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Introduction: It is unclear whether anticoagulant or antiplatelet medications increase the risk for intracranial bleeding in older adults after a fall. Our aim was to report the incidence of intracranial bleeding among older adults presenting to the emergency department (ED) with a fall, among patients taking anticoagulants, antiplatelet medications, both medications and neither medication. Methods: This was a systematic review and meta-analysis, PROSPERO reference CRD42019122626. Medline, EMBASE (via OVID 1946 - July 2019), Cochrane, Database of Abstracts of Reviews of Effects databases and the grey literature were searched for studies reporting on older adults who were evaluated after a fall. We included prospective studies conducted in the ED where more than 80% of the cohort were 65 years or older and had fallen. We contacted study authors for aggregate data on intracranial bleeding in patients prescribed anticoagulant medication, antiplatelet medication and neither medication. Incidences of intracranial bleeding were pooled using random effect models, and I2 index was used to assess heterogeneity. Results: From 7,240 publication titles, 10 studies met inclusion criteria. The authors of 8 of these 10 studies provided data (on 9,489 patients). All studies scored low or moderate risk of bias. The pooled incidence of intracranial bleeding among patients taking an anticoagulant medication was 5.1% (n = 5,016, 95% Confidence Interval (CI): 4.1 to 6.3%) I2 = 42%, a single antiplatelet 6.4% (n = 2,148, 95% CI: 5.4 to 7.6%) I2 = 75%, both anticoagulant and antiplatelet medications 5.9% (n = 212, 95% CI: 1.3 to 13.5%) I2 = 72%, and neither of these medications 4.8% (n = 1,927, 95% CI: 3.5 to 6.2%) I2 = 50%. A sensitivity analysis restricted to patients who had a head CT in the ED reported incidences of 6.1% (n = 3,561, 95% CI: 3 to 8.3%), 8.4% (n = 1,781, 95% CI: 5.5 to 11.8%), 6.7% (n = 206, 95% CI 1.5 to 15.2%) and 6.6% (n = 1,310, 95% CI: 5.0 to 8.4%) respectively. Conclusion: The incidence of fall-related intracranial bleeding in older ED patients was similar among patients who take anticoagulant medication, antiplatelet medication, both and neither medication, although there was heterogeneity between study findings.
Background: Brain tumors present unique challenges to patient and family quality of life (QOL). Cognitive dysfunction is common and functionally limiting, with no established treatments. These studies evaluate feasibility and preliminary efficacy of behavioral interventions developed for neuro-oncology patients. Study 1: A randomized controlled trial (N=25 primary brain tumor patients) compared an adapted version of Goal Management Training (GMT, a neuroscience-based integration of mindfulness and strategy training) and a newly-designed supportive psychoeducational intervention (Brain Health Program, BHP) to standard of care. Each intervention comprised 8 individual sessions and at-home practice between sessions. GMT patients’ executive functions improved immediately (p=.077, d=1.13), with maintenance at 4-month follow-up (p=.046, d=1.09). Both intervention groups reported improvements in everyday cognitive functioning immediately (p=.049; d’s GMT=0.43, BHP=0.79) and at follow-up (p=.001; d’s GMT=0.22, BHP=1.01). BHP patients also reported improved mood (p’s=.026 & .012, d’s=0.61 & 0.62). Study 2: Following a needs assessment about cognitive concerns and QOL in brain metastases patients (N=109) and caregivers (N=31), we developed a novel, brief (3 sessions + homework) Cognitive Support Program to provide education and strategy-training in key areas of concern: executive functions, memory, and communication. Options include caregiver co-training, and in-person or web-based delivery. Preliminary data from a pilot trial in progress demonstrate objective and subjective improvements. Conclusions: Cognitive rehabilitation may be a feasible and effective option for primary or metastatic brain tumor patients, addressing a need that is largely unmet in standard cancer care. Further development and larger trials appear warranted, with capacity for remote delivery recommended.
