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Introduction: Despite an overall decline in opioid prescriptions in Canada, healthcare visits, hospitalizations, and deaths due to opioid-related harms continue to rise for children. Clinicians urgently require high quality synthesized evidence to inform personalized decisions regarding opioid use for children. The objective of this systematic review was to examine the association between short-term therapeutic exposure to opioids and development of opioid use disorder. Methods: A medical librarian conducted a comprehensive search of 10 databases from inception to May 2019. Two authors independently assessed studies for inclusion. Studies were eligible if they reported primary research in English or French, and study participants had short (<14 days) or non-specific duration of therapeutic exposure to opioids before age 18 years. Primary outcome was the development of an opioid use disorder; secondary outcomes included opioid addiction, dependence, misuse, and abuse. Data extraction involved two independent reviewers utilizing a standardized form. Methodological quality was assessed using the NIH tools for observational studies. Results are described narratively. Results: The search identified 4,072 unique citations; 82 were selected for review, and 17 were included (3 retrospective cohort, 4 prospective cohort, and 10 cross-sectional). All studies took place in the USA. A total of 1,562,503 participants were analyzed. Nine studies were administered in schools, 3 used administrative data. While most settings were non-specific, 1 study examined opioid use in dentistry, 1 in trauma, and 1 in organized sports. One comparative study showed an association between short-term therapeutic use and opioid misuse. Two studies showed opioid related adverse events (e.g., overdose) among cohorts exposed to short-term use. The remaining 14 studies did not specify duration of exposure; therefore, confirming whether misuse was due to short-term therapeutic exposure was not possible. Conclusion: A small number of studies in this review suggest an association between short-term opioid use and opioid misuse; however, further analysis is underway with consideration of methodological limitations of the individual studies (final results pending). Careful consideration of the risk and benefits of short-term opioid use should be undertaken prior to prescribing opioids. PROSPERO Registration Number: 122681.
Efficacious resource harvesting constitutes new modes of conceptualizing the interactions of buildings with surrounding environmental conditions. The internal logic of a biotechnical paradigm in architectural design allows for the potential of fluid exchanges between medium and material to be realized with correlated metabolism. Such concepts avert existing mechanical paradigms based upon linear conservation of energy processes and approach entropic integrated design interactions of nonlinear dynamical processes. Through a physiological analogy that informs architectural anatomy, the genetic code of hydrogels embeds emergent morphological responses to discrete interactions with environmental phenomena. In contrast to the static hard tissue of the skeletal system, viscoelastic soft tissue provides significant environmental impact by means of integrating spatiotemporal adaptation in building systems.
This framework provides an interscalar perspective for integrating biopolymeric membranes within building-envelope systems and informs the microstate design of the polymer chains for optimized mechanical performance. Hydrogels are a translucent three-dimensional water-swollen polymer, which exhibit mechanical work upon interaction with water vapor. In effect, this interaction provides for a variant index of refraction, a variant heat capacitance, and a physical shift in surface morphology. Characteristic changes in material thermal and mechanical properties parallel diurnal climate profiles for circadian biorhythmic membrane designs. The macrostates of temperature, pressure, and volume reciprocally inform the potential microscopic properties, including position and velocity of each molecule within the material system. The viscoelastic molecular entropy (Maxwell model) of hydrogels is established as a fundamental basis for situating a dynamic material logic influencing a high efficacy architectural physiology. The Maxwell model is translated as an algorithmic framework for mechanical control through tetra-functional polymer chain development of biopolymeric hydrogels. In contrast to polyacrylamide hydrogels, the chemistry of biopolymeric polysaccharide hydrogels is well suited for renewable sourcing and down cycling to achieve sustainable material life cycles. However, these biopolymers do not inherently exhibit robust structural properties necessary for influencing morphological shifts of the membranes for intelligent passive design strategies such as self-actuating ventilation apertures or self-shading surface geometries. The research encompassed in this work engages the development of a more acute framework for the trajectory of biopolymeric hydrogel dynamics based upon a necessity for controlled morphological modulations in response to specific environmental conditions.
