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Dialysis patients may not have access to conventional renal replacement therapy (RRT) following disasters. We hypothesized that improvised renal replacement therapy (ImpRRT) would be comparable to continuous renal replacement therapy (CRRT) in a porcine acute kidney injury model.
Following bilateral nephrectomies and 2 hours of caudal aortic occlusion, 12 pigs were randomized to 4 hours of ImpRRT or CRRT. In the ImpRRT group, blood was circulated through a dialysis filter using a rapid infuser to collect the ultrafiltrate. Improvised replacement fluid, made with stock solutions, was infused pre-pump. In the CRRT group, commercial replacement fluid was used. During RRT, animals received isotonic crystalloids and norepinephrine.
There were no differences in serum creatinine, calcium, magnesium, or phosphorus concentrations. While there was a difference between groups in serum potassium concentration over time (P < 0.001), significance was lost in pairwise comparison at specific time points. Replacement fluids or ultrafiltrate flows did not differ between groups. There were no differences in lactate concentration, isotonic crystalloid requirement, or norepinephrine doses. No difference was found in electrolyte concentrations between the commercial and improvised replacement solutions.
The ImpRRT system achieved similar performance to CRRT and may represent a potential option for temporary RRT following disasters.
Marine-terminating glaciers, such as those along the coastline of Greenland, often release meltwater into the ocean in the form of subglacial discharge plumes. Though these plumes can dramatically alter the mass loss along the front of a glacier, the conditions surrounding their genesis remain poorly constrained. In particular, little is known about the geometry of subglacial outlets and the extent to which seawater may intrude into them. Here, the latter is addressed by exploring the dynamics of an arrested salt wedge – a steady-state, two-layer flow system where salty water partially intrudes a channel carrying fresh water. Building on existing theory, we formulate a model that predicts the length of a non-entraining salt wedge as a function of the Froude number, the slope of the channel and coefficients for interfacial and wall drag. In conjunction, a series of laboratory experiments were conducted to observe a salt wedge within a rectangular channel. For experiments conducted with laminar flow (Reynolds number
), good agreement with theoretical predictions are obtained when the drag coefficients are modelled as being inversely proportional to
. However, for fully turbulent flows on geophysical scales, these drag coefficients are expected to asymptote toward finite values. Adopting reasonable drag coefficient estimates for this flow regime, our theoretical model suggests that typical subglacial channels may permit seawater intrusions of the order of several kilometres. While crude, these results indicate that the ocean has a strong tendency to penetrate subglacial channels and potentially undercut the face of marine-terminating glaciers.
Alcohol misuse is common in bipolar disorder and is associated with worse outcomes. A recent study evaluated integrated motivational interviewing and cognitive behavioural therapy for bipolar disorder and alcohol misuse with promising results in terms of the feasibility of delivering the therapy and the acceptability to participants.
Here we present the experiences of the therapists and supervisors from the trial to identify the key challenges in working with this client group and how these might be overcome.
Four therapists and two supervisors participated in a focus group. Topic guides for the group were informed by a summary of challenges and obstacles that each therapist had completed at the end of therapy for each individual client. The audio recording of the focus group was transcribed and data were analysed using thematic analysis.
We identified five themes: addressing alcohol use versus other problems; impact of bipolar disorder on therapy; importance of avoidance and overcoming it; fine balance in relation to shame and normalising use; and ‘talking the talk’ versus ‘walking the walk’.
Findings suggest that clients may be willing to explore motivations for using alcohol even if they are not ready to change their drinking, and they may want help with a range of mental health problems. Emotional and behavioural avoidance may be a key factor in maintaining alcohol use in this client group and therapists should be aware of a possible discrepancy between clients’ intentions to reduce misuse and their actual behaviour.
