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Designing engineering components that make optimal use of materials requires consideration of the nonlinear static and dynamic characteristics associated with both manufacturing and working environments. The modeling of these characteristics can only be done through numerical formulation and simulation, which requires an understanding of the theoretical background and associated computer solution techniques. By presenting nonlinear solid mechanics, dynamic conservation laws and principles, and the associated finite element techniques together, the authors provide a unified treatment of the dynamic simulation of nonlinear solids. Alongside numerous worked examples and exercises are user instructions, program descriptions, and examples for two MATLAB computer implementations with source code available online. While this book is designed to complement postgraduate courses, it is also relevant to industry professionals requiring an appreciation of the way their computer simulation programs work.
We performed a cross-sectional survey of infection preventionists in 60 US community hospitals between April 22 and May 8, 2020, and found several differences in hospital preparedness for SARS-CoV-2 with respect to personal protective equipment conservation strategies, protocols related to testing, universal masking and restarting elective procedures.
To test the functional implications of impaired white matter (WM) connectivity among patients with schizophrenia and their relatives, we examined the heritability of fractional anisotropy (FA) measured on diffusion tensor imaging data acquired in Pittsburgh and Philadelphia, and its association with cognitive performance in a unique sample of 175 multigenerational non-psychotic relatives of 23 multiplex schizophrenia families and 240 unrelated controls (total = 438).
We examined polygenic inheritance (h2r) of FA in 24 WM tracts bilaterally, and also pleiotropy to test whether heritability of FA in multiple WM tracts is secondary to genetic correlation among tracts using the Sequential Oligogenic Linkage Analysis Routines. Partial correlation tests examined the correlation of FA with performance on eight cognitive domains on the Penn Computerized Neurocognitive Battery, controlling for age, sex, site and mother's education, followed by multiple comparison corrections.
Significant total additive genetic heritability of FA was observed in all three-categories of WM tracts (association, commissural and projection fibers), in total 33/48 tracts. There were significant genetic correlations in 40% of tracts. Diagnostic group main effects were observed only in tracts with significantly heritable FA. Correlation of FA with neurocognitive impairments was observed mainly in heritable tracts.
Our data show significant heritability of all three-types of tracts among relatives of schizophrenia. Significant heritability of FA of multiple tracts was not entirely due to genetic correlations among the tracts. Diagnostic group main effect and correlation with neurocognitive performance were mainly restricted to tracts with heritable FA suggesting shared genetic effects on these traits.
We studied the compositional turnover in infracommunities and component communities of ecto- and endoparasites infesting a bat, Miniopterus natalensis (Chiroptera, Miniopteridae), across seven sampling sites using the zeta diversity metric (measuring similarity between multiple communities) and calculating zeta decline and retention rate (both scales) and zeta decay (component communities). We asked whether the patterns of zeta diversity differ between (a) infracommunities and component communities; (b) ecto- and endoparasites and (c) subsets of communities infecting male and female bats. The pattern of compositional turnover differed between infracommunities and component communities in endoparasites only. The shape of zeta decline for infracommunities indicated that there were approximately equal probabilities of ecto- and endoparasitic species to occur on/in any bat individual within a site. The shape of zeta decline for component communities suggested the stochasticity of ectoparasite turnover, whereas the turnover of endoparasites was driven by niche-based processes. Compositional turnover in component communities of ectoparasites was more spatially dependent than that of endoparasites. Spatial independence of compositional turnover in endoparasites was due to subcommunities harboured by female bats. We conclude that the patterns of compositional turnover in infracommunities were similar in ecto- and endoparasites, whereas the patterns of turnover in component communities differed between these groups.
Radiofrequency ablation (RFA) is a non-invasive image-guided procedure where tumors are heated in the body with electrical current. RFA procedures are commonly indicated for patients with limited local disease or who are not surgical candidates. Current methods of RFA use multiple cords and wires that ergonomically complicate the procedure and present the risk of cutting or shorting the circuit if they are damaged. A wireless RFA technique based on electromagnetic induction is presented in this paper. The transmitting and receiving coils were coupled to resonate at the same frequency to ensure the highest power output. The receiving coil was connected to two insulated electrodes on a catheter, which allowed the current to flow to the targeted tissue. The prototype system was tested with ex-vivo bovine tissue, which has similar thermal and electrical properties to human tissue. The setup can monitor the received power, efficiency, temperature, and ablation zone during ablation procedures. The maximum received power was 15 W, and the average maximum efficiency was 63.27%. The novel system was also able to ablate up to a 2 cm ablation zone in non-perfused tissue. This proof of concept for performing RFA wirelessly with electromagnetic induction may merit further optimization.
