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Despite the global significance of the Leach’s Storm-petrel Hydrobates leucorhous colony on Baccalieu Island, Newfoundland and Labrador, Canada, the estimate of 3.36 million breeding pairs reported for 1984 by Sklepkovych and Montevecchi stands as the single published population estimate for the world’s largest colony. This study increases knowledge of this population by analysing data from additional independent surveys conducted in 1984 and 1985, and by updating the population status with a survey conducted in 2013. Population estimates were derived by extrapolating occupied burrow densities to the estimated occupied area of four main habitat types (heath, forest, grass and fern), which in turn were based on proportions of habitats observed in plots (1984 and 1985) or by using a Geographic Information System approach (2013). Based on these surveys, the Leach’s Storm-petrel breeding population size on Baccalieu Island was estimated at 5.12 ± 0.73 (SE) and 4.60 ± 0.42 (SE) million pairs in 1984 and 1985 respectively, representing estimates 37–51% greater than the original 1984 survey. While discrepancies among these estimates were largely driven by the way occupied areas were estimated, our study confirms that Baccalieu Island hosts the largest Leach’s Storm-petrel colony in the world. Results from the 2013 survey estimate the current breeding Leach’s Storm-petrel population at 1.95 ± 0.14 (SE) million pairs, representing a 42% decline over 29 years (-1.4% per year), relative to the original published estimate of 3.36 ± 0.12 (SE) million pairs. The most prominent change has occurred in the density of storm-petrel burrows found in forest habitat which dropped by 70% despite forest remaining the second most abundant habitat available to nesting storm-petrels on Baccalieu Island. The cause of this decline remains unknown and is likely multi-faceted. Future research focusing on demographic studies is required to understand what is driving the population decline of this internationally important colony.
A 15-month-old child underwent percutaneous expansion of a Melody transcatheter pulmonary valve in the mitral position to accommodate growth after initial surgical implantation during infancy, but transiently decompensated after valvuloplasty owing to stent malformation. The Melody valve in the mitral position of small patients can be further expanded by percutaneous dilation, but there are a number of potential complications and technical improvements to consider.
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.
A crucial component of a hospital’s disaster plan is an efficient staff recall communication method. Many hospitals use a “calling tree” protocol to contact staff members and recall them to work. Alternative staff recall methods have been proposed and explored.
An unannounced, multidisciplinary, randomized emergency department (ED) staff recall drill was conducted at night - when there is the greatest need for back-up personnel and staff is most difficult to reach. The drill was performed on December 14, 2017 at 4:00am and involved ED staff members from three hospitals which are all part of the McGill University Health Centre (MUHC; Montreal, Quebec, Canada). Three tools were compared: manual phone tree, instant messaging application (IMA), and custom-made hospital Short Message Service (SMS) system. The key outcome measures were proportion of responses at 45 minutes and median response time.
One-hundred thirty-two participants were recruited. There were 44 participants in each group after randomization. In the manual phone tree group, 18 (41%) responded within 45 minutes. In the IMA group, 11 participants (25%) responded in the first 45 minutes. In the SMS group, seven participants responded in the first 45 minutes (16%). Manual phone tree was significantly better than SMS with an effect size of 25% (95% confidence interval for effect: 4.6% to 45.0%; P=.018). Conversely, there was no significant difference between manual phone tree and IMA with an effect size of 16% (95% confidence interval for effect: −5.7% to 38.0%; P=.17) There was a statistically significant difference in the median response time between the three groups with the phone tree group presenting the lowest median response time (8.5 minutes; range: 2.0 to 8.5 minutes; P=.000006).
Both the phone tree and IMA groups had a significantly higher response rate than the SMS group. There was no significant difference between the proportion of responses at 45 minutes in the phone tree and the IMA arms. This study suggests that an IMA may be a viable alternative to the traditional phone tree method. Limitations of the study include volunteer bias and the fact that there was only one communication drill, which did not allow staff members randomized to the IMA and SMS groups to fully get familiar with the new staff recall methods.