Architectural design research in next-generation building systems is transforming dynamic building envelope performance towards systems that not only meet the energy demands of buildings but also respond to occupant preferences for aesthetics, comfort and control. Although research provides tremendous potential for future systems, existing tools and methods of evaluation primarily focus on energy efficiency and continue to postpone human factors issues. In order to assess the architectural opportunities of nano- and micro-material innovations for building facades, new simulation methods are needed to predict and program their multifunctional performance capabilities, particularly in relationship to human interaction. This paper describes the construction of augmented reality simulations and preliminary experimental results of co-optimizing advanced building skin performance according to multiuser interaction and bioclimatic response. The strengths and limitations of the augmented reality simulations in relation to environmental performance and human interaction are presented. A discussion of ongoing work focuses on the integration of multiuser interactions and virtual reality techniques coupled with whole-building energy modeling methods.
Preterm birth is common and the associated short-term morbidity well described. The adult-onset consequences of preterm birth are less clear, but cardiovascular and metabolic health may be adversely affected. Although large animal models of preterm birth addressing important short-term issues exist, long-term studies are hampered by significant logistical constraints. Current small animal models of prematurity require terminal caesarean section of the mother; both caesarean birth and early maternal care modify offspring adult cardio-metabolic function.
We describe a novel method for inducing preterm labour in guinea pigs. With support comparable to that received by moderately preterm human infants, preterm pups are viable. Growth trajectories between preterm and term-born pups differ significantly; between term equivalent age and weaning ex-preterm animals demonstrate increased weight and ponderal index.
We believe this novel paradigm will significantly improve our ability to investigate the cardio-metabolic sequelae of preterm birth throughout the life course and into the second generation.
Researchers have long been interested in whether particular temperamental traits in childhood connote risk for depressive disorders. For example, children characterized as having high negative emotionality (NE; sadness, fear, anger) and low positive emotionality (PE; anhedonia, listlessness, and lack of enthusiasm) are hypothesized to be at risk for depression. Few studies, however, have examined whether (and how) these two temperamental dimensions interact to confer risk. In a sample of 329 preschoolers, the present study addressed this question by examining the relation between PE and NE and asymmetry in resting EEG activity in frontal and posterior regions, which are putative biomarkers for depression. Using a laboratory battery to define temperament, we found an interaction of PE and NE on posterior asymmetry. Specifically, when PE was high, NE was associated with greater relative right activity. When PE was low, NE was not related to posterior asymmetry. These results were driven by differences in EEG activity in right posterior regions, an area associated with emotional processing and arousal, and were specific to girls. We found no relation between temperament and frontal asymmetry. These findings suggest that, at least for girls, PE and NE may have an interactive effect on risk for depression.
Division VI gathers astronomers studying the diffuse matter in space between stars, ranging from primordial intergalactic clouds, via dust and neutral and ionized gas in galaxies, to the densest molecular clouds and the processes by which stars are formed.
The majority of people with severe traumatic brain injury (TBI) experience long-term disability and are unable to return to their usual activities. Services that offer community social and leisure participation programs are likely to reduce the social burden associated with severe TBI. The aim of this study was to gain an understanding of the personal effects of becoming engaged in community leisure activities. It was hypothesised that adults with severe TBI who participated regularly in leisure activities over a 6-month period would show measurable positive change in the domains of community integration, social support, mental health and quality of life (QOL). Participants numbered 25 adults (mean age 36.95 years) who had been referred to community leisure programs participated in the study. All participants had sustained severe injuries (post-traumatic amnesia > 1 month). A repeated measures design over 6 months was used. Assessment involved a semistructured interview, global subjective QOL rating and administration of standardised measures: SF-12v2, Neurobehavioral Functioning Inventory, Instrumental-Expressive Social Support-Scale, and Community Integration Questionnaire. Adults who participated regularly over 6 months reported positive and statistically significant changes in social integration and mental health. These findings support the use of assisted community participation programs for adults with severe TBI.
Observers were placed on pelagic vessels in the Scottish fisheries for mackerel (Scomber scombrus), herring (Clupea harengus), "maatje" herring (herring caught just before their first spawning) and argentines (Argentina silus) to monitor by-catch composition and discarding practices. A total of 67 days was spent at sea, 11 on the argentine fleet, 28 on the herring fleet, 12 on the "maatje" herring fleet and 16 on the mackerel fleet. The level of by-catch generally ranged from <1% to around 2.5% of the total catch. The argentine fishery took a significant proportion of blue whiting (Micromesistius poutassou) (approx. 10% of the overall catch) but this was landed and sold in the market. The greatest range of by-catch species was found in the argentine fishery, including 11 species of fish and one species of squid. Discarding rates in the fisheries varied, with herring and argentine fisheries showing no discards, the mackerel fishery a discard rate of around 4% and the "maatje" herring fishery a discard rate of around 11%. By-catches included small numbers of gannets (Morus bassanus) but no marine mammals. If the sampled trips were representative, results indicate that marine mammal by-catch events typically occur during less than one in 20 hauls in the fisheries studied. A larger scale study is needed to confirm this. Cetaceans were sighted in the vicinity of the fishing boats during 4% of observed fishing activities.