To explore the phenomenology of auditory verbal hallucinations (AVHs) in a clinical sample of young people who have a ‘non-psychotic’ diagnosis.
Ten participants aged 17–31 years with presentation of emotionally unstable personality disorder or post-traumatic stress disorder and frequent AVHs were recruited and participated in a qualitative study exploring their subjective experience of hearing voices. Photo-elicitation and ethnographic diaries were used to stimulate discussion in an otherwise unstructured walking interview.
‘Non-psychotic’ voices comprised auditory qualities such as volume and clarity. Participants commonly personified their voices, viewing them as distinct characters with which they could interact and form relationships. There appeared to be an intimate and unstable relationship between participant and voice, whereby voices changed according to the participants’ mood, insecurities, distress and circumstance. Equally, participants reacted to provocation by the voice, leading to changes in mood and circumstance through emotional and physical disturbances. In contrast to our previous qualitative work in psychosis, voice hearing was not experienced with a sense of imposition or control.
This phenomenological research yielded in-depth and novel accounts of ‘non-psychotic’ voices which were intimately linked to emotional experience. In contrast to standard reports of voices in disorders such as schizophrenia, participants described a complex and bi-directional relationship with their voices. Many other features were in common with voice hearing in psychosis. Knowledge of the phenomenology of hallucinations in non-psychotic disorders has the potential to inform future more successful management strategies. This report gives preliminary evidence for future research.
Prior research has shown that sipping of alcohol begins to emerge during childhood and is potentially etiologically significant for later substance use problems. Using a large, community sample of 9- and 10-year-olds (N = 11,872; 53% female), we examined individual differences in precocious alcohol use in the form of alcohol sipping. We focused explicitly on features that are robust and well-demonstrated correlates of, and antecedents to, alcohol excess and related problems later in the lifespan, including youth- and parent-reported externalizing traits (i.e., impulsivity, behavioral inhibition and activation) and psychopathology. Seventeen percent of the sample reported sipping alcohol outside of a religiously sanctioned activity by age 9 or 10. Several aspects of psychopathology and personality emerged as small but reliable correlates of sipping. Nonreligious sipping was related to youth-reported impulsigenic traits, aspects of behavioral activation, prodromal psychotic-like symptoms, and mood disorder diagnoses, as well as parent-reported externalizing disorder diagnoses. Religious sipping was unexpectedly associated with certain aspects of impulsivity. Together, our findings point to the potential importance of impulsivity and other transdiagnostic indicators of psychopathology (e.g., emotion dysregulation, novelty seeking) in the earliest forms of drinking behavior.
Palmer amaranth, an annual weed, and Verticillium dahliae, a fungal pathogen, can substantially reduce chile pepper yield. On the basis of the results of this study, we clarified implementation strategies for a potential management tactic for Palmer amaranth and V. dahliae in chile pepper: mustard seed meal (MSM). The objectives were to (1) determine MSM effects on Palmer amaranth seedbanks under different moisture levels, (2) measure glucosinolate degradation in soil hydrated to saturation and field capacity, and (3) determine the effects of decreasing moisture availability on MSM control of Palmer amaranth and V. dahliae. To address objective 1, seedbanks with and without MSM were hydrated to levels expected to both inhibit and promote germination (flooded, saturated, −0.03, −0.6 MPa, respectively). For objective 2, soil columns with MSM were held at different moisture levels and sampled over time. For objective 3, Palmer amaranth seeds were incubated with and without MSM, and with polyethylene glycol (PEG) solutions comprising a range of water potentials (0, −0.03, −0.6, −1.0, and −2.0 MPa). These PEG solutions were also used to hydrate MSM in agar plates with plugs of V. dahliae. All experiments were performed in growth chambers with temperatures and light conditions conducive to Palmer amaranth germination and V. dahliae mycelial growth. MSM-induced mortality in Palmer amaranth seedbanks was greater in soil at field capacity than in saturated soil and flooded soil; however, rates of glucosinolate degradation were greatest in saturated soil. Decreasing water availability progressively decreased the efficacy of MSM on Palmer amaranth because MSM was ineffective on nongerminated seeds. When incubated with PEG solutions with water potentials of 0, −0.03, and −0.6 MPa, MSM stopped growth of V. dahliae; however, MSM-induced control of V. dahliae was reduced by water potentials of −1.0 and −2.0 MPa. The results of this study indicate soils hydrated to field capacity maximize MSM-induced control of Palmer amaranth and V. dahliae.