HomierV, HamadR, LarocqueJ, ChasséP, KhalilE, FrancJM.A Randomized Trial Comparing Telephone Tree, Text Messaging, and Instant Messaging App for Emergency Department Staff Recall for Disaster Response. Prehosp Disaster Med. 2018;33(5):471–477.
Archaeological sites in the Canadian Arctic often contain substantial quantities of marine mammal bones and in some cases completely lack terrestrial mammal bones. A distrust of radiocarbon (14C) dates on marine mammal bones among Arctic archaeologists has caused many sites to be insufficiently dated. The goal of this study was to investigate the marine reservoir effect on Atlantic walrus in the Foxe Basin region of the Canadian Arctic through a two-pronged approach: dating of live-harvested specimens of known age collected prior to AD 1955 and dating of pairs of animal remains (walrus and caribou) from stratigraphically contemporaneous levels within archaeological features. 14C dates on pre-bomb, live-harvested walrus indicate that a ΔR value of 160±50 yr be used in calibrating dates on walrus from this region. These results differed significantly from a similar set of pre-bomb mollusks, which argues against applying mollusk-based corrections to marine mammals. The results of comparative dating of caribou and walrus from archaeological features provided maximum estimates of reservoir ages that were more varied than the directly measured ages. Although about half of inferred ΔR values overlap the museum specimen results, the others indicate that the assumption of contemporaneity does not hold true.
To make pragmatic recommendations on best practices for the engagement of patients in emergency medicine (EM) research.
We created a panel of expert Canadian EM researchers, physicians, and a patient partner to develop our recommendations. We used mixed methods consisting of 1) a literature review; 2) a survey of Canadian EM researchers; 3) qualitative interviews with key informants; and 4) feedback during the 2017 Canadian Association of Emergency Physicians (CAEP) Academic Symposium.
We synthesized our literature review into categories including identification and engagement, patients’ roles, perceived benefits, harms, and barriers to patient engagement; 40/75 (53% response rate) invited researchers completed our survey. Among respondents, 58% had engaged patients in research, and 83% intended to engage patients in future research. However, 95% stated that they need further guidance to engage patients. Our qualitative interviews revealed barriers to patient engagement, including the need for training and patient partner recruitment.
Our panel recommends 1) an overarching positive recommendation to support patient engagement in EM research; 2) seven policy-level recommendations for CAEP to support the creation of a national patient council, to develop, adopt and adapt training material, guidelines, and tools for patient engagement, and to support increased patient engagement in EM research; and 3) nine pragmatic recommendations about engaging patients in the preparatory, execution, and translational phases of EM research.
Patient engagement can improve EM research by helping researchers select meaningful outcomes, increase social acceptability of studies, and design knowledge translation strategies that target patients’ needs.
Previous work has identified associations between psychotic experiences (PEs) and general medical conditions (GMCs), but their temporal direction remains unclear as does the extent to which they are independent of comorbid mental disorders.
In total, 28 002 adults in 16 countries from the WHO World Mental Health (WMH) Surveys were assessed for PEs, GMCs and 21 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. Discrete-time survival analyses were used to estimate the associations between PEs and GMCs with various adjustments.
After adjustment for comorbid mental disorders, temporally prior PEs were significantly associated with subsequent onset of 8/12 GMCs (arthritis, back or neck pain, frequent or severe headache, other chronic pain, heart disease, high blood pressure, diabetes and peptic ulcer) with odds ratios (ORs) ranging from 1.3 [95% confidence interval (CI) 1.1–1.5] to 1.9 (95% CI 1.4–2.4). In contrast, only three GMCs (frequent or severe headache, other chronic pain and asthma) were significantly associated with subsequent onset of PEs after adjustment for comorbid GMCs and mental disorders, with ORs ranging from 1.5 (95% CI 1.2–1.9) to 1.7 (95% CI 1.2–2.4).