Network analysis is an emerging approach in the study of psychopathology, yet few applications have been seen in eating disorders (EDs). Furthermore, little research exists regarding changes in network strength after interventions. Therefore the present study examined the network structures of ED and co-occurring depression and anxiety symptoms before and after treatment for EDs.
Participants from residential or partial hospital ED treatment programs (N = 446) completed assessments upon admission and discharge. Networks were estimated using regularized Graphical Gaussian Models using 38 items from the Eating Disorders Examination-Questionnaire, Quick Inventory of Depressive Symptomatology, and State-Trait Anxiety Inventory.
ED symptoms with high centrality indices included a desire to lose weight, guilt about eating, shape overvaluation, and wanting an empty stomach, while restlessness, self-esteem, lack of energy, and feeling overwhelmed bridged ED to depression and anxiety symptoms. Comparisons between admission and discharge networks indicated the global network strength did not change significantly, though symptom severity decreased. Participants with denser networks at admission evidenced less change in ED symptomatology during treatment.
Findings suggest that symptoms related to shape and weight concerns and guilt are central ED symptoms, while physical symptoms, self-esteem, and feeling overwhelmed are links that may underlie comorbidities in EDs. Results provided some support for the validity of network approaches, in that admission networks conveyed prognostic information. However, the lack of correspondence between symptom reduction and change in network strength indicates that future research is needed to examine network dynamics in the context of intervention and relapse prevention.
The pepper weevil, Anthonomus eugenii Cano (Coleoptera: Curculionidae), is the most important pest of pepper (Capsicum Linnaeus; Solanaceae) crops in North America. Native to Mexico, the southern United States of America, and Central America, it is intercepted in Canada when peppers are imported to supplement domestic production. Given the proximity of greenhouse and field production to packing facilities, this pest poses a serious risk to the cultivation of peppers in Canada. Once established, it is difficult to control because immature stages of the weevil are protected within the pepper fruit. As such, chemical control targeting these life stages is not effective, and other strategies, including biological control, may prove useful. To explore the potential for biological control options to manage the pepper weevil in areas at risk in Canada, natural enemy surveys were conducted in southern Ontario following the reports of transient, localised field populations in 2016. Parasitoids belonging to three Hymenoptera families including Pteromalidae (Jaliscoa hunteri Crawford, Pteromalus anthonomi Ashmead), Eupelmidae (Eupelmus pulchriceps Cameron), and Braconidae (Nealiolus Mason species, Bracon Fabricius species) were reared from infested field-collected pepper fruits. Together, these new natural enemy records could facilitate the exploration and development of novel agents for the biological control of the pepper weevil.
Neighboring tidewater glaciers often exhibit asynchronous dynamic behavior, despite relatively uniform regional atmospheric and oceanic forcings. This variability may be controlled by a combination of local factors, including glacier and fjord geometry, fjord heat content and circulation, and glacier surface melt. In order to characterize and understand contrasts in adjacent tidewater glacier and fjord dynamics, we made coincident ice-ocean-atmosphere observations at high temporal resolution (minutes to weeks) within a 10 000 km2 area near Uummannaq, Greenland. Water column velocity, temperature and salinity measurements reveal systematic differences in neighboring fjords that imply contrasting circulation patterns. The observed ocean velocity and hydrography, combined with numerical modeling, suggest that subglacial discharge plays a major role in setting fjord conditions. In addition, satellite remote sensing of seasonal ice flow speed and terminus position reveal both speedup and slow-down in response to melt, as well as differences in calving style among the neighboring glaciers. Glacier force budgets and modeling also point toward subglacial discharge as a key factor in glacier behavior. For the studied region, individual glacier and fjord geometry modulate subglacial discharge, which leads to contrasts in both fjord and glacier dynamics.
An overview of the Czech national R&D project HiLASE (High average power pulsed laser) is presented. The project focuses on the development of advanced high repetition rate, diode pumped solid state laser (DPSSL) systems with energies in the range from mJ to 100 J and repetition rates in the range from 10 Hz to 100 kHz. Some applications of these lasers in research and hi-tech industry are also presented.