Introduction: Workplace based assessments (WBAs) are integral to emergency medicine residency training. However many biases undermine their validity, such as an assessor's personal inclination to rate learners leniently or stringently. Outlier assessors produce assessment data that may not reflect the learner's performance. Our emergency department introduced a new Daily Encounter Card (DEC) using entrustability scales in June 2018. Entrustability scales reflect the degree of supervision required for a given task, and are shown to improve assessment reliability and discrimination. It is unclear what effect they will have on assessor stringency/leniency – we hypothesize that they will reduce the number of outlier assessors. We propose a novel, simple method to identify outlying assessors in the setting of WBAs. We also examine the effect of transitioning from a norm-based assessment to an entrustability scale on the population of outlier assessors. Methods: This was a prospective pre-/post-implementation study, including all DECs completed between July 2017 and June 2019 at The Ottawa Hospital Emergency Department. For each phase, we identified outlier assessors as follows: 1. An assessor is a potential outlier if the mean of the scores they awarded was more than two standard deviations away from the mean score of all completed assessments. 2. For each assessor identified in step 1, their learners’ assessment scores were compared to the overall mean of all learners. This ensures that the assessor was not simply awarding outlying scores due to working with outlier learners. Results: 3927 and 3860 assessments were completed by 99 and 116 assessors in the pre- and post-implementation phases respectively. We identified 9 vs 5 outlier assessors (p = 0.16) in the pre- and post-implementation phases. Of these, 6 vs 0 (p = 0.01) were stringent, while 3 vs 5 (p = 0.67) were lenient. One assessor was identified as an outlier (lenient) in both phases. Conclusion: Our proposed method successfully identified outlier assessors, and could be used to identify assessors who might benefit from targeted coaching and feedback on their assessments. The transition to an entrustability scale resulted in a non-significant trend towards fewer outlier assessors. Further work is needed to identify ways to mitigate the effects of rater cognitive biases.
Introduction: The Ottawa Emergency Department Shift Observation Tool (O-EDShOT) was recently developed to assess a resident's ability to safely run an ED shift and is supported by multiple sources of validity evidence. The O-EDShOT uses entrustability scales, which reflect the degree of supervision required for a given task. It was found to discriminate between learners of different levels, and to differentiate between residents who were rated as able to safely run the shift and those who were not. In June 2018 we replaced norm-based daily encounter cards (DECs) with the O-EDShOT. With the ideal assessment tool, most of the score variability would be explained by variability in learners’ performances. In reality, however, much of the observed variability is explained by other factors. The purpose of this study is to determine what proportion of total score variability is accounted for by learner variability when using norm-based DECs vs the O-EDShOT. Methods: This was a prospective pre-/post-implementation study, including all daily assessments completed between July 2017 and June 2019 at The Ottawa Hospital ED. A generalizability analysis (G study) was performed to determine what proportion of total score variability is accounted for by the various factors in this study (learner, rater, form, pgy level) for both the pre- and post- implementation phases. We collected 12 months of data for each phase, because we estimated that 6-12 months would be required to observe a measurable increase in entrustment scale scores within a learner. Results: A total of 3908 and 3679 assessments were completed by 99 and 116 assessors in the pre- and post- implementation phases respectively. Our G study revealed that 21% of total score variance was explained by a combination of post-graduate year (PGY) level and the individual learner in the pre-implementation phase, compared to 59% in the post-implementation phase. An average of 51 vs 27 forms/learner are required to achieve a reliability of 0.80 in the pre- and post-implementation phases respectively. Conclusion: A significantly greater proportion of total score variability is explained by variability in learners’ performances with the O-EDShOT compared to norm-based DECs. The O-EDShOT also requires fewer assessments to generate a reliable estimate of the learner's ability. This study suggests that the O-EDShOT is a more useful assessment tool than norm-based DECs, and could be adopted in other emergency medicine training programs.
