cognitive outcomes in the highly educated group, but we found no unique predictor of cognition for the low educated older adults. Conclusions: These findings highlight that memory-protective factors may differ across older adults with distinct educational backgrounds, and the need to evaluate a broader range of potential resilience factors for older adults with few years of school.
Childhood maltreatment is one of the strongest predictors of adulthood depression and alterations to circulating levels of inflammatory markers is one putative mechanism mediating risk or resilience.
To determine the effects of childhood maltreatment on circulating levels of 41 inflammatory markers in healthy individuals and those with a major depressive disorder (MDD) diagnosis.
We investigated the association of childhood maltreatment with levels of 41 inflammatory markers in two groups, 164 patients with MDD and 301 controls, using multiplex electrochemiluminescence methods applied to blood serum.
Childhood maltreatment was not associated with altered inflammatory markers in either group after multiple testing correction. Body mass index (BMI) exerted strong effects on interleukin-6 and C-reactive protein levels in those with MDD.
Childhood maltreatment did not exert effects on inflammatory marker levels in either the participants with MDD or the control group in our study. Our results instead highlight the more pertinent influence of BMI.
Declaration of interest
D.A.C. and H.W. work for Eli Lilly Inc. R.N. has received speaker fees from Sunovion, Jansen and Lundbeck. G.B. has received consultancy fees and funding from Eli Lilly. R.H.M.-W. has received consultancy fees or has a financial relationship with AstraZeneca, Bristol-Myers Squibb, Cyberonics, Eli Lilly, Ferrer, Janssen-Cilag, Lundbeck, MyTomorrows, Otsuka, Pfizer, Pulse, Roche, Servier, SPIMACO and Sunovian. I.M.A. has received consultancy fees or has a financial relationship with Alkermes, Lundbeck, Lundbeck/Otsuka, and Servier. S.W. has sat on an advisory board for Sunovion, Allergan and has received speaker fees from Astra Zeneca. A.H.Y. has received honoraria for speaking from Astra Zeneca, Lundbeck, Eli Lilly, Sunovion; honoraria for consulting from Allergan, Livanova and Lundbeck, Sunovion, Janssen; and research grant support from Janssen. A.J.C. has received honoraria for speaking from Astra Zeneca, honoraria for consulting with Allergan, Livanova and Lundbeck and research grant support from Lundbeck.
The Pueblo population of Chaco Canyon during the Bonito Phase (AD 800–1130) employed agricultural strategies and water-management systems to enhance food cultivation in this unpredictable environment. Scepticism concerning the timing and effectiveness of this system, however, remains common. Using optically stimulated luminescence dating of sediments and LiDAR imaging, the authors located Bonito Phase canal features at the far west end of the canyon. Additional ED-XRF and strontium isotope (87Sr/86Sr) analyses confirm the diversion of waters from multiple sources during Chaco’s occupation. The extent of this water-management system raises new questions about social organisation and the role of ritual in facilitating responses to environmental unpredictability.
This paper presents a rare case of oculostapedial synkinesis.
After partial resolution of an idiopathic facial palsy, a male patient presented with persistent distortion of hearing when blinking and closing his eye. Audiometry findings were unremarkable, and cross-sectional imaging of the facial nerve revealed no abnormalities apart from an incidental contralateral meningioma. Initial conservative management, with referral to a specialist physiotherapist, failed to resolve the symptoms. The patient subsequently opted for surgical intervention, and underwent a transmeatal tympanotomy and transection of the stapedial tendon. Following this, he had complete resolution of symptoms.
Oculostapedial synkinesis is a rare complication of facial palsy, but is recognised in the literature. Given its unusual presentation, it can be overlooked, especially by more junior team members. This case highlights the need to pay careful attention to patients' symptoms and listen out for the description of hearing distortion on facial movement.
