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Both India and Nepal are prone to a wide range of natural and man-made disasters. Almost 85% of India’s area is vulnerable to one or more hazards, and more than 80% of the total population of Nepal is at risk of natural hazards. In terms of the number of people affected in reported disastrous events, India is in the top 10 and Nepal is in the top 20 globally. Over the last two decades, India and Nepal have taken steps to establish their respective National Disaster Management organizations, which provide essential disaster responses. However, key gaps still remain in trained clinical capacity for managing impacts from various disasters. Our review of the region has shown that large parts of the population suffer injuries, diseases, disabilities, psychosocial, and other health-related problems from disasters.
Develop disaster medicine clinical capacity to reduce morbidities and mortalities from disasters.
Independent published data and work undertaken by the lead author in various disasters in India and Nepal since 1993 formed the basis of establishing the Faculty of Disaster Medicine for South Asia. The Faculty of Disaster Medicine - India and Nepal (FDMIN) was launched from Pune in March 2015. This initiative is supported by the National Association of Primary Care (UK), Public Health England, Faculty of Pre-hospital Care of Royal College of Surgeons - Edinburgh and CRIMEDIM (Novara) - Italy.
FDMIN has international expert advisors and has outlined 16 modules training curriculum for health care professionals. FDMIN currently has partnerships for teaching disaster medicine program with 3 medical universities and 12 major health care providers. Six pilot training programmes have been conducted in Pune, Delhi, Chennai, and Kochin. Work is underway to submit an application to the Indian regulatory bodies for approval to establish a post-graduate diploma and Master’s for Disaster Medicine.
Malnutrition remains a leading contributor to the morbidity and mortality of children under the age of 5 years and can weaken the immune system and increase the severity of concurrent infections. Livestock milk with the protective properties of human milk is a potential therapeutic to modulate intestinal microbiota and improve outcomes. The aim of this study was to develop an infection model of childhood malnutrition in the pig to investigate the clinical, intestinal and microbiota changes associated with malnutrition and enterotoxigenic Escherichia coli (ETEC) infection and to test the ability of goat milk and milk from genetically engineered goats expressing the antimicrobial human lysozyme (hLZ) milk to mitigate these effects. Pigs were weaned onto a protein–energy-restricted diet and after 3 weeks were supplemented daily with goat, hLZ or no milk for a further 2 weeks and then challenged with ETEC. The restricted diet enriched faecal microbiota in Proteobacteria as seen in stunted children. Before infection, hLZ milk supplementation improved barrier function and villous height to a greater extent than goat milk. Both goat and hLZ milk enriched for taxa (Ruminococcaceae) associated with weight gain. Post-ETEC infection, pigs supplemented with hLZ milk weighed more, had improved Z-scores, longer villi and showed more stable bacterial populations during ETEC challenge than both the goat and no milk groups. This model of childhood disease was developed to test the confounding effects of malnutrition and infection and demonstrated the potential use of hLZ goat milk to mitigate the impacts of malnutrition and infection.
Neuropsychological investigations can help untangle the aetiological and phenomenological heterogeneity of schizophrenia but have scarcely been employed in the context of treatment-resistant (TR) schizophrenia. No population-based study has examined neuropsychological function in the first-episode of TR psychosis.
We report baseline neuropsychological findings from a longitudinal, population-based study of first-episode psychosis, which followed up cases from index admission to 10 years. At the 10-year follow up patients were classified as treatment responsive or TR after reconstructing their entire case histories. Of 145 cases with neuropsychological data at baseline, 113 were classified as treatment responsive, and 32 as TR at the 10-year follow-up.
Compared with 257 community controls, both case groups showed baseline deficits in three composite neuropsychological scores, derived from principal component analysis: verbal intelligence and fluency, visuospatial ability and executive function, and verbal memory and learning (p values⩽0.001). Compared with treatment responders, TR cases showed deficits in verbal intelligence and fluency, both in the extended psychosis sample (t = −2.32; p = 0.022) and in the schizophrenia diagnostic subgroup (t = −2.49; p = 0.017). Similar relative deficits in the TR cases emerged in sub-/sensitivity analyses excluding patients with delayed-onset treatment resistance (p values<0.01–0.001) and those born outside the UK (p values<0.05).