Neuroticism is associated with the onset and maintenance of a number of mental health conditions, as well as a number of deleterious outcomes (e.g. physical health problems, higher divorce rates, lost productivity, and increased treatment seeking); thus, the consideration of whether this trait can be addressed in treatment is warranted. To date, outcome research has yielded mixed results regarding neuroticism's responsiveness to treatment, perhaps due to the fact that study interventions are typically designed to target disorder symptoms rather than neuroticism itself. The purpose of the current study was to explore whether a course of treatment with the unified protocol (UP), a transdiagnostic intervention that was explicitly developed to target neuroticism, results in greater reductions in neuroticism compared to gold-standard, symptom focused cognitive behavioral therapy (CBT) protocols and a waitlist (WL) control condition.
Patients with principal anxiety disorders (N = 223) were included in this study. They completed a validated self-report measure of neuroticism, as well as clinician-rated measures of psychological symptoms.
At week 16, participants in the UP condition exhibited significantly lower levels of neuroticism than participants in the symptom-focused CBT (t(218) = −2.17, p = 0.03, d = −0.32) and WL conditions(t(207) = −2.33, p = 0.02, d = −0.43), and these group differences remained after controlling for simultaneous fluctuations in depression and anxiety symptoms.
Treatment effects on neuroticism may be most robust when this trait is explicitly targeted.
People with severe mental illnesses, such as schizophrenia, depression or bipolar disorder, have worse physical health and reduced life expectancy compared to the general population. The excess cardiovascular mortality associated with schizophrenia and bipolar disorder is attributed in part to an increased risk of the modifiable coronary heart disease risk factors; obesity, smoking, diabetes, hypertension and dyslipidaemia. Antipsychotic medication and possibly other psychotropic medication like antidepressants can induce weight gain or worsen other metabolic cardiovascular risk factors. Patients may have limited access to general healthcare with less opportunity for cardiovascular risk screening and prevention than would be expected in a non-psychiatric population. The European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC) published this statement with the aim of improving the care of patients suffering from severe mental illness. The intention is to initiate cooperation and shared care between the different healthcare professionals and to increase the awareness of psychiatrists and primary care physicians caring for patients with severe mental illness to screen and treat cardiovascular risk factors and diabetes.
To examine genetic influences the anatomy of the Corpus Callosum (CC) in Bipolar Disorder (BD) by examining first-degree relatives in addition to BD patients.
We compared CCl size and shape in 180 individuals: 70 with BD, 45 of their unaffected first-degree relatives, and 75 healthy controls. The CC was extracted from a mid-sagittal slice from T1-weighted magnetic resonance images; its total area, length and curvature were compared across groups. A non-parametric permutation method was used to examine for alterations in width of the callosum along 39 points.
Validating our previous findings, a significant global reduction in CC thickness was seen in BD patients, with a disproportionate thinning in the anterior body. First-degree relatives did not differ in CC size or shape from controls. Duration of illness was associated with thinning in the anterior body, whereas Lithium treatment associated with thicker anterior CC midbody.
Global and regional CC thinning is a disease related feature of BD and may not represent a marker of familial disposition.
Depression is the most common mental disease in patients hospitalized with physical illness. Disorders of anxiety and depression in general hospitals are frequently underdiagnosed and inappropriately treated. Our objective was to assess the prevalence of undiagnosed anxiety and depression in surgical inpatients and assess the referral rate and utilization of liaison psychiatry services.
A prospective multi-centre study of surgical admissions (n=96) to two surgical services at two separate institutions between 1/01/05 and 31/12/05. The surgical services included general surgery and cardiothoracic surgery. Data was collected prospectively utilizing the computerized hospital inpatient system (HIS) and supplemented with data from medical records. The Hospital Anxiety and Depression (HAD) scale was used to evaluate all patients in the study cohort. Patients with a documented psychiatric history and established psychiatric diagnosis were excluded.
We had 96 individuals in our patient cohort. The mean age was 59.6 years. There was a slight female predominance with a female: male ratio of 1.18:1. Surgical procedures were performed in 68.75% of our patient cohort. 12.5% of patients were discovered to suffer with significant depression. 18.75% of patients suffered with significant anxiety. 8.3% of patients had significant mixed anxiety and depression. 22.9% of patients warranted referral to liaison psychiatry services for further assessment and management.
Disorders of anxiety and depression are highly prevalent in surgical inpatients. There needs to be an increased awareness of the possibility of undiagnosed psychiatric disorders in such patients along with prompt and appropriate use of liaison psychiatry services.