Though theory suggests that individual differences in neuroticism (a tendency to experience negative emotions) would be associated with altered functioning of the amygdala (which has been linked with emotionality and emotion dysregulation in childhood, adolescence, and adulthood), results of functional neuroimaging studies have been contradictory and inconclusive. We aimed to clarify the relationship between neuroticism and three hypothesized neural markers derived from functional magnetic resonance imaging during negative emotion face processing: amygdala activation, amygdala habituation, and amygdala-prefrontal connectivity, each of which plays an important role in the experience and regulation of emotions. We used general linear models to examine the relationship between trait neuroticism and the hypothesized neural markers in a large sample of over 500 young adults. Although neuroticism was not significantly associated with magnitude of amygdala activation or amygdala habituation, it was associated with amygdala–ventromedial prefrontal cortex connectivity, which has been implicated in emotion regulation. Results suggest that trait neuroticism may represent a failure in top-down control and regulation of emotional reactions, rather than overactive emotion generation processes, per se. These findings suggest that neuroticism, which has been associated with increased rates of transdiagnostic psychopathology, may represent a failure in the inhibitory neurocircuitry associated with emotion regulation.
The Norfolk Youth Service was created in 2012 in response to calls to redesign mental health services to better meet the needs of young people. The new service model transcends traditional boundaries by creating a single, ‘youth friendly’ service for young people aged 14–25 years. The aim of this study was to investigate the effect of the transition to this new model on patterns of referral, acceptance and service use. We analysed routinely collected data on young people aged 14–25 years referred for secondary mental healthcare in Norfolk before and after implementation of the youth mental health service. The number of referrals, their age and gender, proportion of referrals accepted and average number of service contacts per referral by age pre- and post-implementation were compared.
Referrals increased by 68% following implementation of the new service model, but the proportion of referrals accepted fell by 27 percentage points. Before implementation of the youth service, there was a clear discrepancy between the peak age of referral and the age of those seen by services. Following implementation, service contacts were more equitable across ages, with no marked discontinuity at age 18 years.
Our findings suggest that the transformation of services may have succeeded in reducing the ‘cliff edge’ in access to mental health services at the transition to adulthood. However, the sharp rise in referrals and reduction in the proportion of referrals accepted highlights the importance of considering possible unintended consequences of new service models.
This study explores the formation of circular thin-film hydraulic jumps caused by the normal impact of a jet on an infinite planar surface. For more than a century, it has been believed that all hydraulic jumps are created due to gravity. However, we show that these thin-film hydraulic jumps result from energy loss due to surface tension and viscous forces alone. We show that, at the jump, surface tension and viscous forces balance the momentum in the liquid film and gravity plays no significant role. Experiments show no dependence on the orientation of the surface and a scaling relation balancing viscous forces and surface tension collapses the experimental data. A theoretical analysis shows that the downstream transport of surface energy is the previously neglected critical ingredient in these flows, and that capillary waves play the role of gravity waves in a traditional jump in demarcating the transition from the supercritical to subcritical flow associated with these jumps.
Halloysite with tubular morphology is formed in a wide range of geological environments from the alteration of various rock types. Intrusive acidic coarse-grained rocks, such as granites, pegmatites and anorthosite, with large potash and sodic feldspars contents, are subsequently altered to kaolinite, halloysite and other clay minerals by weathering or shallow hydrothermal fluid activity. Processing to separate the halloysite-kaolinite fraction from the altered host rock provides a product which can be used as a paper filler and in ceramics and fibreglass, among other uses, with various deposits in Brazil, China, Thailand and elsewhere. In the Kerikeri-Matauri Bay district of Northland, North Island, New Zealand, volcanic alkali rhyolite was extruded as domes and cooled rapidly with fine-grained feldspar subsequently altered to halloysite. The IMERYS plant in Matauri Bay separates the clay from the quartz-cristobalite matrix with an ∼20% yield of halloysite. The principal market is for high-quality porcelain and bone china that require low levels of Fe2O3 and TiO2. Deposits with high levels of halloysite occur in China, Turkey and the USA. The Dragon mine in Utah, USAwas recently reopened by Applied Minerals Inc. and now produces halloysite from zones of up to 100% white halloysite. Smaller occurrences of tubular halloysite are mined in China, Turkey and elsewhere from masses of comparatively pure clay that appear to have crystallized directly from solutions in which Al and Si were soluble.
