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When Hurricane Harvey landed along the Texas coast on August 25, 2017, it caused massive flooding and damage and displaced tens of thousands of residents of Harris County, Texas. Between August 29 and September 23, Harris County, along with community partners, operated a megashelter at NRG Center, which housed 3365 residents at its peak. Harris County Public Health conducted comprehensive public health surveillance and response at NRG, which comprised disease identification through daily medical record reviews, nightly “cot-to-cot” resident health surveys, and epidemiological consultations; messaging and communications; and implementation of control measures including stringent isolation and hygiene practices, vaccinations, and treatment. Despite the lengthy operation at the densely populated shelter, an early seasonal influenza A (H3) outbreak of 20 cases was quickly identified and confined. Influenza outbreaks in large evacuation shelters after a disaster pose a significant threat to populations already experiencing severe stressors. A holistic surveillance and response model, which consists of coordinated partnerships with onsite agencies, in-time epidemiological consultations, predesigned survey tools, trained staff, enhanced isolation and hygiene practices, and sufficient vaccines, is essential for effective disease identification and control. The lessons learned and successes achieved from this outbreak may serve for future disaster response settings. (Disaster Med Public Health Preparedness. 2019;13:97-101)
Aberrant emotional biases have been reported in bipolar disorder (BD), but results are inconsistent. Despite the clinical relevance of chronic mood variability in BD, there is no previous research investigating how the extent of symptom fluctuations in bipolar disorder might relate to emotional biases. This exploratory study investigated, in a large cohort of bipolar patients, whether instability in weekly mood episode symptoms and other clinical and demographic factors were related to emotional bias as measured in a simple laboratory task.
Participants (N = 271, BDI = 206, BDII = 121) completed an ‘emotional categorization and memory’ task. Weekly self-reported symptoms of depression and mania were collected prospectively. In linear regression analyses, associations between cognitive bias and mood variability were explored together with the influence of demographic and clinical factors, including current medication.
Greater accuracy in the classification of negative words relative to positive words was associated with greater instability in depressive symptoms. Furthermore, greater negative bias in free recall was associated with higher instability in manic symptoms. Participants diagnosed with BDII, compared with BDI, showed overall better word recognition and recall. Current antipsychotic use was associated with reduced instability in manic symptoms but this did not impact on emotional processing performance.
Emotional processing biases in bipolar disorder are related to instability in mood. These findings prompt further investigation into the underpinnings as well as clinical significance of mood instability.
Introduction: Recent years have brought an epidemic of opioid abuse to Canada. At present, in Ontario, Naloxone may not be administered by any paramedic without the direct online medical approval of a Base Hospital Physician (BHP). The objective of this study was to review the use of Naloxone by Emergency Medical Service (EMS) personnel, under the existing Advanced Life Support Patient Care Standards (ALS-PCS) medical directive for opioid toxicity, for safety and potential complications that may occur with removal of the mandatory patch point. Methods: This study was a retrospective ambulance call report review of consecutive Naloxone requests placed to a BHP of the Regional Paramedic Program of Eastern Ontario (RPPEO) between Oct 1st, 2013 and Oct 31st, 2015. The RPPEO consists of 10 prehospital services, both urban and rural jurisdictions, and has a mix of advance care and primary care paramedics. All ambulance call reports are electronically stored at the secured RPPEO data warehouse. Data was extracted using a standardized data collection tool. All ambulance call reports were reviewed by 2 independent authors (VC, NC). Compliance with the existing medical directive for opioid toxicity was determined. We calculated the frequency of denied Naloxone requests and the rationale for each patch refusal was recorded. We also categorized all adverse events associated with Naloxone administration. Results: From 244 patches, 215 patients were administered Naloxone. Only 7.8% (19/215) of requests for Naloxone were refused; 78.9% (15/19) did not meet existing inclusion criteria for Naloxone administration in the ALS-PCS medical directive for opioid toxicity because the patient’s respiration rate was above 12/min. Of the 215 patients who were administered Naloxone, adverse events were extremely uncommon: 5 (2.3%) became violent or verbally abusive, 1 (0.5%) was transiently hypertensive and 4 (1.9%) vomited. Conclusion: Requests for Naloxone to a BHP are common and yet are seldom declined. The use of prehospital Naloxone is associated with few adverse events. These results demonstrate that it would be safe to remove online medical direction for Naloxone from the ALS-PCS medical directive for opioid toxicity if combined with updated paramedic education.
