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We used a randomized crossover design with a washout period of 3–4 weeks to compare health literacy scores obtained using the computerized version with scores obtained using the standard interviewer-administered NVS. ANOVA models and McNemar’s tests assessed differences in outcomes assessed with each version of the NVS and order effects of the testing.
Participants were recruited from multicultural catchment areas in Ontario and Nova Scotia.
English- and French-speaking adults aged 18 years or older.
A total of 180 (81 %) of the 222 adults (112 English/110 French) initially recruited completed both the interviewer-NVS and computer-NVS. Scores for those who completed both assessments ranged from 0 to 6 with a mean of 3·63 (sd 2·11) for the computerized NVS and 3·41 (sd 2·21) for the interview-administered NVS. Few (n 18; seven English, eleven French) participants’ health literacy assessments differed between the two versions.
Overall, the computerized Canadian NVS performed as well as the interviewer-administered version for assessing health literacy levels of English- and French-speaking participants. This Canadian adaptation of the NVS provides Canadian researchers and public health practitioners with an easily administered health literacy assessment tool that can be used to address the needs of Canadians across health literacy levels and ultimately improve health outcomes.
Antineuronal antibodies are associated with psychosis, although their clinical significance in first episode of psychosis (FEP) is undetermined.
To examine all patients admitted for treatment of FEP for antineuronal antibodies and describe clinical presentations and treatment outcomes in those who were antibody positive.
Individuals admitted for FEP to six mental health units in Queensland, Australia, were prospectively tested for serum antineuronal antibodies. Antibody-positive patients were referred for neurological and immunological assessment and therapy.
Of 113 consenting participants, six had antineuronal antibodies (anti-N-methyl-D-aspartate receptor antibodies [n = 4], voltage-gated potassium channel antibodies [n = 1] and antibodies against uncharacterised antigen [n = 1]). Five received immunotherapy, which prompted resolution of psychosis in four.
A small subgroup of patients admitted to hospital with FEP have antineuronal antibodies detectable in serum and are responsive to immunotherapy. Early diagnosis and treatment is critical to optimise recovery.
Background: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a recently described life-threatening autoimmune disorder associated with a characteristic multi-stage neuropsychiatric syndrome. Although it is known that the majority of patients experience neuropsychological disturbance post-treatment, some aspects of the cognitive profile remain unclear. Methods: This study sought to investigate patterns of cognitive functioning in a sample of anti-NMDAR encephalitis patients. Seven (6F:1M; mean age, 26.4 years; range, 16–37 years) treated patients completed a comprehensive set of neurocognitive and social functioning measures. Performance was analyzed using normative data (where available), and comparison with matched controls (10F:4M; mean age, 25.8 years; range, 16–38 years). Results: Individual cognitive profiles ranged from within normal limits to extensive dysfunction. Relative to controls, the patient group’s performance was affected in the domains of verbal/ visual memory, working memory, attention, processing speed, executive functioning, and social cognition. The patient group also reported significantly higher levels of anxiety compared to controls. Conclusions: These results add to the accumulating evidence that neurocognitive deficits, consistent with the distribution and functions of the NMDAR system can persist during recovery from anti-NMDAR encephalitis. This is the first study to provide evidence of performance decrements on measures of social cognition, including some involving theory of mind. (JINS, 2016, 22, 828–838)
The Southern Alps – Ligurian basin junction is one of the most active seismic areas in Western Europe countries. The topographic and the structural setting of this region is complex because of (i) its position between the high topography of the Southern Alps and the deep, narrow Ligurian oceanic basin, and (ii) the large number of structures inherited from the Alpine orogeny. Historical seismicity reveals about twenty moderate-size earthquakes (up to M=6.0), mostly distributed along the Ligurian coast and the Vésubie valley. A recent geodetic experiment shows a significant strain rate during the last 50 years in the area between the Argentera massif and the Mediterranean coastline. Results of this experiment suggest a N-S shortening of about 2-4 mm/yr over the network, this shortening direction is consistent with the seismological (P-axes of earthquakes) and the microtectonic data. The Pennic front (E-NE of the Argentera massif) and the northern Ligurian margin are the most seismically active areas. In the Nice arc and in the Argentera massif, some seismic lineaments correspond to faults identified in the field (such as theTaggia-Saorge fault or the Monaco-Sospel fault). In the western part of the Alpes Maritimes, no seismic activity is recorded in the Castellane arc. In the field, geological evidence, such as offsets of recent alluvial sediments, recent fault breccia, speleothem deformations, radon anomalies and others indicates recent deformation along these faults. Nevertheless, to this date active fault scarps have not been identified: this probably results from a relatively high erosion rate versus deformation rate and from the lack of Quaternary markers. We also suspect the presence of two hidden active faults, one in the lower Var valley (Nice city area) and the other one at the base of the Argentera crustal thrust-sheet. Offshore, along the northern Ligurian margin, the seismic reflection data shows traces of Quaternary extensional deformation, but the accuracy of the data does not yet allow the construction of a structural map nor does it allow the determination of the continuity between the offshore and onshore structures. From these data set we propose a preliminary map of 11 active faults and we discuss the questions which remain unsolved in the perspective of seismic hazard evaluations.
