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Given the range and reach of psychosocial support (PSS) interventions in humanitarian settings, within the continuum of mental health and psychosocial support services, evaluation of their impact is critical. Understanding stakeholders' perspectives on which PSS interventions of unknown effectiveness warrant rigorous evaluation is essential to identify research priorities. This project aimed to facilitate a process with stakeholders to reach consensus on PSS interventions that are of high priority for further research based on existing evidence and stakeholders' opinions.
Interviews with 109 stakeholders working on PSS programming in humanitarian settings served as the foundation for two in-person regional meetings and four webinars. Nominal Group Technique (NGT) was used to develop a priority PSS program list. The top five priorities from each meeting were combined for a final online survey distributed globally.
Seventy participants across six meetings contributed to the prioritization process. Eighty-seven individuals completed the final online survey. ‘Community based PSS’ was the top-ranked research priority, followed by PSS integrated into basic services, providing PSS to caregivers to improve child wellbeing, PSS-focused gender-based violence programming, and classroom-based PSS interventions.
NGT and online surveys were effective methods to engage stakeholders in a priority setting exercise to development a research agenda. Information from this stage of the project will be combined with findings from a concurrent systematic review to form the base of a second phase of work, which will include the development and implementation of a research strategy to strengthen the evidence base for those prioritized interventions.
In Canada, recreational use of cannabis was legalized in October 2018. This policy change along with recent publications evaluating the efficacy of cannabis for the medical treatment of epilepsy and media awareness about its use have increased the public interest about this agent. The Canadian League Against Epilepsy Medical Therapeutics Committee, along with a multidisciplinary group of experts and Canadian Epilepsy Alliance representatives, has developed a position statement about the use of medical cannabis for epilepsy. This article addresses the current Canadian legal framework, recent publications about its efficacy and safety profile, and our understanding of the clinical issues that should be considered when contemplating cannabis use for medical purposes.
Background: SMA is characterized by reduced levels of survival of motor neuron (SMN) protein from deletions and/or mutations of the SMN1 gene. While SMN1 produces full-length SMN protein, a second gene, SMN2, produces low levels of functional SMN protein. Risdiplam (RG7916/RO7034067) is an investigational, orally administered, centrally and peripherally distributed small molecule that modulates pre-mRNA splicing of SMN2 to increase SMN protein levels. Methods: FIREFISH (NCT02913482) is an ongoing, multicenter, open-label operationally seamless study of risdiplam in infants aged 1–7 months with Type 1 SMA and two SMN2 gene copies. Exploratory Part 1 (n=21) assesses the safety, tolerability, pharmacokinetics and pharmacodynamics of different risdiplam dose levels. Confirmatory Part 2 (n=40) is assessing the safety and efficacy of risdiplam. Results: In a Part 1 interim analysis (data-cut 09/07/18), 93% (13/14) of babies had ≥4-point improvement in CHOP-INTEND total score from baseline at Day 245, with a median change of 16 points. The number of infants meeting HINE-2 motor milestones (baseline to Day 245) increased. To date (data-cut 09/07/18), no drug-related safety findings have led to patient withdrawal. No significant ophthalmological findings have been observed. Conclusions: In FIREFISH Part 1, risdiplam improved motor function in infants with Type 1 SMA.
Background: Déjà vu is a common manifestation of temporal lobe seizures. It can be reproduced by electrical stimulation of the hippocampus, amygdala and temporal neocortex with stereotactically implanted electrodes. We report here déjà vu triggered by the stimulation of the insula. Methods: Two patients suffering from intractable temporal lobe epilepsy exhibiting auras of déjà vu underwent invasive EEG studies. One patient had a prior temporal lobectomy with reoccurrence of similar symptoms after surgery. We performed functional connectivity analyses using phase locking value (PLV) to estimate changes in connectivity between different brain regions in the standard EEG frequency bands during stimulation. Results: Stimulation of the insular cortex induced reproducible déjà vu symptoms in both patients. In one patient, PLV analysis showed increased synchronization in the alpha band between insular and temporal regions after an evoked déjà vu compared to a control stimulation. Conclusions: Our results suggest that the insula may in rare occasions generate déjà vu. This implies that insular epileptogenicity cannot be ruled out in patients exhibiting such an aura nor in patients with persisting déjà vu despite an initial amygdalo-hippocampectomy.
