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There is a growing body of evidence highlighting the presence of a single general dimension of psychopathology that can account for multiple associations across mental and substance use disorders. However, relatively little evidence has emerged regarding the validity of this model with respect to a range of factors that have been previously implicated across multiple disorders. The current study utilized a cross-sectional population survey of adolescents (n = 2,003) to examine the extent to which broad psychopathology factors account for specific associations between psychopathology and key validators: poor sleep, self-harm, suicidality, risky sexual behavior, and low self-esteem. Confirmatory factor models, latent class models, and factor mixture models were estimated to identify the best structure of psychopathology. Structural equation models were then estimated to examine the broad and specific associations between each psychopathology indicator and the validators. A confirmatory factor model with three lower-order factors, representing internalizing, externalizing, and psychotic-like experiences, and a single higher-order factor evidenced the best fit. The associations between manifest indicators of psychopathology and validators were largely nonspecific. However, significant and large direct effects were found between several pairwise associations. These findings have implications for the identification of potential targets for intervention and/or tailoring of prevention programs.
Radiocarbon (14C) analysis of carbon dioxide (CO2) provides unique information on the age, turnover and source of this important greenhouse gas, raising the prospect of novel scientific investigations into a range of natural and anthropogenic processes. To achieve these measurements, cartridges containing zeolite molecular sieves are a reliable and convenient method for collecting CO2 samples. At the NERC Radiocarbon Facility (East Kilbride) we have been refining our molecular sieve methods for over twenty years to achieve high-quality, reproducible and precise measurements. At the same time, we have been developing novel field sampling methods to expand the possibilities in collecting gas from the atmosphere, soil respiration and aquatic environments. Here, we present our latest improvements to cartridge design and procedures. We provide the results of tests used to verify the methods using known 14C content standards, demonstrating reliability for sample volumes of 3 mL CO2 (STP; 1.6 mg C) collected in cartridges that had been prepared at least three months earlier. We also report the results of quality assurance standards processed over the last two years, with results for 22 out of 23 international 14C standards being within measurement uncertainty of consensus values. We describe our latest automated procedures for the preparation of cartridges prior to use.
Dementia, a term that describes a variety of brain conditions marked by gradual, persistent and progressive cognitive decline, affects a significant proportion of older adults. Older adults with dementia are sometimes perceived less favourably than those without dementia. Furthermore, compared to persons without dementia, those with dementia are often perceived by others as having reduced personhood. This study was aimed at investigating whether differences in attitudes towards dementia and personhood perceptions vary as a function of age group, care-giver status, attitudes towards ageing, dementia knowledge, gender and education. In total 196 younger, middle-aged and older adults were recruited. Findings revealed that being a care-giver as well as having less ageist attitudes were predictive of being more comfortable around persons with dementia, having more knowledge about dementia and ascribing greater personhood to people with dementia. Those with more dementia knowledge (prior to the study) were less comfortable around people with dementia. Finally, when controlling this prior dementia knowledge, older adults were more comfortable around people with dementia compared to younger and middle-aged adults. Gender and education were not associated with any of the variables under study. Findings contribute to a better understanding of the role of age- and care-giver-related factors in the determination of attitudes towards dementia.
In toroidal magnetic confinement devices, such as tokamaks and stellarators, neoclassical transport is usually an order of magnitude larger than its classical counterpart. However, when a high-collisionality species is present in a stellarator optimized for low Pfirsch–Schlüter current, its classical transport can be comparable to the neoclassical transport. In this letter, we compare neoclassical and classical fluxes and transport coefficients calculated for Wendelstein 7-X (W7-X) and Large Helical Device (LHD) cases. In W7-X, we find that the classical transport of a collisional impurity is comparable to the neoclassical transport for all radii, while it is negligible in the LHD cases, except in the vicinity of radii where the neoclassical transport changes sign. In the LHD case, electrostatic potential variations on the flux surface significantly enhance the neoclassical impurity transport, while the classical transport is largely insensitive to this effect in the cases studied.