The penultimate scene of Euripides' Troades, lines 1123–1250, presents the dressing of a child's corpse for burial. Even as the body is being carried away for interment, firebrands are seen on the heights of Troy (1256–9). All that remains is the commencement of the final burning of the city while the remaining Trojan captives are ordered off for embarkation and exile. The end of the play, therefore, enacts the annihilation of a city and its total abandonment; in such a context the funeral which immediately precedes surely makes a crucial contribution to the significance of the play and deserves close study.
A systematic study has been made of the growth of both hydrogenated amorphous silicon (a-Si:H) and silicon nitride (a-SiN) by electron cyclotron resonance plasma enhanced chemical vapour deposition (ECR-PECVD). In the case of a-SiN, helium and nitrogen gas is injected into the system such that it passes through the resonance zone. These highly ionised gases provide sufficient energy to ionise the silane gas, which is injected further downstream. It is demonstrated that a gas phase reaction occurs between the silane and nitrogen species. It is control of the ratio of silane to nitrogen in the plasma which is critical for the production of stoichiometric a-SiN. Material has been produced at 80 °C with a Si:N ratio of 1:1.3 a breakdown strength of ∼6 MV cm−1 and resistivity of >1014 Ωcm. In the case of a-Si:H, helium and hydrogen gas is injected into the ECR zone and silane is injected downstream. It is shown that control of the gas phase reactions is critical in this process also. a-Si:H has been deposited at 80 °C with a dark conductivity of 10−11 Ω−1 cm−1 and a photosensitivity of just below 4×104. Such materials are suitable for use in thin film transistors on plastic substrates.
The meaning of the expression simul ultima signant in Virgil's description of the foot race in the memorial funeral games for Anchises has been controversial since ancient times. The interpretation implied by R. A. B. Mynors's Oxford text printed above is that the word simul in line 317 is a conjunction and that the expression refers to the final section of the race. The sense presumably is: ‘As soon as they trod the last stretch’ Nisus came out in front, whereas previously the runners had all been in a bunch, pouring forth like a storm cloud from the start. This interpretation, which requires a full stop in the middle of line 317, was proposed by F. H. Sandbach in response to problems generally acknowledged in the line as traditionally punctuated, that is, with a lighter pause after similes and a full stop at the end of the line—as, for example, in F. A. Hirzel's Oxford text: effusi nimbo similes: simul ultima signant. With this punctuation the last three words of the line have been taken to mean either that the runners fix their eyes on the finish, which gives a meaning to the verb which is difficult in the absence of any reference to the eyes, or that other people apart from the runners mark out the finishing line, which gives unexceptional sense to the verb but an implausible timing to the operation: it is odd indeed to leave the marking of the finish until after the race has started. These and other suggestions are discussed by Sandbach and R. D. Williams, who believe that they are untenable.
Isoenzyme typing was used to study a number of oocyst isolates of Cryptosporidium parvum from different geographical locations and of human or animal origin. All isolates showed identical enzyme motility when glucose phosphate isomerase (GPI; 23 isolates tested) or lactate dehydrogenases (LDH; 20 isolates tested) was assayed. However, two isoenzyme forms were observed with phosphoglucomutase (PGM; 9 animal isolates showed one form, while 8/9 human isolates showed a second form) and hexokinase (HK; 4 human isolates showed one form and 6 animal isolates showed a second form). Thus, PGM and HK each exhibit 2 isoenzymes corresponding to 2 parasite populations associated with separate hosts. The data from this study, plus supportive evidence obtained by different methods and by independent researchers, lend support to the hypothesis that separate cycles of transmission of C. parvum may exist within human and animal hosts.