Twenty one samples of relatively pure tubular halloysites (HNTs) from localities in Australia, China, New Zealand, Scotland, Turkey and the USA have been investigated by X-ray diffraction (XRD), infrared spectroscopy (IR) and electron microscopy. The halloysites occur in cylindrical tubular forms with circular or elliptical cross sections and curved layers and also as prismatic tubular forms with polygonal cross sections and flat faces. Measurements of particle size indicate a range from 40 to 12,700 nm for tube lengths and from 20 to 600 nm for diameters. Size distributions are positively skewed with mean lengths ranging from 170 to 950 nm and mean diameters from 50 to 160 nm. Cylindrical tubes are systematically smaller than prismatic ones. Features related to order/ disorder in XRD patterns e.g. as measured by a ‘cylindrical/prismatic’ (CP) index and IR spectra as measured by an ‘OH-stretching band ratio’ are related to the proportions of cylindrical vs. prismatic tubes and correlated with other physical measurements such as specific surface area and cation exchange capacity. The relationships of size to geometric form, along with evidence for the existence of the prismatic form in the hydrated state and the same 2M1 stacking sequence irrespective of hydration state (i.e. 10 vs. 7 Å) or form, suggests that prismatic halloysites are the result of continued growth of cylindrical forms.
“Democracy is more dangerous than pig's meat!” declared Habib Rizieq Shihab, leader of the Front Pembela Islam (FPI; Defenders of Islam Front) during a speech at a local branch in West Java in April 2013. According to Rizieq, embracing democracy was tantamount to abandoning fundamentals of the Islamic faith, posing a far greater threat to the spiritual integrity of the ummah than the consumption of forbidden substances such as pork. “If we consume pig”, he stated, “we are polluted, but can still be returned to a state of purity if we cleanse ourselves seven times. If we eat it we've sinned, however we haven't become an infidel.”
Democracy, however, he argued, marks an irredeemable point of no return. “If democracy is fully embraced by Muslims, and the laws of Allah in turn ignored, then they become apostates (murtad). Democracy can transform us into infidels”.
Established in 1998, and initially subsidized by the military and police as part of a street-level militia mobilized against the student-led reform movement, the FPI has now for over fifteen years expressed “alarm” and outrage at liberal democracy, representing it as a threat to Islamic practice and belief. Many in Indonesia consider it the latest manifestation of political thuggery, albeit wearing religious robes rather than the camouflage fatigues of former regime henchmen such as the Pemuda Pancasila, but with far greater autonomy from its patrons; itself a product of the greater freedom of organization available in the post-New Order period. Its mission statement, the Quranic edict of amar makruf nahi mungkar (to command the good and forbid the bad), is framed as a necessary defensive response to the excesses unleashed by Indonesia's post-authoritarian transition. As one FPI leader expressed it, “democratic reform opened the door for change, the problem however is that just about anyone or anything has been able to walk through that door…pornographers, homosexuals, apostates, all manner of heresy and deviancy”. The door of democratic reform, in their opinion, needs to be closed shut.
Despite its unambiguous rejection of electoral democracy as being antithetical to Islam, and as a virtual “pathway to hell”, hardliners and conservatives such as the FPI have nonetheless proved adept in playing a particular kind of politics shaped by the broader framework of Indonesia's decentralized electoral system.
In North America, terrestrial records of biodiversity and climate change that span Marine Oxygen Isotope Stage (MIS) 5 are rare. Where found, they provide insight into how the coupling of the ocean–atmosphere system is manifested in biotic and environmental records and how the biosphere responds to climate change. In 2010–2011, construction at Ziegler Reservoir near Snowmass Village, Colorado (USA) revealed a nearly continuous, lacustrine/wetland sedimentary sequence that preserved evidence of past plant communities between ~140 and 55 ka, including all of MIS 5. At an elevation of 2705 m, the Ziegler Reservoir fossil site also contained thousands of well-preserved bones of late Pleistocene megafauna, including mastodons, mammoths, ground sloths, horses, camels, deer, bison, black bear, coyotes, and bighorn sheep. In addition, the site contained more than 26,000 bones from at least 30 species of small animals including salamanders, otters, muskrats, minks, rabbits, beavers, frogs, lizards, snakes, fish, and birds. The combination of macro- and micro-vertebrates, invertebrates, terrestrial and aquatic plant macrofossils, a detailed pollen record, and a robust, directly dated stratigraphic framework shows that high-elevation ecosystems in the Rocky Mountains of Colorado are climatically sensitive and varied dramatically throughout MIS 5.