Oscillations jn "d" vs. sin2ψ plots are due to the inhomogeneous partitioning of strains within the diffracting volume. In polycrystalline specimens, such inhomogeneity can be caused by the elastic incompatibility of neighboring grains or by the inhoniogeneous partitioning of plastic deformation within the diffracting volume. There is, however, little work on the degree of inhomogeneity required to cause a given oscillation, and the relative contribution from the elastic and plastic deformation components to a given oscillation.
Recent studies indicate that, if the stress/strain field within the irradiated volume in an x-ray stress determination experiment is inhomogeneous, oscillations occur in the interplanar spacing vs. sin2ψ plots. There is, however, little work on the degree of inhomogeneity required to cause a given oscillation, the uniqueness of the stress fields that can cause a given set of oscillations, or the error caused by applying the traditional methods currently in use to oscillatory data.
In this paper, numerical modeling and eiasto-plastic finite element analysis was used to determine the strain fields in the diffracting volume of a polycrystalline sample under load. The elastic strain fields obtained from the analysis were then averaged over the regions that would diffract in an x-ray experiment/and then correlated to x-ray strain data to obtain an idea of the problems described ahove.
The results of an experimental study on residual stresses within the encapsulation layers of electronic components are described. For this study, silicon wafers were coated with a flexibilized cycloaliphatic formulation filled with 30 and 40 (vol.) % of Cu particles. The residual stresses were determined by measuring the radii of curvature of the encapsulated wafers. The stress in the Cu particles at the surface was also measured by X-Ray diffraction. It was seen that the stresses within the structure are primarily macro-stresses, with little stress present within the Cu particles. Comparison of the experimental values to those calculated from linear elasticity theory also indicate relaxation within the composite during curing.
In this paper, we derive geometric and analytic properties of invariant sets, including orbit closures, of a large class of piecewise-affine maps
. We assume that (i)
consists of finitely many affine maps defined on a Borel measurable partition of
, (ii) there is a lattice
that contains all of the mutual differences of the translation vectors of these affine maps, and (iii) all of the affine maps have the same linear part that is an automorphism of
. We prove that finite-volume invariant sets of such piecewise-affine maps always consist of translational tiles relative to this lattice, up to some multiplicity. When the partition is Jordan measurable, we show that closures of bounded orbits of
are invariant and yield Jordan measurable tiles, again up to some multiplicity. In the latter case, we show that compact
-invariant sets also consist of Jordan measurable tiles. We then utilize these results to quantify the rate of convergence of ergodic averages for
in the case of bounded single tiles.
To characterise subjective symptoms in patients undergoing surgical repair of superior semicircular canal dehiscence.
Questionnaires assessing symptom severity and impact on function and quality of life were administered to patients before superior semicircular canal dehiscence surgery, between June 2011 and March 2016. Questionnaire sections included general quality of life, internal amplified sounds, dizziness and tinnitus, with scores of 0–100 points.
Twenty-three patients completed the questionnaire before surgery. Section scores (mean±standard deviation) were: 38.2 ± 25.2 for general quality of life, 52.5 ± 23.9 for internal amplified sounds, 35.1 ± 28.8 for dizziness, 33.3 ± 30.7 for tinnitus, and 39.8 ± 22.2 for the composite score. Cronbach's α statistic averaged 0.93 (range, 0.84–0.97) across section scores, and 0.83 for the composite score.
The Gopen–Yang Superior Semicircular Canal Dehiscence Questionnaire provides a holistic, patient-centred characterisation of superior semicircular canal dehiscence symptoms. Internal consistency analysis validated the questionnaire and provided a quantitative framework for further optimisation in the clinical setting.
Lithium-ion batteries featuring electrodes of silicon nanoparticles, conductive carbon, and polymer binders were constructed with electrolyte containing 1.2 M LiPF6 in ethylene carbonate and diethyl carbonate (1:1, w/w). Material binders used include polyvinylidene difluoride (PVdF), polyacrylic acid (PAA), sodium carboxymethyl cellulose (CMC), and a mixture of equal masses of CMC and PAA (CMCPAA). Hard X-ray photoelectron spectroscopy (HAXPES) was performed on the electrodes when fresh, cycled at reduced potential, and cycled one full time to study how substrate material binders affect the early formation of the solid electrolyte interphase (SEI) layer. Electrodes cycled 5, 10, and 20 times were also analyzed to discern what changes to the SEI occur after initial formation. We also present estimates of the SEI thickness by cycle count, indicating that PAA develops the thinnest SEI, followed by CMCPAA, CMC, and PVdF in order of increasing layer thickness.