The physiology of mesophotic Scleractinia varies with depth in response to environmental change. Previous research has documented trends in heterotrophy and photosynthesis with depth, but has not addressed between-site variation for a single species. Environmental differences between sites at a local scale and heterogeneous microhabitats, because of irradiance and food availability, are likely important factors when explaining the occurrence and physiology of Scleractinia. Here, 108 colonies of Agaricia lamarcki were sampled from two locations off the coast of Utila, Honduras, distributed evenly down the observed 50 m depth range of the species. We found that depth alone was not sufficient to fully explain physiological variation. Pulse Amplitude-Modulation fluorometry and stable isotope analyses revealed that trends in photochemical and heterotrophic activity with depth varied markedly between sites. Our isotope analyses do not support an obligate link between photosynthetic activity and heterotrophic subsidy with increasing depth. We found that A. lamarcki colonies at the bottom of the species depth range can be physiologically similar to those nearer the surface. As a potential explanation, we hypothesize sites with high topographical complexity, and therefore varied microhabitats, may provide more physiological niches distributed across a larger depth range. Varied microhabitats with depth may reduce the dominance of depth as a physiological determinant. Thus, A. lamarcki may ‘avoid’ changes in environment with depth, by instead existing in a subset of favourable niches. Our observations correlate with site-specific depth ranges, advocating for linking physiology and abiotic profiles when defining the distribution of mesophotic taxa.
Introduction: There is an opioid epidemic which has seen an increased mortality rate of 200% related to opioid use over the past decade. Prescription practices amongst ED physicians may be contributing to this problem. Our objective was to analyze ED physician prescription practices for patients discharged from the ED with acute fractures. Methods: We conducted a health records review of ED patients seen at two campuses of a tertiary care hospital with total annual census of 160,000 visits. We evaluated a consecutive sample of patients with acute fractures (January 1 2016–April 15 2016) seen and discharged by ED physicians. Patients admitted to hospital or discharged by consultant services were excluded. The primary outcome measure was the proportion of patients discharged with an opioid prescription. We collected data using a screening list, review of electronic records, and interobserver agreement for measures. We calculated simple descriptive statistics and estimated 4 months would be required to enroll 250 patients receiving opioid prescriptions. Results: We enrolled 816 patients, with 442 females (54.2%), median CTAS score of 3, and median pain score at triage of 6/10. The most common fractures were wrist/hand (35.2%) and foot excluding ankle (14.8%). An ED pain directive was used at triage for 21.2% and 281 patients (34.4%) received an opioid during ED stay, with tramadol (21.2%) being the most common. Overall, 250 patients (30.6%) were discharged with the following opioid prescriptions and median total dosages: hydromorphone (N = 114, median dosage 23mg, range 1–120mg), tramadol (N = 86, 1000mg, 200–2000mg), oxycodone (N = 33, 100mg, 10–170mg), codeine (N = 20, 600mg, 360–1200mg), and morphine (N = 9, 100mg, 25–200mg). Of patients prescribed hydromorphone, 61 (53.5%) were prescribed > 20mg. Overall, 35 patients (4.3%) had a pain related ED visit <1 month after discharge, of which 14 (40%) received an opioid prescription on initial discharge, and 12 (34.2%) received an opioid prescription upon subsequent discharge. Conclusion: Amongst patients presenting to the ED with acute fractures, the majority were not discharged home with an opioid prescription from ED physicians. Hydromorphone was the most common opioid prescribed, with large variations in total dosage. Despite only a minority of patients receiving opioid prescriptions, there were very few return to ED visits. To limit potential abuse, we recommend standardization of opioid prescribing in the ED, with attention to limiting the total dosage given.
impurities in magnetic-confinement devices are prone to develop density variations on the flux surface, which can significantly affect their transport. In this paper, we generalize earlier analytic stellarator calculations of the neoclassical radial impurity flux in the mixed-collisionality regime (collisional impurities and low-collisionality bulk ions) to include the effect of such flux-surface variations. We find that only in the homogeneous density case is the transport of highly collisional impurities (in the Pfirsch–Schlüter regime) independent of the radial electric field. We study these effects for a Wendelstein 7-X (W7-X) vacuum field, with simple analytic models for the potential perturbation, under the assumption that the impurity density is given by a Boltzmann response to a perturbed potential. In the W7-X case studied, we find that larger amplitude potential perturbations cause the radial electric field to dominate the transport of the impurities. In addition, we find that classical impurity transport can be larger than the neoclassical transport in W7-X.
We report daptomycin minimum inhibitory concentrations (MICs) for vancomycin-resistant Enterococcus faecium isolated from bloodstream infections over a 4-year period. The daptomycin MIC increased over time hospital-wide for initial isolates and increased over time within patients, culminating in 40% of patients having daptomycin-nonsusceptible isolates in the final year of the study.