Verbal intelligence and fluency are impaired in patients with TR psychosis compared with those who respond to treatment. This differential is already detectable – at a group level – at the first illness episode, supporting the conceptualisation of TR psychosis as a severe, pathogenically distinct variant, embedded in aberrant neurodevelopmental processes.
The value of the nosological distinction between non-affective and affective psychosis has frequently been challenged. We aimed to investigate the transdiagnostic dimensional structure and associated characteristics of psychopathology at First Episode Psychosis (FEP). Regardless of diagnostic categories, we expected that positive symptoms occurred more frequently in ethnic minority groups and in more densely populated environments, and that negative symptoms were associated with indices of neurodevelopmental impairment.
This study included 2182 FEP individuals recruited across six countries, as part of the EUropean network of national schizophrenia networks studying Gene–Environment Interactions (EU-GEI) study. Symptom ratings were analysed using multidimensional item response modelling in Mplus to estimate five theory-based models of psychosis. We used multiple regression models to examine demographic and context factors associated with symptom dimensions.
A bifactor model, composed of one general factor and five specific dimensions of positive, negative, disorganization, manic and depressive symptoms, best-represented associations among ratings of psychotic symptoms. Positive symptoms were more common in ethnic minority groups. Urbanicity was associated with a higher score on the general factor. Men presented with more negative and less depressive symptoms than women. Early age-at-first-contact with psychiatric services was associated with higher scores on negative, disorganized, and manic symptom dimensions.
Our results suggest that the bifactor model of psychopathology holds across diagnostic categories of non-affective and affective psychosis at FEP, and demographic and context determinants map onto general and specific symptom dimensions. These findings have implications for tailoring symptom-specific treatments and inform research into the mood-psychosis spectrum.
Objectives: The Addenbrooke’s Cognitive Examination (ACE) is a common cognitive screening test for dementia. Here, we examined the relationship between the most recent version (ACE-III) and its predecessor (ACE-R), determined ACE-III cutoff scores for the detection of dementia, and explored its relationship with functional ability. Methods: Study 1 included 199 dementia patients and 52 healthy controls who completed the ACE-III and ACE-R. ACE-III total and domain scores were regressed on their corresponding ACE-R values to obtain conversion formulae. Study 2 included 331 mixed dementia patients and 87 controls to establish the optimal ACE-III cutoff scores for the detection of dementia using receiver operator curve analysis. Study 3 included 194 dementia patients and their carers to investigate the relationship between ACE-III total score and functional ability. Results: Study 1: ACE-III and ACE-R scores differed by ≤1 point overall, the magnitude varying according to dementia type. Study 2: a new lower bound cutoff ACE-III score of 84/100 to detect dementia was identified (compared with 82 for the ACE-R). The upper bound cutoff score of 88/100 was retained. Study 3: ACE-III scores were significantly related to functional ability on the Clinical Dementia Rating Scale across all dementia syndromes, except for semantic dementia. Conclusions: This study represents one of the largest and most clinically diverse investigations of the ACE-III. Our results demonstrate that the ACE-III is an acceptable alternative to the ACE-R. In addition, ACE-III performance has broader clinical implications in that it relates to carer reports of functional impairment in most common dementias. (JINS, 2018, 24, 854–863)