PEs were associated with the subsequent onset of a wide range of GMCs, independent of comorbid mental disorders. There were also associations between some medical conditions (particularly those involving chronic pain) and subsequent PEs. Although these findings will need to be confirmed in prospective studies, clinicians should be aware that psychotic symptoms may be risk markers for a wide range of adverse health outcomes. Whether PEs are causal risk factors will require further research.
Horizontal branch (HB) models were evolved using the Yale stellar evolution code, YREC, to test the possibility that mass loss during the RR Lyrae phase is able to produce the observed color (mass) dispersion on the HB (Willson and Bowen 1984) and the anomalous period changes in RR Lyrae stars (Laskarides 1974). Models of total mass 0.64, 0.66, 0.68, 0.70, and 0.72 M⊙ (YMS = 0.23, Z = 0.001) were evolved with constant mass loss rates of 0, 10-10, and 10-9 M⊙ yr-1. Mass loss was assumed to occur only in the RR Lyrae phase, and the instability strip was defined by 3.800 < log Teff < 3.875.
HB stars which lose mass evolve further to the blue. Low mass loss rates do not affect the shape of the tracks significantly. Stars, which without mass loss could not become blue HB stars, were able to emerge from the instability strip on the blue side.
This paper uses matched asymptotic expansions to study the non-localized (which we refer to as global) boundary layer instabilities generated by free-stream acoustic and vortical disturbances at moderate supersonic Mach numbers. The vortical disturbances produce an unsteady boundary layer flow that develops into oblique instability waves with a viscous triple-deck structure in the downstream region. The acoustic disturbances (which for reasons given herein are assumed to have obliqueness angles that are close to a certain critical angle) generate slow boundary layer disturbances which eventually develop into oblique stable disturbances with an inviscid triple-deck structure in a region that lies downstream of the viscous triple-deck region. The paper shows that both the vortically generated instabilities and the acoustically generated oblique disturbances ultimately develop into modified Rayleigh-type instabilities (which can either grow or decay) further downstream.
We assessed clinicians’ continuing professional development (CPD) needs at family practice teaching clinics in the province of Quebec. Our mixed methodology design comprised an environmental scan of training programs at four family medicine departments, an expert panel to determine priority clinical situations for senior care, a supervisors survey to assess their perceived CPD needs, and interviews to help understand the rationale behind their needs. From the environmental scan, the expert panel selected 13 priority situations. Key needs expressed by the 352 survey respondents (36% response rate) included behavioral and psychological symptoms of dementia, polypharmacy, depression, and cognitive disorders. Supervisors explained that these situations were sometimes complex to diagnose and manage because of psychosocial aspects, challenges of communicating with patients and families, and coordination of interprofessional teams. Supervisors also reported more CPD needs in long-term and home care, given the presence of caregivers and complexity of senior care in these settings.
Migration has been reported to be associated with higher prevalence of mental disorders and suicidal behaviour.
To examine the prevalence of emotional and behavioural difficulties, suicidal ideation and suicide attempts among migrant adolescents and their non-migrant peers.
A school-based survey was completed by 11 057 European adolescents as part of the Saving and Empowering Young Lives in Europe (SEYLE) study.
A previous suicide attempt was reported by 386 (3.6%) adolescents. Compared with non-migrants, first-generation migrants had an elevated prevalence of suicide attempts (odds ratio (OR) 2.08; 95% CI 1.32–3.26; P=0.001 for European migrants and OR 1.86; 95% CI 1.06–3.27; P=0.031 for non-European migrants) and significantly higher levels of peer difficulties. Highest levels of conduct and hyperactivity problems were found among migrants of non-European origin.
Appropriate mental health services and school-based supports are required to meet the complex needs of migrant adolescents.