Approximately 25% of people will be affected by a mental disorder at some stage in their life. Despite the prevalence and negative impacts of mental disorders, many people are not diagnosed or do not receive adequate treatment. Therefore primary healthcare has been identified as essential to improving the delivery of mental healthcare. Consultation liaison is a model of mental healthcare where the primary care provider maintains the central role in the delivery of mental healthcare, with a mental health specialist providing consultative support. Consultation liaison has the potential to enhance the delivery of mental healthcare in the primary care setting and, in turn, improve outcomes for people with a mental disorder.
We conducted a systematic review to examine the relationship between intracranial pressure monitors (ICP) monitors and mortality in traumatic brain injury (TBI). We systematically searched for articles that met the following criteria: (1) adults patients, (2) TBI, (3) use of an ICP monitor, (4) point estimate for mortality with ICP monitoring (5) adjustment for potential confounders. Six observational studies were identified with 11,371 patients. There was marked between-study heterogeneity that precluded a pooled analysis. Patients with ICP monitors had different clinical characteristics and received more ICP targeted therapy in the ICU. Four studies found no significant relationship between ICP monitoring and survival, while the other two studies demonstrated conflicting results. Significant confounding by indication in observational studies limits the examination of isolated TBI interventions. More research should focus on interventions that affect TBI careplan systems. Further research is needed to identify which subset of severe TBI patients may benefit from ICP monitoring.
Results of a series of oscillatory dynamic stall tests of a rotor aerofoil fitted with a pulsed, trailing-edge flap are presented. Flap deflection amplitude, motion profile, duration and starting phase were investigated to assess the potential of the flap for mitigating the adverse effects of dynamic stall, which is one of the limiting factors for rotor blades on the retreating side of a helicopter rotor. The tests were a continuation of the investigations by Ref. 1 who used a computational fluid dynamics method on a symmetric NACA section, and our results broadly confirm their conclusions by experimental test, using a modern rotor section. The results presented in this paper also confirm the observations from experimental work by Refs 2 and 3, which were undertaken at lower Reynolds number and with a larger flap. In the present study, the flap mitigates the high negative pitching moment and negative pitch damping seen in dynamic stall by strong suction being generated over the aerofoil lower surface, and it is the modification to the lower surface shape by the flap that creates this effect. The dynamic stall vortex acts to enhance the lower surface suction, and careful flap phasing and flap motion profile shaping can make the control more effective.
Maternal fat intake and adipose reserves are major sources of PUFA during lactation. The present study examined the cross-sectional relationship between prolonged breast-feeding and maternal BMI, assessed adequacy of fat intake among lactating and non-lactating mothers of children 24–48 months of age and determined breast-milk fatty acid composition. Multi-stage sampling was used to select a representative sample of mothers from two rural districts in Bangladesh (n 474). Dietary data were collected during two non-consecutive 24 h periods via 12 h in-home daytime observations and recall. The National Cancer Institute method for episodically consumed foods was used to estimate usual intake distributions. Breast milk samples were collected from ninety-eight women, and breast-milk fatty acid methyl esters were quantified using GC. Approximately 42 % of lactating v. 26 % of non-lactating mothers were underweight (BMI < 18·5 kg/m2; P = 0·0003). The maternal diet was low in total fat (approximately 8 % of mean total energy) and food sources of PUFA, including oil and animal source foods, resulting in a low estimated mean total consumption of PUFA (5·1 g/d). Almost all women were estimated to consume less than the recommended intake levels for total fat, total PUFA, α-linolenic acid (ALA) and DHA. Median breast-milk linoleic acid (8·5 % weight) and ALA (0·2 %) concentrations were among the lowest reported in the literature, in contrast with arachidonic acid (0·5 %) and DHA (0·3 %) concentrations, which were mid-range. Bangladeshi women in general, and especially those who practise prolonged breast-feeding, may benefit from increased consumption of food sources of PUFA.