Generalized Algebraic Data Types, or simply GADTs, can encode non-trivial properties in the types of the constructors. Once such properties are encoded in a datatype, however, all code manipulating that datatype must provide proof that it maintains these properties in order to typecheck. In this paper, we take a step toward gradualizing these obligations. We introduce a tool, Ghostbuster, that produces simplified versions of GADTs which elide selected type parameters, thereby weakening the guarantees of the simplified datatype in exchange for reducing the obligations necessary to manipulate it. Like ornaments, these simplified datatypes preserve the recursive structure of the original, but unlike ornaments, we focus on information-preserving bidirectional transformations. Ghostbuster generates type-safe conversion functions between the original and simplified datatypes, which we prove are the identity function when composed. We evaluate a prototype tool for Haskell against thousands of GADTs found on the Hackage package database, generating simpler Haskell'98 datatypes and round-trip conversion functions between the two.
The accumulation of impurities in the core of magnetically confined plasmas, resulting from standard collisional transport mechanisms, is a known threat to their performance as fusion energy sources. Whilst the axisymmetric tokamak systems have been shown to benefit from the effect of temperature screening, that is an outward flux of impurities driven by the temperature gradient, impurity accumulation in stellarators was thought to be inevitable, driven robustly by the inward pointing electric field characteristic of hot fusion plasmas. We have shown in Helander et al. (Phys. Rev. Lett., vol. 118, 2017a, 155002) that such screening can in principle also appear in stellarators, in the experimentally relevant mixed collisionality regime, where a highly collisional impurity species is present in a low collisionality bulk plasma. Details of the analytic calculation are presented here, along with the effect of the impurity on the bulk ion flow, which will ultimately affect the bulk contribution to the bootstrap current.
Introduction: Data regarding adverse events (AEs) (unintended harm to the patient from health care provided) among children seen in the emergency department (ED) are scarce despite the high risk setting and population. The objective of our study was to estimate the risk and type of AEs, and their preventability and severity, among children treated in pediatric EDs. Methods: Our prospective cohort study enrolled children <18 years of age presenting for care during 21 randomized 8 hr-shifts at 9 pediatric EDs from Nov 2014 to October 2015. Exclusion criteria included unavailability for follow-up or insurmountable language barrier. RAs collected demographic, medical history, ED course, and systems level data. At day 7, 14, and 21 a RA administered a structured telephone interview to all patients to identify flagged outcomes (e.g. repeat ED visits, worsening/new symptoms, etc). A validated trigger tool was used to screen admitted patients’ health records. For any patients with a flagged outcome or trigger, 3 ED physicians independently determined if an AE occurred. Primary outcome was the proportion of patients with an AE related to ED care within 3 weeks of their ED visit. Results: We enrolled 6377 (72.0%) of 8855 eligible patients; 545 (8.5%) were lost to follow-up. Median age was 4.4 years (range 3 months to 17.9 yrs). Eight hundred and seventy seven (13.8%) were triaged as CTAS 1 or 2, 2638 (41.4%) as CTAS 3, and 2839 (44.7%) as CTAS 4 or 5. Top entrance complaints were fever (11.2%) and cough (8.8%). Flagged outcomes/triggers were identified for 2047 (32.1%) patients. While 252 (4.0%) patients suffered at least one AE within 3 weeks of ED visit, 163 (2.6%) suffered an AE related to ED care. In total, patients suffered 286 AEs, most (67.9%) being preventable. The most common AE types were management issues (32.5%) and procedural complications (21.9%). The need for a medical intervention (33.9%) and another ED visit (33.9%) were the most frequent clinical consequences. In univariate analysis, older age, chronic conditions, hospital admission, initial location in high acuity area of the ED, having >1 ED MD or a consultant involved in care, (all p<0.001) and longer length of stay (p<0.01) were associated with AEs. Conclusion: While our multicentre study found a lower risk of AEs among pediatric ED patients than reported among pediatric inpatients and adult ED patients, a high proportion of these AEs were preventable.
The bootstrap current and flow velocity of a low-collisionality stellarator plasma are calculated. As far as possible, the analysis is carried out in a uniform way across all low-collisionality regimes in general stellarator geometry, assuming only that the confinement is good enough that the plasma is approximately in local thermodynamic equilibrium. It is found that conventional expressions for the ion flow speed and bootstrap current in the low-collisionality limit are accurate only in the
-collisionality regime and need to be modified in the
-regime. The correction due to finite collisionality is also discussed and is found to scale as
Background: The psychological literature suggests that therapist perfectionism is common and potentially detrimental to client recovery. Little is known about the relationship between therapist perfectionism and client outcomes. Aims: This study aimed to measure perfectionism in High Intensity Cognitive Behavioural therapists, and establish any relationships between dimensions of therapist perfectionism, client outcomes and drop-out rates in treatment. Method: Thirty-six therapists took part in the study; levels of perfectionism were measured using a self-report questionnaire and these were analysed in relation to the clinical outcomes from a sample of their clients. Results: The results indicated that therapist perfectionism may be less common than previously suggested. Overall, a number of significant negative associations were observed between aspects of therapist perfectionism (e.g. having high standards for others), treatment efficacy and client retention in treatment. Conclusions: Therapist perfectionism is associated with CBT treatment outcomes; tentative recommendations for therapists managing their own schema as part of their clinical practice have been made, although further investigation is required.