At the start of the play Prometheus is brought on stage by two agents of Zeus, Kratos and Bia. He is to be fastened up against the side of a rock and exposed to the elements. Hephaestus, who enters with the others, is to provide the tackle and the skills to do the job. Hephaestus shows extreme reluctance to perform his duties, both in his initial utterances (17-21, 39-54) and during the actual process of fastening, particularly when dealing with the chest (66) and legs (78); Kratos, however, browbeats him brutally, at which Hephaestus acknowledges that he has no choice and obeys.
With this reflection on mortal folly Poseidon concludes the divine prologue of Euripides' Troades. This text was printed by Murray with the addition of a comma at the end of line 95, but Diggle accepts Page's emendation I shall argue that the manuscript reading gives perfect sense and that, since it is good Greek, there is no need for emendation.
D. Kovacs has pointed out that these lines make no mention of desecration, for to bring temples into desolation () is quite different from desecrating them. Further, since it is regularly assumed in Greek thought that cities can be sacked without sacrilege, the folly on which Poseidon comments does not consist in a victor's incurring divine punishment simply by the act of sacking a city. I agree with Kovacs on these points and believe that his argument refutes the widely held view that in these lines Euripides is condemning on moral or religious grounds the sacking of cities in general.
In his vigorous analysis of Dido's soliloquy J. Henry confronts the problem of line 543: ‘How comes it that, having just decided that she will not go with the Trojans, that they would not even receive her if she went, she so immediately inquires shall she go with them, alone or accompanied?’ He suggests that the words introduce ‘a new category of objections’; hitherto the issue has been between herself and the Trojans, but now she reflects that the Trojans are not the only people she has to deal with. To go alone is but to run away from her own people, and she cannot in the circumstances of their recent arrival at Carthage ask them to sail with her. ‘Even more impossible to leave Carthage than to go with Aeneas.’
The importance of environment, health and welfare nowadays asks for new approaches. Lessons may be learned from experiences elsewhere. In the Netherlands some consumers dislike the intensive pig production systems with little room for movement of the pigs. The pollution problem is considered to be unacceptable. They might also be afraid of harmful effects of additives on their health. A free-range pig keeping system was set up to accommodate these customers. The name of the system is “Scharrelvarkens” and is derived from the Dutch word “Scharrelen” which refers to feed intake behaviour of poultry in free-range conditions. “Varkens” stands for pigs. The free-range production system is according to certain rules. Animals are group housed, partly outdoors and no feed additives are allowed. Details are in the appendix.
The precise relationship between the two accounts of the death of Palinurus in the Aeneid (5.833-71, 6.337-83) remains elusive, in spite of the wealth of discussion bestowed upon them in recent years. When the helmsman falls overboard in Book 5, according to the narrative, sea and sky are serene, but in the version which his spirit recounts to Aeneas in the underworld in Book 6, there is suggestion of rough seas, great waves rising and violent winter wind. On the other hand, the two accounts have not been developed in total separation, with the natural causation of a storm replacing the supernatural operation of the god Sleep as an explanation of Palinurus’ undoing. For, although Palinurus in his own version of events does not men tion Sleep—how could he, since the god came in human disguise?
The above is the text of Medea 922–33 and a selection of the critical apparatus from the Oxford text edited by J. Diggle. In his discussion of the variant readings at 926 Diggle leaves open the choice between θήσομαι and θήσω. It seems to me worth noticing that an old proposal of Theodor Ladewig to transpose 926–8 and 929–31, which has in any case much to commend it, has a bearing on the solution of this problem.
By comparison with Aeschylus and Sophocles, Euripides makes remarkable use of young children in his tragedies. There are vocal parts, sung by individual children in Alcestis and Andromache, cries off for the two boys in Medea, and a song for a supplementary chorus of boys in Supplices. Important episodes concern silent children on stage in Heracles and Troades, lesser roles occur in Hecuba and Iphigeneia in Aulis, and suppliant children may be on stage throughout Heracleidae. No children figure in the extant plays of Aeschylus, and Sophocles gives them silent parts only in Ajax and Oedipus Tyrannus. It seems reasonable to suppose that children are proportionally more central to Euripides’ idea of tragedy, and that individual plays might be studied from this angle. Accordingly I propose to analyse the part of the children in Alcestis, not with questions of methods of performance in mind, but for what the presence, action, utterance or absence of children at any point can tell us about the issues and themes of the play.