This themed section has at its heart reflections on the development of policy of, and for, information in health and social care over the last ten years in both the UK and Australia. It addresses a set of concerns often overlooked within social policy, namely the use of information and information systems as tools by organisations, policy makers and practitioners in the modernisation or transformation of public services, including in this case health and social care. Not long ago, in both countries, information was perceived as a panacea for the problems of integrating care services between health and social care organisations and these organisations and the patient, client or user of services. The authors focus upon England and Australia and contrast them briefly with other countries in Europe where the state plays a range of roles in the provision of health and social care.
The woylie Bettongia penicillata is categorized as Critically Endangered, having declined by c. 90% between 1999 and 2006. The decline continues and the cause is not fully understood. Within a decline diagnosis framework we characterized the nature of the decline and identified potential causes, with a focus on the species’ largest populations, located in south-west Western Australia. We described the spatio-temporal pattern of the decline, and several attributes that are common across sites. We categorized the potential causes of the decline as resources, predators, disease and direct human interference. Based on the available evidence the leading hypothesis is that disease may be making woylies more vulnerable to predation but this remains to be tested. No substantial recoveries have been sustained to date, and one of the three remaining indigenous populations now appears to be extinct. Therefore, verifying the factors causing the decline and those limiting recovery is becoming increasingly urgent. Active adaptive management can be used to test putative agents, such as introduced predators. Insurance populations and ecological monitoring should also be included in an integrated conservation and management strategy for the species.
One goal of this essay is to offer an exploratory, historiographical analysis of the conquest account in the book of Joshua, an analysis that focuses upon the sociocultural milieu of ancient Judah. I propose to show how this narrative of conquest might have contributed to discourse(s) among the literate Judean community that perpetuated the text, and I will offer a few thoughts on the potential relationship between the narrative and the supposed cultic reforms of the late seventh century b.c.e. A number of biblical scholars have argued that the late monarchic period gave rise to the conquest story as recounted in Joshua. In this essay, I would like to pay special attention to precisely how this narrative might have functioned within the milieu of the late monarchic period, thus refining our understanding of the narrative's contribution to the discourses of this era and our knowledge of its relationship to other narratives that were probably extant at the same time. In other words, what particular features of the narrative might have had special import in this period? Specifically, I will argue that the narrative reveals certain discursive statements about Yahweh's cultic supremacy and about important cultic sites in late monarchic Judah, and that this is evident in particular narratival features that are present in the text.
The Global Energy Assessment (GEA) emphasizes the importance of energy to all societies, which explains a longstanding tendency for governments to be closely involved in the energy sector. The nature and extent of this involvement – the degree and types of energy-related policies – depends on a government's ideological orientation, the particular energy resource endowment in its jurisdiction, the development level of its economy, and specific concerns of its society with respect to energy access, energy security, and the environmental and human health impacts of energy supply and use.
In every country, energy's critical role for the goal of sustainable development is widely acknowledged. This means that energy-related policies need to be assessed in terms of performance with respect to the social, economic, and environmental dimensions that are encompassed by the concept of sustainable development. Ideally, energyrelated policies will make advances with respect to all three of these critical sustainability dimensions. But frequently policymakers are faced with difficult trade-offs in which improvement in one dimension is at the cost of another. Thus, the first goal of energy-related policy design should be to seek win-win opportunities for simultaneously advancing social, economic, and environmental goals. When this is not possible, the goal should be to apply decision-support mechanisms that integrate diverse social objectives and values into the policy design process, such as the application of multi-criteria analysis as described by Munasinghe (1992; 2009).