Objectives: To evaluate prospective and retrospective memory abilities in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans with and without a self-reported history of blast-related mild traumatic brain injury (mTBI). Methods: Sixty-one OEF/OIF/OND Veterans, including Veterans with a self-reported history of blast-related mTBI (mTBI group; n=42) and Veterans without a self-reported history of TBI (control group; n=19) completed the Memory for Intentions Test, a measure of prospective memory (PM), and two measures of retrospective memory (RM), the California Verbal Learning Test-II and the Brief Visuospatial Memory Test-Revised. Results: Veterans in the mTBI group exhibited significantly lower PM performance than the control group, but the groups did not differ in their performance on RM measures. Further analysis revealed that Veterans in the mTBI group with current PTSD (mTBI/PTSD+) demonstrated significantly lower performance on the PM measure than Veterans in the control group. PM performance by Veterans in the mTBI group without current PTSD (mTBI/PTSD-) was intermediate between the mTBI/PTSD+ and control groups, and results for the mTBI/PTSD- group were not significantly different from either of the other two groups. Conclusions: Results suggest that PM performance may be a sensitive marker of cognitive dysfunction among OEF/OIF/OND Veterans with a history of self-reported blast-related mTBI and comorbid PTSD. Reduced PM may account, in part, for complaints of cognitive difficulties in this Veteran cohort, even years post-injury. (JINS, 2018, 24, 324–334)
Uncertainties in estimates of glacier and ice-cap contribution to sea-level rise exist in part due to poor quantification of mass-balance errors, particularly those resulting from extrapolation of sparse measurements. Centre-line data are often assumed to be representative of the glacier as a whole, with little attention paid to extrapolation errors or their effect on mass-balance estimates. Here we present detailed digital elevation model (DEM) measurements of glacier-wide elevation changes over the last ~40 years at two glaciers on Svalbard, Norwegian Arctic. Austre Br0ggerbreen and Midtre Lovenbreen are shown to have lost 27.54 ± 0.98 and 9.65 ± 0.76 × 107m3 of ice, respectively, between 1966 and 2005, findings that we relate to trends in average summer air temperatures and winter accumulation. These volume losses correspond to geodetic balances of -0.58 ± 0.03 and -0.41 ± 0.03 mw.e. a-1, respectively. Our analysis revealed high spatial complexity in patterns of elevation change, varying between glaciers, between measurement intervals and within and between elevation bins. Balances from extrapolated centre-line geodetic data were the same (within errors) as those from full-coverage DEM differencing in the majority of comparisons, yet significantly underestimated balance in three instances. Additionally, field mass balance from centre-line ablation stake data underestimated balances from full-coverage geodetic measurements during three of six measurement periods. These findings may support the hypothesis that field measurements underestimate Svalbard glacier mass loss, at least partly as a result of the failure of centre-line measurements to account for glacier-wide variations in ablation. Our results demonstrate the importance of deriving accurate interpolation functions and constraining extrapolation errors from sparse measurements.
Photogrammetric processing of archival stereo imagery offers the opportunity to reconstruct glacier volume changes for regions where no such data exist, and to better constrain the contribution to sea-level rise from small glaciers and ice caps. The ability to derive digital elevation model (DEM) measurements of glacier volume from photogrammetry relies on good-quality, well-distributed ground reference data, which may be difficult to acquire. This study shows that ground-control points (GCPs) can be identified and extracted from point-cloud airborne lidar data and used to control photogrammetric glacier models. The technique is applied to midtre Lovénbreen, a small valley glacier in northwest Svalbard. We show that the amount of ground control measured and the elevation accuracy of GCP coordinates (based on known and theoretical error considerations) has a significant effect on photogrammetric model statistics, DEM accuracy and the subsequent geodetic measurement of glacier volume change. Models controlled with fewer than 20 lidar control points or GCPs from sub-optimal areas within the swath footprint overestimated volume change by 14–53% over a 2 year period. DEMs derived from models utilizing 20–25 or more GCPs, however, gave volume change estimates within ∼4% of those from repeat lidar data (−0.51 m a−1 between 2003 and 2005). Our results have important implications for the measurement of glacier volume change from archival stereo-imagery sources.