The Environment Agency Guidance on Requirements for Authorisation (GRA) of a geological disposal facility (GDF) requires a demonstration that "the possibility of a local accumulation of fissile material such as to produce a neutron chain reaction is not a significant concern." A neutron chain reaction that is just self-sustaining is also known as critical.
Waste packages can be designed to ensure that criticality is impossible during the transport and operational phases of a GDF, and for a significant period post-closure. Over longer times, however, packages may degrade, and groundwater flows could lead to a localized accumulation of fissile material. Hence, even though the initial distribution of materials would need to change substantially, criticality cannot be ruled out completely.
This paper describes how an accumulation of fissile material could, hypothetically, lead to a critical configuration; how such a system could evolve; what the local consequences could be; and how the engineered and geological barriers could be affected. The conclusion from studies to date is that, even for large (and very unlikely) fissile accumulations, the consequences of a post-closure criticality event are not a significant concern.
Organic agriculture aims to build soil quality and provide long-term benefits to people and the environment; however, organic practices may reduce crop yields. This long-term study near Mead, NE was conducted to determine differences in soil fertility and crop yields among conventional and organic cropping systems between 1996 and 2007. The conventional system (CR) consisted of corn (Zea mays L.) or sorghum (Sorghum bicolor (L.) Moench)–soybean (Glycine max (L.) Merr.)–sorghum or corn–soybean, whereas the diversified conventional system (DIR) consisted of corn or sorghum–sorghum or corn–soybean–winter wheat (wheat, Triticum aestivum L.). The animal manure-based organic system (OAM) consisted of soybean–corn or sorghum–soybean–wheat, while the forage-based organic system (OFG) consisted of alfalfa (Medicago sativa L.)–alfalfa–corn or sorghum–wheat. Averaged across sampling years, soil organic matter content (OMC), P, pH, Ca, K, Mg and Zn in the top 15 cm of soil were greatest in the OAM system. However, by 2008 OMC was not different between the two organic systems despite almost two times greater carbon inputs in the OAM system. Corn, sorghum and soybean average annual yields were greatest in either of the two conventional systems (7.65, 6.36 and 2.60 Mg ha−1, respectively), whereas wheat yields were greatest in the OAM system (3.07 Mg ha−1). Relative to the mean of the conventional systems, corn yields were reduced by 13 and 33% in the OAM and OFG systems, respectively. Similarly, sorghum yields in the OAM and OFG systems were reduced by 16 and 27%, respectively. Soybean yields were 20% greater in the conventional systems compared with the OAM system. However, wheat yields were 10% greater in the OAM system compared with the conventional DIR system and 23% greater than yield in the OFG system. Alfalfa in the OFG system yielded an average of 7.41 Mg ha−1 annually. Competitive yields of organic wheat and alfalfa along with the soil fertility benefits associated with animal manure and perennial forage suggest that aspects of the two organic systems be combined to maximize the productivity and sustainability of organic cropping systems.
Brian C. Schweinsburg, Department of Psychiatry Yale University School of Medicine New Haven, CT, USA,
Alecia D. Dager Schweinsburg, Department of Psychiatry Yale University School of Medicine New Haven, CT, USA,
Graeme F. Mason, Department of Psychiatry and Department of Diagnostic Radiology Yale University School of Medicine New Haven, CT, USA
The use of substances for psychoactive effects dates to antiquity with evidence in archaeological finds of alcohol-related intoxication and possibly ritualistic use of Nymphaea caerulea in ancient Egypt and alcohol abuse in classic Greek and Roman culture. The neurobehavioral characterization of addiction encompasses a broad spectrum of features. In line with a neurobiological model of addiction, altered neurochemistry remains at the core of the acute and chronic addictive process that is so disruptive to individuals, their families, and the public. This underscores the importance of describing the addiction process through careful in-vivo neurochemical investigation, and it is fortunate that there exist today powerful imaging tools to enhance understanding of human addiction. Drugs of abuse that include methamphetamine, opioids, nicotine, methylenedioxymethamphetamine (MDMA), cannabinoids, and alcohol are discussed. Gender differences in response to acute and long-term exposure may be subserved by neurochemical differences as well.