Objectives: Cross-sectional and longitudinal evidence from largely non-Hispanic White cohorts suggests that positive psychosocial factors, particularly self-efficacy and social support, may protect against late-life cognitive decline. Identifying potentially protective factors in racial/ethnic minority elders is of high importance due to their increased risk of Alzheimer’s disease. The overall goal of this study was to characterize cross-sectional associations between positive psychosocial factors and cognitive domains among Black, Hispanic, and White older adults. Methods: A total of 548 older adults (41% Black, 28% Hispanic, 31% White) in the Washington Heights-Inwood Columbia Aging Project completed cognitive and psychosocial measures from the NIH Toolbox and standard neuropsychological tests. Multiple-group regressions were used to compare cross-sectional associations between positive psychosocial factors and cognition across racial/ethnic groups, independent of demographics, depressive symptoms, and physical health. Results: Positive associations between self-efficacy and language did not significantly differ across race/ethnicity, although the bivariate association between self-efficacy and language was not significant among Hispanics. Additional positive associations were observed for Whites and Blacks, but not Hispanics. Negative associations between emotional support and purpose in life and working memory were seen only in Hispanics. Conclusions: Results confirm and extend the link between self-efficacy and cognition in late life, particularly for White and Black older adults. Previous studies on positive psychosocial factors in cognitive aging may not be generalizable to Hispanics. Longitudinal follow-up is needed to determine whether negative relationships between certain psychosocial factors and cognition in Hispanics reflect reverse causation, threshold effects, and/or negative aspects of having a strong social network. (JINS, 2018, 24, 294–304)
Until recently community opiate detoxification strategies have largely been limited to gradual dose reductions in opiate substitute treatment (OST). These detoxes are often lengthy leading to “windows of opportunities” in patients’ motivation to detox being missed. Furthermore, many patients remain on sub-optimal OST doses for long periods of time, during which they are more vulnerable to relapse to illicit opiate use.
Within our community service, we adapted and implemented a novel two-week community opiate detoxification programme using buprenorphine front-loading and lofexidine. We worked in partnership with Bristol drugs project (BDP) to offer an 8-week psychosocial intervention alongside the medically assisted detoxification.
Assessing the completion rates and clinical safety of this intervention.
Data collection was performed through retrospective review of patients’ case notes over a 9-month period.
Seventy-five percent of the patients starting an opiate detox successfully completed the intervention.
Lofexidine improved the mean opiate withdrawal scores by 28% at 45 min after the first dose and this was a sustained effect throughout the detox. Mean systolic blood pressure dropped by 6.2 mmHg at 45 min after the first dose of lofexidine and by 16.5 mmHg two days later however this was asymptomatic in all patients. There was no significant change in the heart rate and no adverse events.
Our team innovatively adapted and tailored a cost-effective community opiate detoxification programme using a multi-agency strategy in a climate of limited funding and staff resources. Our data clearly indicates positive outcomes in terms of completion rates and clinical safety.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Geothermal heat flux (GHF) is one of the key thermal boundary conditions for ice-sheet models. We assess the sensitivity of the Lambert-Amery glacial system in East Antarctica to four different GHF datasets using a regional ice-sheet model. A control solution of the regional model is initialised by minimising the misfit to observations through an optimisation process. The Lambert-Amery glacial system simulation contains temperate ice up to 150 m thick and has an average basal melt of 1.3 mm a−1, with maximum basal melting of 504 mm a−1. The simulations which use a relatively high GHF compared to the control solution increase the volume and area of temperate ice, which causes higher surface velocities at higher elevations, which leads to the advance of the grounding line. The grounding line advance leads to changes in the local flow configuration, which dominates the changes within the glacial system. To investigate the difference in spatial patterns within the geothermal datasets, they were scaled to have the same median value. These scaled GHF simulations showed that the ice flow was most sensitive to the spatial variation in the underlying GHF near the ice divides and on the edges of the ice streams.
When children have marked problems with motor coordination, they often have problems with attention and impulse control. Here, we map the neuroanatomic substrate of motor coordination in childhood and ask whether this substrate differs in the presence of concurrent symptoms of attention-deficit/hyperactivity disorder (ADHD).
Participants were 226 children. All completed Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)-based assessment of ADHD symptoms and standardized tests of motor coordination skills assessing aiming/catching, manual dexterity and balance. Symptoms of developmental coordination disorder (DCD) were determined using parental questionnaires. Using 3 Tesla magnetic resonance data, four latent neuroanatomic variables (for the cerebral cortex, cerebellum, basal ganglia and thalamus) were extracted and mapped onto each motor coordination skill using partial least squares pathway modeling.
The motor coordination skill of aiming/catching was significantly linked to latent variables for both the cerebral cortex (t = 4.31, p < 0.0001) and the cerebellum (t = 2.31, p = 0.02). This effect was driven by the premotor/motor cortical regions and the superior cerebellar lobules. These links were not moderated by the severity of symptoms of inattention, hyperactivity and impulsivity. In categorical analyses, the DCD group showed atypical reduction in the volumes of these regions. However, the group with DCD alone did not differ significantly from those with DCD and co-morbid ADHD.
The superior cerebellar lobules and the premotor/motor cortex emerged as pivotal neural substrates of motor coordination in children. The dimensions of these motor coordination regions did not differ significantly between those who had DCD, with or without co-morbid ADHD.