The dietary inflammatory index (DIITM) is a novel composite score based on a range of nutrients and foods known to be associated with inflammation. DII scores have been linked to the risk of a number of cancers, including oesophageal squamous cell cancer and oesophageal adenocarcinoma (OAC). Given that OAC stems from acid reflux and that the oesophageal epithelium undergoes a metaplasia-dysplasia transition from the resulting inflammation, it is plausible that a high DII score (indicating a pro-inflammatory diet) may exacerbate risk of OAC and its precursor conditions. The aim of this analytical study was to explore the association between energy-adjusted dietary inflammatory index (E-DIITM) in relation to risk of reflux oesophagitis, Barrett’s oesophagus and OAC. Between 2002 and 2005, reflux oesophagitis (n 219), Barrett’s oesophagus (n 220) and OAC (n 224) patients, and population-based controls (n 256), were recruited to the Factors influencing the Barrett’s Adenocarcinoma Relationship study in Northern Ireland and the Republic of Ireland. E-DII scores were derived from a 101-item FFQ. Unconditional logistic regression analysis was applied to determine odds of oesophageal lesions according to E-DII intakes, adjusting for potential confounders. High E-DII scores were associated with borderline increase in odds of reflux oesophagitis (OR 1·87; 95 % CI 0·93, 3·73), and significantly increased odds of Barrett’s oesophagus (OR 2·05; 95 % CI 1·22, 3·47), and OAC (OR 2·29; 95 % CI 1·32, 3·96), when comparing the highest with the lowest tertiles of E-DII scores. In conclusion, a pro-inflammatory diet may exacerbate the risk of the inflammation-metaplasia-adenocarcinoma pathway in oesophageal carcinogenesis.
We model a massless viscous disk using smoothed particle hydrodynamics (SPH) and note that it evolves according to the Lynden-Bell & Pringle (1974) theory until a non-axisymmetric instability develops at the inner edge of the disk. This instability may have the same origin as the instability of initially axisymmetric viscous disks discussed by Lyubarskij, Postnov & Prokhorov (1994). To clarify the evolution we evolved single and double rings of particles. It is actually inconsistent with the SPH scheme to set up a single ring as an initial condition because SPH assumes a smoothed initial state. As would be expected from an SPH simulation, the ring rapidly breaks up into a band. We analyse the stability of the ring and show that the predictions are confirmed by the simulation.
Smoothed Particle Hydrodynamics (SPH) is now seen as a numerical scheme well suited to the study of accretion disks. SPH simulations have been conducted of cataclysmic variable disks (Lubow 1991, Murray 1996, Armitage and Livio 1996), galactic disks (Artymowicz and Lubow 1989), and protostellar disks (Artymowicz and Lubow 1994). It is therefore important to test the technique against theory and other numerical results to obtain an estimate of the accuracy and reliability of SPH in this context. Previously SPH has been tested against standard stationary and time-dependent results of viscous thin disk theory (Murray 1996). Strictly these tests relate to disks where ‘viscous’ terms dominate pressure terms in the equations of motion.
In this paper we describe tests of the code more appropriate for hot disks where pressure forces are relatively more important than viscosity. Specifically we consider the form of the spiral density waves that can be excited in a disk by a perturbing gravitational potential. Very low mass perturbing bodies excite linear spiral waves which redistribute angular momentum in the disk. For increasingly massive perturbers, the disk response becomes nonlinear and eventually shocks form. In the standard formulation of SPH, an artificial viscosity term is added to the SPH equations to improve shock capture. This is equivalent to introducing a fixed ratio of shear to bulk viscosity into the equations of motion. In Eulerian schemes, artificial viscosity has been discarded in favour of other more accurate, less dissipative schemes for resolving shocks. The continued use of artificial viscosity in SPH has become a source of ‘friction’ between numericists. The simulations described here demonstrate the scheme’s ability to resolve spiral shocks, and show that SPH is a valuable tool for probing the structure of tidally perturbed accretion disks.
We use two dimensional Smoothed Particle Hydrodynamics simulations to investigate the the Tidal Resonance Instability (TRI) model for superhumps in SU UMa stars.
