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Tanzania is commonly cited as “a success story” where a cohesive society has been built in tandem with its nationhood. In this chapter, we offer an account of interplay between ethnicity and social norms in the context of nation building in Tanzania and highlight the historical transformation of localized, ethnic-based mechanisms for self-protection, “trust networks”, to a national framework for trust enhancement and resolution of conflicts at local levels. This, we argue, was the key for acceptance of national identity by Tanzanians for self-protection, and, hence, a transition from divided pasts to cohesive futures. The chapter traces nation building efforts in Tanzania, and explains why Tanzania is an exception to the patterns of violence and instability experienced in Sub-Saharan Africa. It is argued that that, although conflicts are sometime inevitable, cross-cutting identities such as occupation, and particularly the all-encompassing identity of nationality, can help to decrease the likelihood that conflicts will divide the nation. Diversity may present a challenge to national unity, but it is not insuperable if the political leadership is genuinely committed to deemphasizing ethnic group identities in the public sphere and pursues policies which consider the goal of equality.
Residual herbicides are routinely applied to control troublesome weeds in pumpkin production. Fluridone and acetochlor, Groups 12 and 15 herbicides, respectively, provide broad-spectrum PRE weed control. Field research was conducted in Virginia and New Jersey to evaluate pumpkin tolerance and weed control to PRE herbicides. Treatments consisted of fomesafen at two rates, ethalfluralin, clomazone, halosulfuron, fluridone, S-metolachlor, acetochlor emulsifiable concentrate (EC), acetochlor microencapsulated (ME), and no herbicide. At one site, fluridone, acetochlor EC, acetochlor ME, and halosulfuron injured pumpkin 81%, 39%, 34%, and 35%, respectively, at 14 d after planting (DAP); crop injury at the second site was 40%, 8%, 19%, and 33%, respectively. Differences in injury between the two sites may have been due to the amount and timing of rainfall after herbicides were applied. Fluridone provided 91% control of ivyleaf morningglory and 100% control of common ragweed at 28 DAP. Acetochlor EC controlled redroot pigweed 100%. Pumpkin treated with S-metolachlor produced the most yield (10,764 fruits ha–1) despite broadcasting over the planted row; labeling requires a directed application to row-middles. A separate study specifically evaluated fluridone applied PRE at 42, 84, 126, 168, 252, 336, and 672 g ai ha–1. Fluridone resulted in pumpkin injury ≥95% when applied at rates of ≥168 g ai ha–1; significant yield loss was noted when the herbicide was applied at rates >42 g ai ha–1. We concluded that fluridone and acetochlor formulations are unacceptable candidates for pumpkin production.
Introduction: Although use of point of care ultrasound (PoCUS) protocols for patients with undifferentiated hypotension in the Emergency Department (ED) is widespread, our previously reported SHoC-ED study showed no clear survival or length of stay benefit for patients assessed with PoCUS. In this analysis, we examine if the use of PoCUS changed fluid administration and rates of other emergency interventions between patients with different shock types. The primary comparison was between cardiogenic and non-cardiogenic shock types. Methods: A post-hoc analysis was completed on the database from an RCT of 273 patients who presented to the ED with undifferentiated hypotension (SBP <100 or shock index > 1) and who had been randomized to receive standard care with or without PoCUS in 6 centres in Canada and South Africa. PoCUS-trained physicians performed scans after initial assessment. Shock categories and diagnoses recorded at 60 minutes after ED presentation, were used to allocate patients into subcategories of shock for analysis of treatment. We analyzed actual care delivered including initial IV fluid bolus volumes (mL), rates of inotrope use and major procedures. Standard statistical tests were employed. Sample size was powered at 0.80 (α:0.05) for a moderate difference. Results: Although there were expected differences in the mean fluid bolus volume between patients with non-cardiogenic and cardiogenic shock, there was no difference in fluid bolus volume between the control and PoCUS groups (non-cardiogenic control 1878 mL (95% CI 1550 – 2206 mL) vs. non-cardiogenic PoCUS 1687 mL (1458 – 1916 mL); and cardiogenic control 768 mL (194 – 1341 mL) vs. cardiogenic PoCUS 981 mL (341 – 1620 mL). Likewise there were no differences in rates of inotrope administration, or major procedures for any of the subcategories of shock between the control group and PoCUS group patients. The most common subcategory of shock was distributive. Conclusion: Despite differences in care delivered by subcategory of shock, we did not find any significant difference in actual care delivered between patients who were examined using PoCUS and those who were not. This may help to explain the previously reported lack of outcome difference between groups.