Introduction: In Canada, major trauma is a healthcare priority and in 2014 was responsible for over 15866 deaths, with a total economic burden of 26.8 billion dollars. Numerous factors influence the likelihood of occurrence and outcome from major trauma, including incident factors, host, EMS response, emergency, surgical and critical care. Traditionally trauma registers contained information that mainly concerning hospital treatment and host factors. This collaborative analysis uses matched data from a Provincial Trauma Research Register and records from a Provincial Ambulance Service. Methods: A retrospective observational (registry) study comparing rural and urban adult and pediatric major trauma patients (Injury Severity Score >15) who were injured in a motor vehicle crash (ICD V20-V99) and presented to a level 1 or level 2 trauma centre by EMS by primary or secondary transfer, between April 2011 and March 2013 in a selected province in Canada. Comparisons of the process care times, and patient disposition, were made in an inclusive trauma system. Results: 108 cases meet the inclusion criteria with 78 considered rural and 30 urban using published definitions. The median response times were 16.2 minutes for rural (95% CI: 13.2 -19.8) and 7.8 minutes for urban (95% CI: 7.2 - 10.5) with 60% and 61% meeting response targets respectively. A greater proportion of urban patients are taken initially to level 3-5 centers and require secondary transfer (45% urban vs 24% rural p=<0.01). Median times intervals to surgical care were double for the urban patients (14 rural vs 32 hrs urban p=<0.01). Conclusion: The majority of serious road traffic collisions occur in rural areas. Although rural patients wait longer for an initial EMS response, more rural patients are taken directly to a level 1 or 2 trauma center. Unexpectedly then rural patients have much shorter times to surgical care. The benefits of an inclusive trauma system should be weighed against the benefits of bypass processes in urban environments where the nearest Emergency Department is not a Level 1 or 2 Trauma Center.
The appearance of SN 1987A led to the implementation of a fast sampling option in the data collection system of the photometer on the University of Tasmania’s optical telescope. This option permits acquisition of continuous data trains of over one hour’s duration at sample rates of 5 kHz. Monitoring of SN 1987 A at regular intervals has permitted upper limits to be assigned to any pulsed fraction of the optical flux. Successful test observations of the Crab pulsar have been obtained, as well as observations of the geostationary Aussat satellites during their bi-annual specular-reflection episodes. For the latter, very accurate spin rates (∼1 Hz) are determinable in short data runs because of the higher frequency components (∼100 Hz) in their light curves. These components are produced by the rows of solar cells on the outer surfaces of the satellites, and fast-Fourier transform analyses essentially permit the numbers of rows of cells to be counted precisely.
Methadone, a long-acting opioid agonist commonly used in the treatment of opiate dependence, has been reported to cause QTc interval prolongation, increasing the risk of a fatal cardiac arrhythmia – Torsades-de-Pointes (TdP). This effect seems to be attributable to methadone's inhibitory effect on the cardiac “hERG”-K+ ion channel and is dose-dependent. There is a lack of consensus regarding when to perform an ECG for patients on methadone.
Identifying other TdPPRFs in a cohort of patients receiving ≥ 85 mg (high dose) methadone daily to inform local clinical safety guidelines.
Our outpatient caseload was filtered to select opiate-dependent patients receiving more than 85 mg methadone daily. Primary care summaries and laboratory results databases were analysed for the presence of other TdPPRFs: female sex a documented history of ECG abnormalities, electrolyte imbalance, liver or renal failure, and concomitant use of other QT prolonging medication or stimulants.
Fourteen opiate-dependent patients (10.29% of patients on methadone) were maintained on ≥ 85 mg methadone daily. Gender distribution was F:M = 1:1.8; 64% misused illicit stimulants; 57% were prescribed other QTc prolonging medication and 29% had a documented history of liver/renal failure or electrolyte imbalance. Only 14% had previous ECGs documented in primary care summaries. Of patients on high dose methadone, 85.7% had at least one TdPPRFs present and 64.3% had at least two.
These results demonstrate an increased rate of TdPPRFs in this patient group and highlight the importance of ECG monitoring which ideally should be offered to patients receiving even lower doses of methadone.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Percolation of blood and of interstitial fluids into implantable continuous glucose sensors (CGS) for diabetics presently limits sensor lifetime between 3 and 7 days. Na+ mobile ions in body fluids damage Si-based CGS sensors electronics. The direct detection of Na percolation is investigated by Ion Beam Analysis (IBA) and Proton Induced X-ray Emission (PIXE) in previously used CGS. Based on these results, a new technology called HemaDropTM is then tested to prepare small volume (5-10 µL) of blood for IBA. A species’s detectability by IBA scales with the square of the ratio of element’s atomic number Z to that of the substrate. Because Na has a low atomic number (Z=11), Si signals from sensor substrates can prevent Na detection in Si by 2 mega electron volt (MeV) IBA.