In the TRI model, superhumps are the signature of an eccentric disk being periodically stressed by the binary system’s rotating tidal field. A slow prograde motion of the disk in the inertial frame is then responsible for the superhump period slightly exceeding the binary orbital period. The disk eccentricity is caused by a 3:1 resonance between orbits in the disk and the orbit of the binary itself. The development of the TRI model is due mainly to Whitehurst (1988), Hirose & Osaki (1990) and Lubow (1991a). Lubow in particular carried out a nonlinear mode analysis of a fluid disk’s response to a weak tidal field and identified the feedback mechanism responsible for disk eccentricity growth.
The Parliament shall, subject to this Constitution, have power to make laws for the peace, order, and good government of the Commonwealth with respect to: … (xxxi) the acquisition of property on just terms from any State or person for any purpose in respect of which the Parliament has power to make laws.
On the imposition of uniform duties of customs, trade, commerce, and intercourse among the States, whether by means of internal carriage or ocean navigation, shall be absolutely free.
The Commonwealth shall not make any law for establishing any religion, or for imposing any religious observance, or for prohibiting the free exercise of any religion, and no religious test shall be required as a qualification for any office or public trust under the Commonwealth.
As noted in Chapter 4, the Australian Constitution is primarily concerned with establishing the institutional foundations of a federal commonwealth. The demarcations and limitations on power imposed by the Constitution are therefore chiefly directed to federal considerations of one kind or another. The Constitution does not contain a general bill of rights because the prevailing view, at the time it was drafted, was that appropriately operating systems of representative and responsible government at a Commonwealth and State level would, on the whole, provide adequate protection for civil and political rights. This reflected the general view that had motivated the framers of the United States Constitution in 1787; that is, before pressure from Antifederalists compelled Federalist leaders such as James Madison to agree to the insertion of ten amendments to the Constitution which have since come to be known as the Bill of Rights. As Denis Galligan has explained:
On the [American] Federalists’ view, Constitutions provide the means to good government; they are not concerned to dictate the substantive ends that good government should achieve. This approach has significant implications for the Bill of Rights issue. It is important to remember that the Federalists did not originally intend to include a Bill of Rights in the American Constitution; indeed they argued vehemently against it.
The executive power of the Commonwealth … extends to the execution and maintenance of this Constitution, and of the laws of the Commonwealth.
Section 61 of the Constitution declares that the ‘executive power of the Commonwealth’ is ‘vested in the Queen’ and that it ‘extends to the execution and maintenance’ of the ‘Constitution’ and the ‘laws of the Commonwealth’. The executive power of the Commonwealth is thus composed of several elements. Its exact content and ambit is one of the most pressing and complex issues in Australian constitutional law.
By declaring that the executive power is vested in the Queen, the framers of the Constitution understood that, subject to the Constitution, this incorporated the various powers customarily exercised by British monarchs as recognised by the common law. Andrew Inglis Clark put it this way:
[T]he supreme depositary of the executive authority in the Commonwealth is the King, and he possesses and may exercise within the Commonwealth all the prerogative rights and powers which are inherent in the … Crown. … [T]he Crown possesses prerogative rights and powers which have their source in the common law, and it is therefore evident that a portion of the common law attaches to the Constitution of the Commonwealth.
William Harrison Moore further maintained, without apparent qualification, that:
[w]here a power or duty committed to ‘the Commonwealth’ is of such a kind as is according to common law exerciseable by the Executive, the Commonwealth Executive is empowered to take such action as the common law allows.
The executive power of the Commonwealth extends to the ‘execution’ of the Constitution. This reinforces the primacy of the Constitution as the ultimate source of Commonwealth governmental authority within the federation. That the power also extends to the execution of Commonwealth laws reflects the principle, noted in Chapter 2, that the Constitution accords a certain normative priority to the role of the Parliament in legislating and holding the Executive Government to account, a role that is fundamental to responsible government and important in establishing the rule of law. This feature of the executive power also reflects the federal nature of the Constitution, for in this respect the power is limited to the execution of Commonwealth laws the subject matter of which is limited by ss 51 and 52 and 122.