Introduction: Point of care ultrasound has been reported to improve diagnosis in non-traumatic hypotensive ED patients. We compared diagnostic performance of physicians with and without PoCUS in undifferentiated hypotensive patients as part of an international prospective randomized controlled study. The primary outcome was diagnostic performance of PoCUS for cardiogenic vs. non-cardiogenic shock. Methods: SHoC-ED recruited hypotensive patients (SBP < 100 mmHg or shock index > 1) in 6 centres in Canada and South Africa. We describe previously unreported secondary outcomes relating to diagnostic accuracy. Patients were randomized to standard clinical assessment (No PoCUS) or PoCUS groups. PoCUS-trained physicians performed scans after initial assessment. Demographics, clinical details and findings were collected prospectively. Initial and secondary diagnoses including shock category were recorded at 0 and 60 minutes. Final diagnosis was determined by independent blinded chart review. Standard statistical tests were employed. Sample size was powered at 0.80 (α:0.05) for a moderate difference. Results: 273 patients were enrolled with follow-up for primary outcome completed for 270. Baseline demographics and perceived category of shock were similar between groups. 11% of patients were determined to have cardiogenic shock. PoCUS had a sensitivity of 80.0% (95% CI 54.8 to 93.0%), specificity 95.5% (90.0 to 98.1%), LR+ve 17.9 (7.34 to 43.8), LR-ve 0.21 (0.08 to 0.58), Diagnostic OR 85.6 (18.2 to 403.6) and accuracy 93.7% (88.0 to 97.2%) for cardiogenic shock. Standard assessment without PoCUS had a sensitivity of 91.7% (64.6 to 98.5%), specificity 93.8% (87.8 to 97.0%), LR+ve 14.8 (7.1 to 30.9), LR- of 0.09 (0.01 to 0.58), Diagnostic OR 166.6 (18.7 to 1481) and accuracy of 93.6% (87.8 to 97.2%). There was no significant difference in sensitivity (-11.7% (-37.8 to 18.3%)) or specificity (1.73% (-4.67 to 8.29%)). Diagnostic performance was also similar between other shock subcategories. Conclusion: As reported in other studies, PoCUS based assessment performed well diagnostically in undifferentiated hypotensive patients, especially as a rule-in test. However performance was similar to standard (non-PoCUS) assessment, which was excellent in this study.
A compact X-ray energy spectrometer has been developed consisting essentially of a radioisotope X-ray source, a lithium-drifted silicon (or germanium) detector and a small computer. Interchangeable sources enable efficient excitation of K X-rays from Na to U and L X-rays from about Ag to U. Energy resolution of K X-rays from adjacent elements down to Na is possible. Depending on the source and the part of the spectrum examined, the characteristic X-rays from up to about 15 elements can be simultaneously excited and measured, for either qualitative or quantitative multi-element analysis. The computer stores detected spectra and performs simple data processing such as peak recognition, background subtraction, peak integration, ratioing and solution of linear equations.
The analysis reported in this paper is the determination of V, Cr, Fe, Co, W and Mo in tool steels and is intended to illustrate the capabilities of the radioisotope X-ray fluorescence analysis technique, and the instrument, for multi-element analysis of a system having fairly complex interelement effects.