Nutrigenomics is the study of how constituents of the diet interact with genes, and their products, to alter phenotype and, conversely, how genes and their products metabolise these constituents into nutrients, antinutrients, and bioactive compounds. Results from molecular and genetic epidemiological studies indicate that dietary unbalance can alter gene–nutrient interactions in ways that increase the risk of developing chronic disease. The interplay of human genetic variation and environmental factors will make identifying causative genes and nutrients a formidable, but not intractable, challenge. We provide specific recommendations for how to best meet this challenge and discuss the need for new methodologies and the use of comprehensive analyses of nutrient–genotype interactions involving large and diverse populations. The objective of the present paper is to stimulate discourse and collaboration among nutrigenomic researchers and stakeholders, a process that will lead to an increase in global health and wellness by reducing health disparities in developed and developing countries.
Measurements of the flow field around a model rotor descending axially into its own vortex wake have been performed using particle image velocimetry (PIV). At low descent rates, the expected cylindrical down-flow structure below the rotor is observed. At slightly higher descent rate, the flow enters the so-called vortex ring state (VRS) where the vorticity from the rotor accumulates into a toroidal structure near the rotor tips, and a large recirculation zone forms above the rotor disk. In the VRS, the flow below the rotor shows a significant upwards component, with a small up-flow zone penetrating right up to the rotor disk. Measurements show there to be a range of descent rates just before the onset of the VRS over which the flow may be interpreted to be in an incipient VRS condition. In this range, analyses of individual PIV measurements indicate that the flow near the rotor intermittently switches between the down-flow topology found at lower descent rates and the flow topology found in the fully developed VRS. The frequency of excursions of the flow into the VRS topology increases as the descent rate of the rotor is increased until, at high enough descent rate, the flow remains locked within its toroidal state.
The role of international private law is often regarded as being ‘derived from a desire to do justice’ for parties involved in cross-border disputes. The onset of electronic commerce and the increasing prevalence of electronic contracts pose new challenges for international private law. Entering into a contract by electronic means enables parties who are domiciled (or have a place of business) in different jurisdictions to use the Internet or e-mail for the purchase and sale of goods and services or a combination of both. Whilst issues of privacy and security are undoubtedly of extreme importance to consumers when conducting their transactions online, other aspects of the electronic consumer contract are just as important. From an international private law perspective, rules of jurisdiction and the law to be applied to online consumer contracts have been the subject of considerable debate.
International private law and electronic commerce
In a paper published in 1997, Vaughan Black asserted that international private law need only be considered in one-off cases when cross-border matters arise. Given today's globalisation of markets and finance, combined with increased co-operation between governments internationally, cross-border cases are by no means exceptional. Rules and principles of international private law need to be considered more often, especially if parties to a contract have not agreed which law is to apply to that contract, or if aspects of their agreement are in dispute.
The Very Large Telescope (VLT) Observatory on Cerro Paranal (2635
m) in Northern Chile is approaching completion. After the four 8-m
Unit Telescopes (UT) individually saw first light in the last years,
two of them were combined for the first time on October 30, 2001 to
form a stellar interferometer, the VLT Interferometer. The remaining
two UTs will be integrated into the interferometric array later this
year, so that any two UTs can be used for interferometry. In this
article, we will describe the subsystems of the VLTI and the planning
for the following years.
Many wake flows exhibit self-excited flow oscillations which are
sustained by the flow
itself and are not caused by amplification of external noise. The archetypal
of a self-excited wake flow is the low Reynolds number flow past a circular
This flow exhibits self-sustained periodic vortex shedding above a critical
number. In general, control of such flows requires stabilization of many
unstable modes; the present work describes a multiple-sensor control strategy
cylinder wake which succeeds in controlling a simplified wake model at
number above that at which single-sensor schemes fail.
Representation of the flow field by a finite set of coherent structures
which are extracted by proper orthogonal decomposition and correspond to
large-scale wake components, allows the efficient design of a closed-loop
algorithm. A neural network is used to furnish an empirical prediction
of the modal
response of the wake to external control forcing. This model avoids the
explicit representation of the control actuator–wake interaction.
neural network structure of the model allows the design of a robust nonlinear
control algorithm. Furthermore the controller does not necessarily require
field information, but can control the wake using other quantities (for
visualization pictures) which characterize the structure of the velocity
control of a simplified cylinder wake model is used to demonstrate the
the low-dimensional control strategy.
‘And many chariots were smashed to pieces in the dust…’ My conjecture seems far more vibrant and vivid than Edgar Lobel's suggestion Adopting my supplement the Greek will mean that the chariots are not only broken but actually smashed to pieces. This Epic form fits well into a poem that already has so much Epic usage.
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