Using 4.7 MeV 23Na (α, α)23Na nuclear resonance (NR) can increase the 23Na scattering cross section and thus its detectability in Si. The NR energy, width, and resonance factor, is calibrated via two well-known alpha (α) particle signals with narrow energy spreads: a 5.486 ± 0.007 MeV 241Am α-source (ΔΕ = 0.12%) and the 3.038 ± 0.003 MeV 16O(α, α)16O NR (ΔΕ = 0.1%). Next, the NR cross section is calibrated via 100 nm NaF thin films on Si(100) by scanning the beam energy. The23Na (α, α) NR energy is found to be 4.696 ± 0.180 MeV, and the NR/RBS cross section 141 ± 7%. This is statistically significant but small compared to the 4.265 MeV 12C NR (1700%) and 3.038 MeV 16O NR (210%), and insufficient to detect small amounts of 23Na in Si. Next, a new method of sample preparation HemaDropTM, is tested for detection of elements in blood, such Fe, Ca, Na, Cl, S, K, C, N, and O, as an alternative to track fluid percolation and Na diffusion in damaged sensors. Detecting more abundant, heavier elements in blood and interstitial fluids can better track fluid percolation and Na+ ions in sensors. Both Na detection and accuracy of measured blood composition by IBA is greatly improved by using HemaDropTM sample preparation to create Homogeneous Thin Solid Films (HTSFs) of blood from 5-10 µL on most substrates. HTSF can be used in vacuo such as 10-8 –10-6 Torr).
General Practitioner consultation rates for influenza-like illness (ILI) are monitored through several geographically distinct schemes in the UK, providing early warning to government and health services of community circulation and intensity of activity each winter. Following on from the 2009 pandemic, there has been a harmonization initiative to allow comparison across the distinct existing surveillance schemes each season. The moving epidemic method (MEM), proposed by the European Centre for Disease Prevention and Control for standardizing reporting of ILI rates, was piloted in 2011/12 and 2012/13 along with the previously proposed UK method of empirical percentiles. The MEM resulted in thresholds that were lower than traditional thresholds but more appropriate as indicators of the start of influenza virus circulation. The intensity of the influenza season assessed with the MEM was similar to that reported through the percentile approach. The MEM pre-epidemic threshold has now been adopted for reporting by each country of the UK. Further work will continue to assess intensity of activity and apply standardized methods to other influenza-related data sources.
Biogenic nitrogen (N2) and nitrous oxide (N2O) accumulations were measured in groundwater, streams and the vadose zone of small agricultural watersheds in the Mid-Atlantic USA. In general, N2 and N2O in excess of atmospheric equilibrium were found in groundwater virtually everywhere that was sampled. Excess N2 in groundwater ranged from undetectable to 616 μmol N2-N/l, the latter representing c. 50% of background N2. The N2O-N concentrations varied from undetectable to 75 μm, and usually greatly exceeded values at atmospheric equilibrium (25–30 nM); however, N2O was generally 1–10% of excess N2. Intermediate levels of deficit and excess N2 in flowing streams (−65 to +250 μmol N2-N/L) resulting from both abiotic and biotic processes were also measured. In vadose zone gases, multiple N2/Ar gas profiles were measured which exhibited seasonal variations with below atmospheric values when the soil was warming in spring/summer and above atmospheric values when groundwater was cooling in fall/winter. Both abiotic and biotic processes contributed to the excess N2 and N2O that was observed. The current data indicate that large concentrations of excess N gases can accumulate within soil, groundwater, and streams of agriculturally dominated watersheds. When excess N gases are exchanged with the atmosphere, the net fluxes to the atmosphere may represent an important loss term for watershed N budgets.
Nitrification inhibitors are used in agriculture for the purpose of decreasing nitrogen (N) losses, by limiting the microbially mediated oxidation of ammonium (NH4+) to nitrate (NO3−). Successful inhibition of nitrification has been shown in numerous studies, but the extent to which inhibitors affect other N transformations in soil is largely unknown. In the present study, cattle slurry was applied to microcosms of three different grassland soils, with or without the nitrification inhibitor dicyandiamide (DCD). A solution containing NH4+ and NO3−, labelled with 15N either on the NH4+ or the NO3− part, was mixed with the slurry before application. Gross N transformation rates were estimated using a 15N tracing model. In all three soils, DCD significantly inhibited gross autotrophic nitrification, by 79–90%. Gross mineralization of recalcitrant organic N increased significantly with DCD addition in two soils, whereas gross heterotrophic nitrification from the same pool decreased with DCD addition in two soils. Fungal to bacterial ratios were not significantly affected by DCD addition. Total gross mineralization and immobilization increased significantly across the three soils when DCD was used, which suggests that DCD can cause non-target effects on soil N mineralization–immobilization turnover.