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The role of air medical and land-based critical care transport services is not always clear amongst traditional emergency medical service providers or hospital-based health care practitioners. Some of this is historical, when air medical services were in their infancy and their role within the broader health care system was limited. Despite their evolution within the regionalized health care system, some myths remain regarding air medical services in Canada. The goal is to clarify several commonly held but erroneous beliefs regarding the role, impact, and practices in air medical transport.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
To determine if utilizing a single paramedic crew configuration is safe for transporting low acuity patients requiring only a primary care paramedic (PCP) level of care in Air Ambulances.
We studied single-PCP transports of low acuity patients done by contract air ambulance carriers, organized by Ornge (Ontario’s Air Ambulance Service) for one year. We only included interfacility transports. We excluded all scene calls, and all Code 4 (emergent) calls. Our primary outcome was clinical deterioration during transport. We then asked a panel to analyze each case of deterioration to determine if a dual-PCP configuration might have reasonably prevented the deterioration or have better treated the deterioration, compared to a single-PCP configuration.
In one year, contract carriers moved 3264 patients, who met inclusion criteria. 85% were from Northern Ontario. There were 21 cases of medical deterioration (0.6%±0.26%). Paper charts were found for 20 of these cases. Most were self-limited cases of pain or nausea. A small number of cases (n=5) were cardiorespiratory decompensation. There was 100% consensus amongst the panel that all cases of clinical deterioration were not related to team size. There was also 100% consensus that a dual-PCP team would not have been better able to deal with the deterioration, compared to a single-PCP crew.
We found that using a single-PCP configuration for transporting low acuity patients is safe. This finding is particularly important for rural areas where air ambulance is the only means for accessibility to care and where staffing issues are magnified.
The principles for universal reading models proposed by Frost correspond to developmental theories, in which neurocognitive constraints and cultural experiences shape development. We question his contention that Hebrew word identification is fundamentally about roots, excluding verbal and nominal word-pattern morphemes; and we propose that readers use all information available in stimuli, adjusting for volume and usefulness.
National and international policies have encouraged the establishment of a representative network of marine protected areas (MPAs) in South Africa, with the aim of protecting marine biodiversity. The extent to which these marine and estuarine protected areas (EPAs) represent marine fish species and communities was assessed by comparing their species compositions with those of exploited areas, as sampled using four fishing techniques. Seven hundred fish species were sampled, representing one-third of South Africa's marine fishes. MPAs in coastal habitats scored c. 40% on the Bray-Curtis measure of similarity for species representativeness, but this score declined markedly for offshore ‘trawlable’ fishing grounds. The combined effects of sampling error, temporal variation and the effects of fishing on relative abundance suggest that 80% similarity would be the maximum achieveable. Forty-nine per cent of all fish species that were recorded were found in the 14 MPAs sampled. Redundancy in the MPA network was low, with fish species most commonly being represented in only one MPA or absent. There was greater redundancy in the 33 EPAs, with 40% of species being found in two or more EPAs, but many of these estuaries were adjacent to each other and embedded in large MPAs. Deep water fish communities (>80 m deep) and communities located on the west and south-east coasts of South Africa were most poorly represented by MPAs. Routine fishery surveys provide a robust and repeatable opportunity to assess species representativeness in MPAs, and the method used could form the basis of an operational definition of ‘representative’. In contrast to an assessment based on presence-absence data, this analysis of quantitative data presents a more pessimistic assessment of protection.
Screening for alcohol use disorders identifies a wide range of needs, varying from hazardous and harmful drinking to alcohol dependence. Stepped care offers a potentially resource-efficient way of meeting these needs, but requires evaluation in a randomised controlled trial.
To evaluate the feasibility, effectiveness and cost-effectiveness of opportunistic screening and a stepped care intervention in primary care.
A total of 1794 male primary care attendees at six practices in South Wales were screened using the Alcohol Use Disorders Identification Test (AUDIT). Of these, 112 participants who scored 8 or more on the AUDIT and who consented to enter the study were randomised to receive either 5 minutes of minimal intervention delivered by a practice nurse (control group) or stepped care intervention consisting of three successive steps (intervention group): a single session of behaviour change counselling delivered by a practice nurse; four 50-minute sessions of motivational enhancement therapy delivered by a trained alcohol counsellor; and referral to a community alcohol treatment agency.
Both groups reduced alcohol consumption 6 months after randomisation with a greater, although not significant, improvement for the stepped care intervention. Motivation to change was greater following the stepped care intervention. The stepped care intervention resulted in greater cost savings compared with the minimal intervention.
Stepped care was feasible to implement in the primary care setting and resulted in greater cost savings compared with minimal intervention.