We investigated an international outbreak of Salmonella Agona with a distinct PFGE pattern associated with an Irish Food company (company X) producing pre-cooked meat products sold in various food outlet chains in Europe. The outbreak was first detected in Ireland. We undertook national and international case-finding, food traceback and microbiological investigation of human, food and environmental samples. We undertook a matched case-control study on Irish cases. In total, 163 cases in seven European countries were laboratory-confirmed. Consumption of food from food outlet chains supplied by company X was significantly associated with being a confirmed case (mOR 18·3, 95% CI 2·2–149·2) in the case-control study. The outbreak strain was isolated from the company's pre-cooked meat products and production premises. Sufficient evidence was gathered to infer the vehicles of infection and sources of the outbreak and to justify the control measures taken, which were plant closure and food recall.
In summer 2008, we investigated an outbreak of diarrhoeal illness in participants of a mountain-bike event in Wales (UK) which had been affected by heavy rain. We conducted a retrospective cohort study to investigate the cause using an internet-based questionnaire. Fifty-three percent of those contacted responded, and 161 (46·5%) out of the 347 responders, reported gastrointestinal symptoms. Median day of onset was 3 days following the event. Ten riders reported receiving a laboratory-confirmed diagnosis of Campylobacter. Multivariate logistic regression analysis identified the inadvertent ingestion of mud (OR 2·5, 95% CI 1·5–4·2, P<0·001) and eating ‘other’ food during the event (OR 2·1, 95% CI 1·2–3·6, P=0·01) as significant risk factors for illness. We concluded that the outbreak was caused by Campylobacter, spread to the riders by the inadvertent ingestion of mud which had been contaminated with sheep faeces from the rural course. Mountain-bike race organizers should consider microbiological hazards when risk-assessing potential race courses. The internet is an efficient tool for the investigation of outbreaks in computer-literate populations.
Duplicate specimens were taken with cotton-wool swabs from the upper tarsal conjunctiva of 63 patients living in Gambian villages in which trachoma is endemic and from 34 infants with ophthalmia neonatorum (ON) attending an outpatient clinic in The Gambia. The detection of Chlamydia trachomatis by direct immunofluorescence (IF) using a conjugated monoclonal antibody to its principal outer membrane protein was compared with isolation in cycloheximide-treated McCoy cells. For trachoma, the sensitivity and specificity of the immunofluorescent technique were 62% and 100% respectively if ten elementary bodies (EBs) was taken as the minimum requirement for positivity by IF. If all cases with one or more EB were considered positive, the sensitivity was 81% and the specificity 85%. For ON the sensitivity and specificity were 100% and 95% respectively, regardless of which criterion was used. In view of its simplicity and easy applicability to field conditions it seems likely that direct IF using monoclonal antibodies may be a useful technique for the detection of C. trachomatis in the conjunctival epithelium of patients with trachoma.
The design of metals and alloys resistant to radiation damage involves the physics of
electronic excitations and the creation of defects and microstructure. During irradiation damage of metals by high energy particles, energy is exchanged between ions and electrons. Such “non-adiabatic” processes violate the Born-Oppenheimer approximation, on which all conservative classical interatomic potentials rest. By treating the electrons of a metal explicitly and quantum mechanically we are able to explore the influence of electronic excitations on the ionic motion during irradiation damage. Simple theories suggest that moving ions should feel a damping force proportional to their velocity and directly opposed to it. In contrast, our simulations of a forced oscillating ion have revealed the full complexity of this force: in reality it is anisotropic and dependent on the ion velocity and local atomic environment. A large set of collision cascade simulations has allowed us to explore the form of the damping force further. We have a means of testing various schemes in the literature for incorporating such a force within molecular dynamics (MD) against our semi-classical evolution with explicitly modelled electrons. We find that a model in which the damping force is dependent upon the local electron density is superior to a simple fixed damping model. We also find that applying a lower kinetic energy cut-off for the damping force results in a worse model. A detailed examination of the nature of the forces reveals that there is much scope for further improving the electronic force models within MD.