A 100 mCi Pu-238 source was used to excite the K X-rays of V, Cr, Fe, Co and Mb and the L X-rays of W. The count time used was five minutes per sample. Data reduction consisted essentially of peak integration, background subtraction and solution of sixth order linear matrices of a modified Criss-Birks type. The 36 matrix coefficients were determined using six standards, and were then used to analyze seven other analyzed specimens which were treated as unknowns. The measured values of concentration were in very good agreement with the quoted values. An iteration technique was employed to reduce errors in the matrix inversioiis.
This contribution discusses results obtained from 3-D neutron diffraction and 2-D fabric analyser in situ deformation experiments on laboratory-prepared polycrystalline deuterated ice and ice containing a second phase. The two-phase samples used in the experiments are composed of an ice matrix with (1) air bubbles, (2) rigid, rhombohedral-shaped calcite and (3) rheologically soft, platy graphite. Samples were tested at 10°C below the melting point of deuterated ice at ambient pressures, and two strain rates of 1 × 10−5 s−1 (fast) and 2.5 × 10−6 s−1 (medium). Nature and distribution of the second phase controlled the rheological behaviour of the ice by pinning grain boundary migration. Peak stresses increased with the presence of second-phase particles and during fast strain rate cycles. Ice-only samples exhibit well-developed crystallographic preferred orientations (CPOs) and dynamically recrystallized microstructures, typifying deformation via dislocation creep, where the CPO intensity is influenced in part by the strain rate. CPOs are accompanied by a concentration of [c]-axes in cones about the compression axis, coinciding with increasing activity of prismatic-<a> slip activity. Ice with second phases, deformed in a relatively slower strain rate regime, exhibit greater grain boundary migration and stronger CPO intensities than samples deformed at higher strain rates or strain rate cycles.
The current study examines experiences of interpersonal mistreatment in federal litigation among a random sample of 4,608 practicing attorneys. Using both quantitative and qualitative survey data, we documented the nature and interplay of general incivility, gender-related incivility, and unwanted sexual attention. Nearly 75% of female attorneys had experienced some form of this misconduct in the previous five years, compared to half of male attorneys. An in-depth examination of instigators revealed that not only fellow attorneys but also federal judges, court personnel, marshals, and court security officers instigated the inappropriate behavior. We further found that most attorneys responded to this mistreatment with avoidance and denial; few used or trusted existing reporting mechanisms. The current study surpassed simple prevalence estimates to document effects of interpersonal mistreatment on the professional well-being of targeted attorneys. We discuss implications of these results, drawing on theories of social dominance, sex-role spillover, cognitive stress, organizations, and intervention.
People with dementia fall twice as often and have more serious fall-related injuries than healthy older adults. While gait impairment as a generic term is understood as a fall risk factor in this population, a clear elaboration of the specific components of gait that are associated with falls risk is needed for knowledge translation to clinical practice and the development of fall prevention strategies for people with dementia.
To review gait parameters and characteristics associated with falls in people with dementia.
Electronic databases CINAHL, EMBASE, MedLine, PsycINFO, and PubMed were searched (from inception to April 2017) to identify prospective cohort studies evaluating the association between gait and falls in people with dementia.
Increased double support time variability, use of mobility aids, walking outdoors, higher scores on the Unified Parkinson’s Disease Rating Scale, and lower average walking bouts were associated with elevated risk of any fall. Increased double support time and step length variability were associated with recurrent falls. The reviewed articles do not support using the Performance Oriented Mobility Assessment and the Timed Up-and-Go tests to predict any fall in this population. There is limited research on the use of dual-task gait assessments for predicting falls in people with dementia.
This systematic review shows the specific spatiotemporal gait parameters and features that are associated with falls in people with dementia. Future research is recommended to focus on developing specialized treatment methods for these specific gait impairments in this patient population.