Adult readers with developmental phonological dyslexia exhibit significant difficulty comparing pseudowords and pure tones in auditory working memory (AWM). This suggests deficient AWM skills for adults diagnosed with dyslexia. Despite behavioral differences, it is unknown whether neural substrates of AWM differ between adults diagnosed with dyslexia and normal readers. Prior neuroimaging of adults diagnosed with dyslexia and normal readers, and post-mortem findings of neural structural anomalies in adults diagnosed with dyslexia support the hypothesis of atypical neural activity in temporoparietal and inferior frontal regions during AWM tasks in adults diagnosed with dyslexia. We used fMRI during two binaural AWM tasks (pseudowords or pure tones comparisons) in adults diagnosed with dyslexia (n = 11) and normal readers (n = 11). For both AWM tasks, adults diagnosed with dyslexia exhibited greater activity in left posterior superior temporal (BA 22) and inferior parietal regions (BA 40) than normal readers. Comparing neural activity between groups and between stimuli contrasts (pseudowords vs. tones), adults diagnosed with dyslexia showed greater primary auditory cortex activity (BA 42; tones > pseudowords) than normal readers. Thus, greater activity in primary auditory, posterior superior temporal, and inferior parietal cortices during linguistic and non-linguistic AWM tasks for adults diagnosed with dyslexia compared to normal readers indicate differences in neural substrates of AWM comparison tasks. (JINS, 2008, 14, 629–639.)
This paper summarizes the general theory and properties for Apodized Pupil Lyot Coronagraphs which consist of a classical hard-edged Lyot coronagraph with an upstream pupil apodization. The ideal apodization function can be determined from an integral eigenvalue problem which solutions are prolate spheroidal functions. Solutions exist for any geometrty, including rectangular, circular, or elliptical. Formal solutions can be extended to the case of arbitrary apertures, using generalized prolate spheroidal functions for centrally obstructed apertures, spiders, or segmented telescopes. The properties of these coronagraphs enable the possibility of multiple stage coronagraphy and achromatization. The new instrument Gemini Planet Imager (GPI) will include such a coronagraph.
Three new species of Fritillaria are described from specimens collected by a remotely operated vehicle (ROV) between 180 and 735 m depth in Monterey Bay, California. Fritillaria rex becomes the largest species now described for this genus (trunk length up to 10 mm, tail length up to 18 mm). This species is characterized by five or six narrow muscle bundles on each side of the tail, slit-shaped spiracles, a spherical ovary and a cylindrical testis. Fritillaria amphigonadis (trunk length up to 5.2 mm, tail length up to 7.5 mm) is characterized by two narrow muscle bundles on each side of the tail, slit-shaped spiracles, paired spherical ovaries, and a unique pi-shaped testis. Fritillaria lucifer (trunk length up to 4.1 mm, tail length up to 7.0 mm) has 12 extremely thin muscle bundles distributed broadly across the tail, rounded spiracles, a spherical ovary and a U-shaped testis. An additional mesopelagic Fritillaria appears to be consistent with the description of the Mediterranean F. fage, but specific differences in pharyngeal cells, cellular patterns on the tail, and gonadal morphology suggest that the specimens from Monterey Bay are a new variety, F. fagei mbarii. Based on the relatively limited number of collections (i.e. only 20 specimens yielding four unique taxa), it would appear that the possible diversity of larvaceans that live below the surface mixed layer is significantly underestimated.
Early in development, steroid hormones structurally organize various regions of the CNS. However, steroid hormones continue to affect the structure and function of the CNS throughout the life of the individual. In this review, we discuss sex differences and similarities in steroid-induced synaptic plasticity in the adult brain. Particular emphasis is placed on steroid-induced plasticity in the hippocampus, a brain region important in learning and memory. This topic is relevant to the growing evidence for the actions of sex hormones outside of the reproductive neuroendocrine axis. It also tells an important and emerging story about non-genomic and genomic actions of steroids at the cellular and molecular levels. Specifically, the effects of estrogen and progesterone as well as the androgens and glucocorticoids are discussed. The influence of steroids on hippocampal structure and function can differ vastly between the sexes. However, there are certain similarities that might aid in our understanding of how steroids affect CNS plasticity in general. Although future studies will undoubtedly lead us to a greater understanding of these phenomena, the data reviewed indicate that when studying synaptic plasticity, the sex and hormonal milieu of the individual might significantly influence the outcome and interpretation of the research.