Background: There are no disease modifying agents for the treatment of Alzheimer’s disease (AD). Pathologically, AD is associated with the misfolding of two peptides: beta-amyloid (plaques) and tau (tangles). Methods: Using large-scale computer simulations, we modelled the misfolding of both beta-amyloid and tau, identifying a common conformational motif (CCM; i.e. an abnormal peptide shape), present in both beta-amyloid and tau, that promotes their misfolding. We screened a library of 11.8 million compounds against this in silico model of protein misfolding, identifying three novel molecular classes of putative therapeutics as anti-protein misfolding agents. We synthesized approximately 400 new chemical entity drug-like molecules in each of these three classes (i.e. 1200 potential drug candidates). These were comprehensively screened in a battery of five in vitro protein oligomerization assays. Selected compounds were next evaluated in the APP/PS1 doubly transgenic mouse model of AD. Results: Two new classes of molecules were identified with the ability to block the oligomerization of both beta-amyloid and tau. These compounds are drug-like with good pharmacokinetic properties and are brain-penetrant. They exhibit excellent efficacy in transgenic mouse models. Conclusion: Computer aided drug design has enabled the discovery of novel drug-like molecules able to inhibit both tau and beta-amyloid misfolding.
The fall of the Berlin Wall in 1989 and the unification of Germany in 1990 allowed East Germans to finally travel freely to western countries. This new freedom to travel to the West not only impacted the worldview of many former GDR citizens, but also found its way into the writings of East German authors throughout the 1990s and into the present. In her study on contemporary German literature around the turn of the twenty-first century, the literary critic Christine Cosentino examines several tendencies by which contemporary German authors deal with America in their texts. One tendency she describes is “die Reise in die USA als Topos für die Suche nach Identität, die den politischen Hintergrund weitgehend ausspart” (the journey to the USA as a symbol for the search for identity, which largely leaves out the political background). This tendency—finding one's identity by traveling to America—is noticeable in literature by East German authors from the 1990s, one of whom is Angela Krauß. In many of her works, particularly in her novels Die Überfliegerin (1995) and Milliarden neuer Sterne (1999), travel to America is a catalyst for the narrator experiencing her own identity in relation to past experiences, specifically her life in East German society. The exploration of the new world manifests itself in these texts as a discovery of the narrator's inner self.
Sophie von La Roche's America novel, Erscheinungen am See Oneida (Phenomena at Lake Oneida, 1798), centers on a French aristocratic couple from Flanders who go to live on a remote island in upstate New York. Carl and Emilie von Wattines have fled to the United States from the French revolutionary Terror, in which several of their relatives lost their lives. On advice from a Quaker friend in Philadelphia, they find their way to an island in Oneida Lake. There they live without contact with other Europeans for four years, producing two children and making a modest life for themselves, before moving to a new town founded by Dutch and German settlers on the lakeshore. A narrator traveling in the region pieces their story together from what he learns from them and their friends. At the crux of the tale is how the Wattineses, Crusoe-like, manage to survive in their isolation.
Three factors play a role. First, in spite of being aristocrats, they possess a bourgeois ethic, demonstrating qualities like modesty, hard work, and resourcefulness that help them to thrive. Second, they have brought a whole library of reference books with them, including the entire Encyclopédie and Buffon's Histoire naturelle, to which they frequently refer for how-to information. Finally and most interestingly, Emilie Wattines decides to reach out and make contact with the local indigenous people, the Oneidas, when she is about to give birth.
In recent years, the works by the German-Jewish poet Gertrud Kolmar (1894–1943) have found renewed interest among scholars. Raised in the upper middle class of Berlin and fully acculturated in the German cultural heritage, Gertrud Kolmar was persecuted, under the pressure of the National Socialist regime, because of her Jewish roots. Unlike many of her contemporaries, she chose to remain in Nazi Berlin and continued to write until her death in Auschwitz in 1943. Even though her published work spanned the innovative period between 1917 and 1937, Kolmar's poetic oeuvre from the years 1927 to 1937 has received the most attention. Though neglected by scholars, Kolmar's earlier work is fascinating precisely because it gives prescient insight into her poetic adaptations of questions concerning place, power, and gender at the end of the First World War.
My essay investigates an early poem in Kolmar's work: “Die Aztekin” (The Aztec Woman), written around 1920 and published in Früher Zyklus I. In memoriam 1918. Kolmar's “Aztekin” illustrates a testing ground for colonial fantasies and gendered mappings in its imaginary space of a poetic “Aztec empire.” The poem responds not only to preestablished writings on gendered conquests in the New World but also, more specifically, rewrites them in the perceived context of an imperial apocalypse in and after 1918, between megalomaniacal power struggles and the collapse of the Wilhelmine empire.