No existing models of alcohol prevention concurrently adopt universal and selective approaches. This study aims to evaluate the first combined universal and selective approach to alcohol prevention.
A total of 26 Australian schools with 2190 students (mean age: 13.3 years) were randomized to receive: universal prevention (Climate Schools); selective prevention (Preventure); combined prevention (Climate Schools and Preventure; CAP); or health education as usual (control). Primary outcomes were alcohol use, binge drinking and alcohol-related harms at 6, 12 and 24 months.
Climate, Preventure and CAP students demonstrated significantly lower growth in their likelihood to drink and binge drink, relative to controls over 24 months. Preventure students displayed significantly lower growth in their likelihood to experience alcohol harms, relative to controls. While adolescents in both the CAP and Climate groups demonstrated slower growth in drinking compared with adolescents in the control group over the 2-year study period, CAP adolescents demonstrated faster growth in drinking compared with Climate adolescents.
Findings support universal, selective and combined approaches to alcohol prevention. Particularly novel are the findings of no advantage of the combined approach over universal or selective prevention alone.
Toxigenic strains of Vibrio cholerae serogroups O1 and O139 have caused cholera epidemics, but other serogroups – such as O75 or O141 – can also produce cholera toxin and cause severe watery diarrhoea similar to cholera. We describe 31 years of surveillance for toxigenic non-O1, non-O139 infections in the United States and map these infections to the state where the exposure probably originated. While serogroups O75 and O141 are closely related pathogens, they differ in how and where they infect people. Oysters were the main vehicle for O75 infection. The vehicles for O141 infection include oysters, clams, and freshwater in lakes and rivers. The patients infected with serogroup O75 who had food traceback information available ate raw oysters from Florida. Patients infected with O141 ate oysters from Florida and clams from New Jersey, and those who only reported being exposed to freshwater were exposed in Arizona, Michigan, Missouri, and Texas. Improving the safety of oysters, specifically, should help prevent future illnesses from these toxigenic strains and similar pathogenic Vibrio species. Post-harvest processing of raw oysters, such as individual quick freezing, heat-cool pasteurization, and high hydrostatic pressurization, should be considered.
Introduction: Diabetes mellitus affects over 2.7 million Canadians, with 90% being Type-2 diabetes (CDA 2010). Complications of diabetes are major causes for emergency department (ED) visits, adversely affecting patients’ health and costing the health system. Improving diabetes self-management can lead to avoidance of ED visits and revisits after discharge. Recent developments in mobile Health (mHealth), such as home health monitoring with sensors, social media, and text messaging, have shown promise in supporting patients in chronic disease self-management. This project tested the feasibility of these tools to support self-management for people with type-2 diabetes. Methods: Forty-three people with type-2 diabetes took part in a three month program that provided: health information via text messages, online access to curated resources and a facilitated discussion board, and access to wireless monitoring devices. Participants were outfitted with a wireless blood pressure monitor and weight scale, standard blood glucose monitor, and online access to their physiological data. Data collected included pre and post-self-reported health measures, tracking of physiological changes, website and discussion board use, cost survey, and interviews. Results: Participants reported significantly less health distress and an increase in diabetes empowerment. HbA1c levels decreased from an average of 7.41 to 6.77. Average weight and blood glucose also decreased over the study period. Interview and cost survey findings revealed most participants felt mDAWN provided good value; 78% expressed interest in continuing all or parts of the program. Interview findings revealed that participants developed self-management routines, and experienced increased self-awareness of, and ownership over, their health achievements. Conclusion: mHealth tools provided participants with their own physiologic information, connection with peers, and evidence informed advice. Participants highly valued this combination and improved their self-management and health outcomes. Equipping patients with similar tools for self-management post ED discharge holds great promise for decreasing revisits and improving health outcomes. This study has stimulated a clinical trial now underway to evaluate the effectiveness of home monitoring to facilitate the transition of patients between acute care and community settings.