During the warmer Holocene Period, two major climatic crises affected the Central African rainforests. The first crisis, around 4000 cal yr BP, caused the contraction of the forest in favor of savanna expansion at its northern and southern periphery. The second crisis, around 2500 cal yr BP, resulted in major perturbation at the forest core, leading to forest disturbance and fragmentation with a rapid expansion of pioneer-type vegetation, and a marked erosional phase. The major driver of these two climatic crises appears to be rapid sea-surface temperature variations in the equatorial eastern Atlantic, which modified the regional atmospheric circulation. The change between ca. 2500 to 2000 cal yr BP led to a large increase in thunderstorm activity, which explains the phase of forest fragmentation. Ultimately, climatic data obtained recently show that the present-day major rise in thunderstorms and lightning activity in Central Africa could result from some kind of solar influence, and hence the phase of forest fragmentation between ca. 2500 to 2000 cal yr BP may provide a model for the present-day global warming-related environmental changes in this region.
Traumatic events are associated with increased risk of psychotic experiences, but it is unclear whether this association is explained by mental disorders prior to psychotic experience onset.
To investigate the associations between traumatic events and subsequent psychotic experience onset after adjusting for post-traumatic stress disorder and other mental disorders.
We assessed 29 traumatic event types and psychotic experiences from the World Mental Health surveys and examined the associations of traumatic events with subsequent psychotic experience onset with and without adjustments for mental disorders.
Respondents with any traumatic events had three times the odds of other respondents of subsequently developing psychotic experiences (OR=3.1, 95% CI 2.7–3.7), with variability in strength of association across traumatic event types. These associations persisted after adjustment for mental disorders.
Exposure to traumatic events predicts subsequent onset of psychotic experiences even after adjusting for comorbid mental disorders.
We summarize the properties of tidal dwarf candidates in a sample of interacting galaxies and classify objects in tidal tails depending on their morphological appearance. New high-resolution dynamical models are needed to understand how the different structures seen in tidal tails are formed.
Surface exposure dating was applied to erosional shorelines associated with the Angliers lake level that marks an important stage of Lake Ojibway. The distribution of 15 10Be ages from five sites shows a main group (10 samples) of coherent 10Be ages yielding a mean age of 9.9±0.7 ka that assigns the development of this lake level to the early part of the Lake Ojibway history. A smaller group (3 samples) is part of a more scattered distribution of older 10Be ages (with 2 outliers) that points to an inheritance of cosmogenic isotopes from a previous exposure, revealing an apparent mean age of 15.8±0.9 ka that is incompatible with the Ojibway inundation and the regional deglaciation. Our results provide the first direct 10Be chronology on the sequence of lake levels in the Ojibway basin, which includes the lake stage presumably associated with the confluence and subsequent drainage of Lakes Agassiz and Ojibway. This study demonstrates the potential of this approach to date glacial lake shorelines and underlies the importance of obtaining additional chronological constraints on the Agassiz-Ojibway shoreline sequence to confidently assign a particular lake stage and/or lake-level drawdown to a specific time interval of the deglaciation.