fMRI was used to determine the frontal, basal ganglia, and thalamic
structures engaged by three facets of language generation: lexical
status of generated items, the use of semantic vs. phonological
information during language generation, and rate of generation. During
fMRI, 21 neurologically normal subjects performed four tasks:
generation of nonsense syllables given beginning and ending consonant
blends, generation of words given a rhyming word, generation of words
given a semantic category at a fast rate (matched to the rate of
nonsense syllable generation), and generation of words given a semantic
category at a slow rate (matched to the rate of generating of rhyming
words). Components of a left pre-SMA–dorsal caudate
nucleus–ventral anterior thalamic loop were active during word
generation from rhyming or category cues but not during nonsense
syllable generation. Findings indicate that this loop is involved in
retrieving words from pre-existing lexical stores. Relatively diffuse
activity in the right basal ganglia (caudate nucleus and putamen) also
was found during word-generation tasks but not during nonsense syllable
generation. Given the relative absence of right frontal activity during
the word generation tasks, we suggest that the right basal ganglia
activity serves to suppress right frontal activity, preventing right
frontal structures from interfering with language production. Current
findings establish roles for the left and the right basal ganglia in
word generation. Hypotheses are discussed for future research to help
refine our understanding of basal ganglia functions in language
generation. (JINS, 2003, 9, 1061–1077.)
We have undertaken an adaptive optics imaging survey of extra-solar planetary systems and stars showing interesting radial velocity trends from high precision radial velocity searches. Adaptive Optics increases the resolution and dynamic range of an image, substantially improving the detectability of faint close companions. This survey is sensitive to objects less luminous than the bottom of the main sequence at separations as close as 1″. We have detected stellar companions to the planet bearing stars HD 114762 and Tau Boo. We have also detected a companion to the non-planet bearing star 16 Cyg A.
Previous studies showed that cortex in the anterior portions of the left frontal and temporal lobes participates in generating words with emotional connotations and processing pictures with emotional content. If these cortices process the semantic attribute of emotional connotation, they should be active whenever processing emotional connotation, without respect to modality of input or mode of output. Thus, we hypothesized that they would activate during monitoring of words with emotional connotations. Sixteen normal subjects performed semantic monitoring of words with emotional connotations, animal names, and implement names during fMRI. Cortex in the anterior left frontal lobe demonstrated significant activity for monitoring words with emotional connotations compared to monitoring tone sequences, animal names, or implement names. Together, the current and previous results implicate cortex in the anterior left frontal lobe in semantic processing of emotional connotation, consistent with connections of this cortex to paralimbic association areas. Current findings also indicate that neural substrates for processing emotional connotation are independent of substrates for processing the categories of living and nonliving things.
The Bethlem Scale was designed as a validated measure of mother–infant adjustment in mother–baby units.
A multi-centre trial was conducted to investigate aspects of the reliability, validity and clinical usefulness of the Bethlem Mother–infant Interaction Scale within five in-patient psychiatric mother–baby units.
This revealed good inter-rater, test-retest and inter-item reliability. Correlations of the scale items with psychiatrist's ratings and changes in scoring over time suggest reasonable validity, despite some design problems with individual items.
Mother–infant interaction scales may have an important role in improving the quality of care for mothers and their babies in the psychiatric setting. The development of a more extensive scale, the Monash Mother–infant Interaction Scale, is discussed.
Thin films of polystyrene (PS) were modified using oxygen (0+) and helium (He+) ions and analyzed via diffusion and hardness measurements. One micron thick films were modified with 400 keV 0+ and He+ ions. The fluence was varied from 1.7 to 34.0 x 1013 ions/cm2 for both incident ions. Following irradiation, some samples were covered with a probe layer of deuterated PS, and annealed at 170°C. Using forward recoil spectrometry, the diffusion of d-PS and the PS hydrogen loss were measured as a function of incident ion species and dose. For all modified samples, d-PS diffusion was significantly retarded compared to the unmodified case. Atomic force microscopy measurements on the as-cast and irradiated PS samples suggest that the relative hardness of the 0+ modified PS was greater than that of the as-cast PS. The force-displacement curves of the modified PS displayed no hysteresis whereas the as-cast PS had a large hysteresis due to tip penetration and tip-polymer adhesion. These results indicate that ion irradiation decreases transport in PS and increases PS hardness.
The kinetics of BST thin film grain nucleation and growth caused by rapid thermal annealing have been investigated. A series of Ba0.67Sr0.33Tii0.5O3 films were deposited on Pt electrodes using a metal-organic decomposition process. The effects of anneal time and temperature on BST grain sizes were studied by altering the processing conditions during RTA. A series of films were annealed by RTA at temperatures ranging from 550°C to 950°C for times ranging from 30 to 120 seconds. Crystallographic and microstructural characterization were done using XRD and TEM. The XRD results indicated that BST grain size increased with increasing anneal temperature, but was not affected by anneal time. Plan-view TEM indicated that BST grains were imbedded in an amorphous matrix. The average grain size was on the order of 200 Å.