Discussion of the phenomena of post-truth and fake news often implicates the closed epistemic networks of social media. The recent conversation has, however, blurred two distinct social epistemic phenomena. An epistemic bubble is a social epistemic structure in which other relevant voices have been left out, perhaps accidentally. An echo chamber is a social epistemic structure from which other relevant voices have been actively excluded and discredited. Members of epistemic bubbles lack exposure to relevant information and arguments. Members of echo chambers, on the other hand, have been brought to systematically distrust all outside sources. In epistemic bubbles, other voices are not heard; in echo chambers, other voices are actively undermined. It is crucial to keep these phenomena distinct. First, echo chambers can explain the post-truth phenomena in a way that epistemic bubbles cannot. Second, each type of structure requires a distinct intervention. Mere exposure to evidence can shatter an epistemic bubble, but may actually reinforce an echo chamber. Finally, echo chambers are much harder to escape. Once in their grip, an agent may act with epistemic virtue, but social context will pervert those actions. Escape from an echo chamber may require a radical rebooting of one's belief system.
Two new species of Oreocharis, O. tribracteata and O. rufescens, are described and a key to the species in Vietnam is provided. The new species have distinct features not previously, or rarely, observed in the genus, both showing the partial fusion of the calyx lobes into a tube, and the presence of three bracts in Oreocharis tribracteata.
Background: Congenital Myasthenic Syndromes (CMS) are heterogeneous disorders caused by genetically determined structural or functional differences in proteins involved with the neuromuscular junctions. Clinical and molecular genetics studies of CMS patients have revealed significant locus heterogeneity; there are 21 known genes related to CMS, but other genes may mimic the phenotype, justifying the use of a multi-gene panel for genetic testing Methods: Our group developed custom sequence capture probes designed to flank 27 different genes associated with CMS, including enrichment for all coding exons as well the flanking intronic regions. We enrolled 20 patients from the paediatric and adult neuromuscular clinic with a clinical phenotype of CMS. Using custom analytical, we -assessed the sequence variants and exon-level CNVs for each patient. Results: Thirteen male and seven female patients with median age of 12.25 years (range 1.5-39y) were assessed. We identified missense and CNVs in 17 patients, including established pathogenic mutations confirming the diagnosis in 5 patients Conclusions: The use of Next Generation Sequence with CNV for CMS can help determine the underlying causes of most CMS disorders and allow appropriate medical treatment, refined genetic counseling, and improved understanding of prognosis, justifying the implementation in the standard clinical screening of CMS.
Recent political changes in Myanmar provide opportunities to expand mental health (MH) services. Given Myanmar's unique situation, we felt a need to assemble and interpret available local information on MH in Myanmar to inform service design, rather than simply drawing lessons from other countries. We reviewed academic and gray literature on the experience of MH problems in Myanmar and the suitability, availability, and effectiveness of MH and psychosocial programming.
We searched: (1) Google Scholar; (2) PubMed; (3) PsychInfo; (4) English-language Myanmar journals and databases; (5) the Mental Health and Psychosocial Support (MHPSS) Network resources website; (6) websites and (7) local contacts of organizations identified during 2010 and 2013 mapping exercise of MHPSS providers; (8) the Myanmar Information Management Unit (MIMU) website; (9) University libraries in Yangon and Mandalay; and (10) identified local MH professionals.
Qualitative data suggest that MH conditions resulting from stress are similar to those experienced elsewhere. Fourteen intervention evaluations were identified: three on community-level interventions, three on adult religion-based practice (meditation), four adult psychotherapeutic interventions, and four child-focused interventions. Support for the acceptability and effectiveness of interventions is mostly anecdotal. With the exception of two rigorous, randomized control trials, most evaluations had serious methodologic limitations.
Few evaluations of psychotherapeutic or psychosocial programs for people from Myanmar have been published in the black or gray literature. Incorporating rigorous evaluations into existing and future programs is imperative for expanding the evidence base for psychotherapeutic and psychosocial programs in this context.
The lead free double perovskite Cs2AgBiBr6 is an upcoming alternative to lead based perovskites as absorber material in perovskite solar cells. So far, the majority of investigations on this interesting material have focused on polycrystalline powders and single crystals. We present vapor and solution based approaches for the preparation of Cs2AgBiBr6 thin films. Sequential vapor deposition processes starting from different precursors are shown and their weaknesses are discussed. Single source evaporation of Cs2AgBiBr6 and sequential deposition of Cs3Bi2Br9 and AgBr result in the formation of the double perovskite phase. Additionally, we show the possibility of the preparation of planar Cs2AgBiBr6 thin films by spin coating.