A mass casualty event can result in an overwhelming number of critically injured pediatric victims that exceeds the available capacity of pediatric critical care (PCC) units, both locally and regionally. To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) was established. The PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from 18 of 25 major NYC PCC-capable hospitals. A PCC surge committee created recommendations for making additional PCC beds available with an emphasis on space, staff, stuff (equipment), and systems. The PDC assisted 15 hospitals in creating PCC surge plans by utilizing template plans and site visits. These plans created an additional 153 potential PCC surge beds. Seven hospitals tested their plans through drills. The purpose of this article was to demonstrate the need for planning for disasters involving children and to provide a stepwise, replicable model for establishing a PDC, with one of its primary goals focused on facilitating PCC surge planning. The process we describe for developing a PDC can be replicated to communities of any size, setting, or location. We offer our model as an example for other cities. (Disaster Med Public Health Preparedness. 2017;11:473–478)
This study assesses the effects of the veterinary medical product ivermectin (IVM) in a range of concentrations on adult reproductive physiology and larval mortality of the dung beetle Euoniticellus intermedius (Reiche) (Coleoptera: Scarabaeidae). The ecotoxicological tests comprised eight treatments, including two controls and six increasing ivermectina concentrations (3.16, 10.0, 31.6, 63.2, 100, and 316 µg IVM/kg fresh dung). After 10 days of exposure, the females were dissected and the brood balls counted (fecundity). The brood balls were opened 15 days later and live larvae were counted to estimate larval mortality. Ivermectin altered the morphology of the ovary and stopped vitellogenesis, causing oocyte resorption and thus decreasing fecundity. The 30% threshold of decline in fecundity was reached at 115.9 µg IVM/kg dung, with no observed effect concentration (NOEC) and lowest observed effect concentration (LOEC) values of 10.0 and 31.6 µg IVM/kg dung, respectively. Larval sensitivity to ivermectin was higher, with a lethal concentration required to kill 50% of the population of 85.9 μg IVM/kg dung, and NOEC and LOEC of 3.16 and 10.0 µg IVM/kg dung, respectively. After cattle were treated with ivermectin at the recommended dose, the ivermectin concentration in their dung during the two first weeks after administration far exceeded the thresholds determined for E. intermedius.
Following release by emergency department (ED) for acute heart failure (AHF), returns to ED represent important adverse health outcomes. The objective of this study was to document relapse events and factors associated with return to ED in the 14-day period following release by ED for patients with AHF.
The primary outcome was the number of return to ED for patients who were release by ED after the initial visit, for any related medical problem within 14 days of this initial ED visit.
Return visits to the EDs occurred in 166 (20%) patients. Of all patients who returned to ED within the 14-day period, 77 (47%) were secondarily admitted to the hospital. The following factors were associated with return visits to ED: past medical history of percutaneous coronary intervention or coronary artery bypass graft (aOR=1.51; 95% CIs [1.01-2.24]), current use of antiarrhythmics medications (1.96 [1.05-3.55]), heart rate above 80 /min (1.89 [1.28-2.80]), systolic blood pressure below 140 mm Hg (1.67[1.14-2.47]), oxygen saturation (SaO2) above 96% (1.58 [1.08-2.31]), troponin above the upper reference limit of normal (1.68 [1.15-2.45]), and chest X-ray with pleural effusion (1.52 [1.04-2.23]).
Many heart failure patients (i.e. 1 in 5 patients) are released from the ED and then suffer return to ED. Patients with multiple medical comorbidities, and those with abnormal initial vital signs are at increased risk for return to ED and should be identified.
Engagement and training of educators in student mental health holds promise for promoting access to care as a task sharing strategy but has not been well-studied in low-income regions.
We used a prospective and convergent mixed methods design to evaluate a customized school mental health 2½ day training for teachers in rural Haiti (n = 22) as the initial component of formative research developing a school-based intervention to promote student mental health. Training prepared teachers to respond to student mental health needs by providing psychoeducational and practical support to facilitate access to care. We examined level of participation and evaluated feasibility, acceptability, and perceived effectiveness by calculating mean scores on self-report Likert-style items eliciting participant experience. We examined effectiveness of the training on improving mental health knowledge and attitudes by comparing mean scores on an assessment administered pre- and post-training. Finally, we examined self-report written open-ended responses and focus group discussion (FGD) interview data bearing on perceived feasibility, acceptability, and effectiveness to contextualize participant ratings of training and to identify recommendations for enhancing the utility of mental health training locally for educators.
Mean scores of knowledge and attitudes significantly improved between the pre-test and post-tests; e.g., knowledge improved from 58% correct at baseline to 68% correct on the second post-test (p = 0.039). Mean ratings of the training were favorable across all categories and FGD data demonstrated widespread participant endorsement of training acceptability and effectiveness; participants recommended extending the duration and number of training sessions.
Findings support feasibility, acceptability, and a limited scope of effectiveness of brief mental health training for secondary school teachers in Haiti. Further development of approaches to engage teachers in promoting school mental health through training is warranted.