Schizophrenia patients have increased risk of cardiovascular disease (CVD) and mortality. Guidelines emphasise need for monitoring risk factors including ECG and blood pressure (BP). There is little naturalistic data on number and severity of categorical abnormalities detected.
A global health clinic was set up in 2004 to undertake systematic physical health monitoring in all schizophrenia outpatients within Larkfield CMHT. Patients received 2 hour assessments from trained nurses. BMI, laboratory (non-fasting) parameters, ECG and BP performed.
Since 2004 from 140 Schizophrenia outpatients 95 have been invited to attend screening of which 53 accepted (56%). An abnormal parameter was measured in 92% (n=49), 72% 2 abnormal findings (n=38) and 47% 3 or more. ECG abnormalities in 50% (n=26) of which 18 were significant findings (prior myocardial infarction and/or ischaemia, conduction blocks, right ventricular hypertrophy). Normal blood pressure using guidelines from British Hypertension Society (BHS) 2004 (<130/85) was determined in 36% (n=20), high-normal 11% (n=6) and varying grades of hypertension 53% (n=27). Grade 3 (severe) hypertension 8% (n=4). No patient had abnormal QTc >500 mscs. One male patient had QTc 458msecs.In 18 patients (34%) the ECG analysis was determined by the analyser to be difficult to analyse due to significant baseline patient movement.
Significant BP and ECG abnormalities are common and require evaluation for treatment. QTc abnormalities are detected significantly less often than other important abnormalities. Using the most conservative definition of hypertension 53% of this cohort would be defined as needing antihypertensive treatments and lifestyle interventions in 64%.
As awareness of ADHD has increased throughout the world, interest has grown beyond the constellation of ADHD symptoms, including long-term effects and impact on people's lives.
To examine the consequences of childhood ADHD and the relevance of these outcomes in different world regions.
This analysis examined the publication trends of studies of long-term outcomes of ADHD over time and among world regions.
Study identification followed Cochrane guidelines. Twelve databases were searched for reports published in English 1980–2010. Limiting criteria were designed to maximize study inclusion while maintaining a high level of study rigor: the studies were to
(1) be peer-reviewed,
(2) be primary study reports,
(3) include a comparator group or baseline, and
(4) report outcome results measured for a mean of 8 years (prospective studies, range of all studies was 6 months-40 years) after the start of the study, in late adolescence, or adulthood.
The fully-defined electronic search yielded 4615 citations, which were then reviewed manually based on the titles and abstracts, yielding a final of 371 studies.
Study publication trends analysed included: publication year, country and world region of origin, outcome types, and study types. In general, the numbers of studies published per year globally has increased substantially (from 2 in 1980 to more than 40/year in 2007 and 2008) with differences observed between Europe and North America.
Analysis of publication trends can provide insight into outcomes of ADHD and the focus of specific world regions.
As awareness of ADHD has increased worldwide, interest has grown beyond the constellation of ADHD symptoms, to include long-term impact on people's lives and society in general.
Examine the results of studies of long-term life consequences of ADHD.
To identify areas of life affected long-term by ADHD and differences in outcomes with and without ADHD treatment.
Following Cochrane guidelines, 12 databases were searched for studies published in English (1980–2010). Limiting criteria maximized study inclusion while maintaining high study rigor: (1) peer-reviewed, (2) primary study reports, (3) including a comparator condition, and (4) reporting long-term outcomes (mean 8 years, range 6 months-40 years from study start for prospective studies; subjects in adolescence or adulthood for retrospective or cross-sectional studies). The fully-defined electronic search yielded 4615 citations. Manual review based on titles and abstracts yielded 340 studies included in this analysis of outcomes.
The majority of studies (86%, 243 of 281; studies of untreated ADHD only) showed that untreated ADHD has substantial negative long-term outcomes, encompassing nine broad-ranging areas of life: non-medicinal drug use/addictive behaviour, antisocial behaviour, academic achievement, occupational achievement, public services use, self-esteem, social function, obesity, and driving outcomes. In contrast, most studies including ADHD pharmacotherapy and/or non-pharmacotherapy (94%, 46 of 49) showed that compared with baseline or untreated ADHD, long-term outcomes improved or stabilized with treatment of ADHD.
ADHD has notable negative long-term consequences, and this negative impact may be reduced with treatment of ADHD. Supported by Shire Development Inc.