Swiss photojournalist and author Annemarie Schwarzenbach was born in 1908 into the family of the wealthy Swiss silk manufacturer Alfred Schwarzenbach and his wife Renée Schwarzenbach-Wille and died under tragic circumstances in 1942. Schwarzenbach's life was marked by her travels to the United States, the Orient, Africa, and through Europe. In this context, during her lifetime Schwarzenbach gained recognition for her travel writing and journalism within Switzerland. For example, her work was regularly published in Zürcher Illustrierte, National-Zeitung, Luzerner Tagblatt, Thurgauer Zeitung, and the journal ABC. As recent scholarship has emphasized, “her travel writings consist of a wide range of genres: from journalistic reportages and feuilletons to stories, novels, and also poems. In addition to her journalistic and travel writing, Schwarzenbach also produced several novels and novellas that thematize same-sex relationships as well as the blurring of gender lines, such as Eine Frau zu sehen (written in 1929, published in 2008), Pariser Novelle (written in 1929, published in 2003), Freunde um Bernhard (1931), and Tod in Persien (1936), among others. This last work also reflects her travels to the Near East. Schwarzenbach's androgynous and striking physical beauty, her homosexuality, travels, and drug abuse, as well as her encounters, friendships, and liaisons with famous contemporaries, made her in public and scholarly discourses into something of an icon. This icon status and the “clear autobiographical dimension” in her work fueled biographical scholarly approaches to Schwarzenbach's oeuvre after its rediscovery in 1987 (Schwelle, 404) after “her name [had] faded into obscurity” following her death.
November 5, 1853. Ida Pfeiffer, an Austrian traveler, is on her way to a village north of Crescent City in California, and the main purpose of her visit to this region is, as she claims, to see Indians. What she finds instead are ethnically hybrid Native Americans:
Nichts erschien mir komischer als die sonderbaren Anzüge, denn auch hier lasen sie alle von den Weißen weggeworfenen Kleidungsstücke auf. So sah ich einen Indianer, welcher ein Beinkleid, eine sehr schadhafte Mantille und einen zerknitterten Frauenhut trug. Ein anderer hatte weiter nichts als einen Frack an, den er nach eigenem Geschmacke auf der Rückseite ganz mit Glasperlen benäht hatte. Ein dritter trug wieder nur eine Weste, dazu einen Männerhut, in welchen er oben ein Loch geschnitten und viele Vogelfedern aufgesteckt hatte. Ebenso geschmackvoll waren die Weiber gekleidet.
[Nothing seemed more comical to me than their strange outfits, for here too they collected all the garments discarded by the whites. I saw an Indian wearing a pair of breeches, a very ragged mantilla, and a crumpled lady's hat. Another one wore nothing but a frock coat, the back of which he had adorned with glass beads according to his own taste. A third one wore only a waistcoat and a man's hat to go with it. On its top he had cut a hole and stuck many feathers into it. The women were dressed in equally good taste.]
In the late nineteenth century, novels by the author “S. Wörishöffer” were best-sellers among young readers, rivaling the works of Karl May in popularity. Although their educational value might be debatable, Wörishöffer's adventure tales, which were set all over the world, seemed to offer the combination of excitement and exoticism that was attractive to young readers. In spite of the books' popularity, however, their readers knew virtually nothing about their author. This was no coincidence; the novelist's identity was a well-kept secret. It was not a globetrotter writing about his own experiences who was hiding behind the pen name “S. Wörishöffer.” Instead, the author lived in Altona near Hamburg and never ventured farther from home than to the East Frisian Islands. In addition, the author was not a man, as the subject matter of the stories might suggest, but a woman—Sophie Wörishöffer. In order to maintain the credibility of her works, Wörishöffer's publisher Velhagen & Klasing consciously hid such details from the public (Klasing, 658).
Nevertheless, Wörishöffer produced at least a dozen exotic adventure novels for the “reifere Knabenwelt” (readership of teenage boys), as many of them were subtitled. Their settings and the travels of their protagonists are not limited to America, but encompass the globe. For example, in her first adventure novel alone, Robert des Schiffsjungen Fahrten und Abenteuer auf der deutschen Handels- und Kriegsflotte (Robert the Cabin Boy's Journeys and Adventures with the German Merchant and Armed Fleet, 1877), Robert travels from Germany to Cuba, the United States, the Arctic Circle, South America, and via North America back to Germany, from whence he then ventures out again.
Gabriele Reuter's textsEpisode Hopkins (1889) and Der Amerikaner (The American, 1907) fall into a historic timeframe that presented German society with the challenge to define itself. Both texts reflect the struggle for a national identity based on a common cultural identity (rather than on an economic collaboration between the wars of 1871 and 1914) and the German state's unilateral position as a tactical outsider to global imperialism. At the time Der Amerikaner was produced, not quite twenty years after the foundation of the German state, the euphoric national climate that united the nation-states against the enemy around the time of the Napoleonic wars at the beginning of the century had faded, and the federal states sought for commonalities in order to stress their national identity. The historian Harold James prominently calls this disposition of the German states a “tortured quest for identity.” The contemporaneous identity crisis, James explains in A German Identity, arose from an attempt of the enemies of political liberalism to install a concept of nationalism based on “the mystical terms of community and, more and more from the 1870s, of race” instead of economic nationalism. This development ultimately lead to “a redefinition of nationality” outside of an economic framework (91). James's analysis explains the political developments that lead to the German crisis of identity, and I argue that such a redefinition shapes the zeitgeist in such a way that it is reflected in fictional works of art.