Laser-based compact MeV X-ray sources are useful for a variety of applications such as radiography and active interrogation of nuclear materials. MeV X rays are typically generated by impinging the intense laser onto ~mm-thick high-Z foil. Here, we have characterized such a MeV X-ray source from 120 TW (80 J, 650 fs) laser interaction with a 1 mm-thick tantalum foil. Our measurements show X-ray temperature of 2.5 MeV, flux of 3 × 1012 photons/sr/shot, beam divergence of ~0.1 sr, conversion efficiency of ~1%, that is, ~1 J of MeV X rays out of 80 J incident laser, and source size of 80 m. Our measurement also shows that MeV X-ray yield and temperature is largely insensitive to nanosecond laser contrasts up to 10−5. Also, preliminary measurements of similar MeV X-ray source using a double-foil scheme, where the laser-driven hot electrons from a thin foil undergoing relativistic transparency impinging onto a second high-Z converter foil separated by 50–400 m, show MeV X-ray yield more than an order of magnitude lower compared with the single-foil results.
In their 1960 book on finite Markov chains, Kemeny and Snell established that a certain sum is invariant. The value of this sum has become known as Kemeny’s constant. Various proofs have been given over time, some more technical than others. We give here a very simple physical justification, which extends without a hitch to continuous-time Markov chains on a finite state space. For Markov chains with denumerably infinite state space, the constant may be infinite and even if it is finite, there is no guarantee that the physical argument will hold. We show that the physical interpretation does go through for the special case of a birth-and-death process with a finite value of Kemeny’s constant.
Movement disorders associated with exposure to antipsychotic drugs are common and stigmatising but underdiagnosed.
To develop and evaluate a new clinical procedure, the ScanMove instrument, for the screening of antipsychotic-associated movement disorders for use by mental health nurses.
Item selection and content validity assessment for the ScanMove instrument were conducted by a panel of neurologists, psychiatrists and a mental health nurse, who operationalised a 31-item screening procedure. Interrater reliability was measured on ratings for 30 patients with psychosis from ten mental health nurses evaluating video recordings of the procedure. Criterion and concurrent validity were tested comparing the ScanMove instrument-based rating of 13 mental health nurses for 635 community patients from mental health services with diagnostic judgement of a movement disorder neurologist based on the ScanMove instrument and a reference procedure comprising a selection of commonly used rating scales.
Interreliability analysis showed no systematic difference between raters in their prediction of any antipsychotic-associated movement disorders category. On criterion validity testing, the ScanMove instrument showed good sensitivity for parkinsonism (90%) and hyperkinesia (89%), but not for akathisia (38%), whereas specificity was low for parkinsonism and hyperkinesia, and moderate for akathisia.
The ScanMove instrument demonstrated good feasibility and interrater reliability, and acceptable sensitivity as a mental health nurse-administered screening tool for parkinsonism and hyperkinesia.
This unique analysis of neuropsychological conditions provides readers with a review of both pediatric and adult presentations in one convenient place. Covering the most common disorders encountered in clinical practice, including those specific to the extremes of the age spectrum, this book provides dedicated chapters on:• Preterm and low weight birth• Spina bifida myelomeningocele • Autism spectrum disorder • Intellectual disability • Fetal alcohol spectrum disorders• Attention-deficit/hyperactivity disorder• Learning disability• Traumatic brain injury • Cancer• Epilepsy • Human immunodeficiency virus• Multiple sclerosis• Stroke• DementiaEach chapter provides evidence-based guidelines that can be readily applied to daily practice.
Amidst the NHS’s (National Health Service) success lies its major weakness, although one that Klein overlooks in his reflections on the NHS as it approaches 70. The focus on, and investment in, curing ill-health has been at the expense of attending to the public’s overall health and well-being. This preoccupation poses a greater threat to the NHS’s future than privatisation. Despite the weakness having been diagnosed decades ago, redressing the imbalance has proved stubbornly hard to achieve. Rhetoric has not been translated into reality. Yet, we may be on the cusp of a tipping point where in order to ensure a sustainable NHS, and one that is capable of meeting the 21st century challenges facing it, there is a renewed and overdue interest in promoting health and well-being in communities. But for this to succeed, the NHS will need to embrace its bete noire, local government.