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This short piece makes reference to an event that was held in May 2019 at the London School of Economics. The occasion was entitled ‘Oral History Research: Illuminating the Past’. There were three speakers and the session was chaired by Professor Michael Lobban. One of the speakers that evening was Lesley Dingle and, following this introduction, her talk is featured in this issue of Legal Information Management.
Infants with single ventricle physiology have arterial oxygen saturations between 75 and 85%. Home monitoring with daily pulse oximetry is associated with improved interstage survival. They are typically sent home with expensive, bulky, hospital-grade pulse oximeters. This study evaluates the accuracy of both the currently used Masimo LNCS and a relatively inexpensive, portable, and equipped with Bluetooth technology study device, by comparing with the gold standard co-oximeter.
Prospective, observational study.
Single institution, paediatric cardiac critical care unit, and neonatal ICU.
Twenty-four infants under 12 months of age with baseline oxygen saturation less than 90% due to cyanotic CHD.
Measurements and Results:
Pulse oximetry with WristOx2 3150 with infant sensors 8008 J (study device) and Masimo LCNS saturation sensor connected to a Philips monitor (hospital device) were measured simultaneously and compared to arterial oxy-haemoglobin saturation measured by co-oximetry. Statistical analysis evaluated the performances of each and compared to co-oximetry with Schuirmann’s TOST equivalence tests, with equivalence defined as an absolute difference of 5% saturation or less. Neither the study nor the hospital device met the predefined standard for equivalence when compared with co-oximetry. The study device reading was on average 4.0% higher than the co-oximeter, failing to show statistical equivalence (p = 0.16). The hospital device was 7.4% higher than the co-oximeter and also did not meet the predefined standard for equivalence (p = 0.97).
Both devices tended to overestimate oxygen saturation in this patient population when compared to the gold standard, co-oximetry. The study device is at least as accurate as the hospital device and offers the advantage of being more portable with Bluetooth technology that allows reliable, efficient data transmission. Currently FDA-approved, smaller portable pulse oximeters can be considered for use in home monitoring programmes.
In July 2013, a train transporting oil derailed and exploded in Lac-Mégantic, causing major human, environmental, and economic impacts. A community-based survey of people aged 10-25, conducted in 2017, revealed that many young people suffer in silence and report feeling isolated. These observations led to the conclusion that we must make room for young people, and that opportunities for engagement and participation must be provided within the community.
The Public Health Direction of Estrie aimed to identify strategies to promote health and wellbeing for young people living in and around Lac-Mégantic.
A collective reflection half-day was hosted with sixty key stakeholders (school board, other education institutions, health and social services, community sector, municipal/political sector, parents, youth). Throughout the event, participants were invited to build on and learn from accomplishments and experiential knowledge, and develop a common vision of the solutions to be pursued or implemented. All qualitative data sources (verbal and written data from large- and sub-group activities) were analyzed through a content analysis.
Several themes (i.e. potential solutions) emerged from the analysis: common venue, diversified activities, communication, collaboration, involvement, support for at-risk youth, intergenerational component, etc. Participants agreed on four priorities for action: 1) creating a gathering place, 2) establishing a Youth Committee, 3) supporting adults working with youth, and 4) fostering a better flow of information.
Several positive outcomes of the collective reflection half-day were observed, including the mobilization of the participants who greatly appreciated the event, and many promising ideas launched by stakeholders. A social worker is now fully dedicated to supporting youth wellbeing and engagement in Lac-Mégantic. A Youth Committee has been established and projects by and for youth are being implemented. Bottom-up approaches to identify solutions to complex situations are not only effective but also respectful of the local culture.
Many studies have identified changes in the brain associated with obsessive–compulsive disorder (OCD), but few have examined the relationship between genetic determinants of OCD and brain variation.
We present the first genome-wide investigation of overlapping genetic risk for OCD and genetic influences on subcortical brain structures.
Using single nucleotide polymorphism effect concordance analysis, we measured genetic overlap between the first genome-wide association study (GWAS) of OCD (1465 participants with OCD, 5557 controls) and recent GWASs of eight subcortical brain volumes (13 171 participants).
We found evidence of significant positive concordance between OCD risk variants and variants associated with greater nucleus accumbens and putamen volumes. When conditioning OCD risk variants on brain volume, variants influencing putamen, amygdala and thalamus volumes were associated with risk for OCD.
These results are consistent with current OCD neurocircuitry models. Further evidence will clarify the relationship between putamen volume and OCD risk, and the roles of the detected variants in this disorder.
Declaration of interest
The authors have declared that no competing interests exist.
Lithium is a mood stabilizer rarely associated with drug-induced parkinsonism (DIP). We present a case of an elderly woman with bipolar disorder who developed parkinsonian symptoms after chronic lithium administration despite therapeutic serum levels. Upon evaluation, classic parkinsonian signs of muscle rigidity, tremor, bradykinesia, freezing of gait, and cognitive decline were observed. Initially, she was diagnosed with Parkinson's disease (PD); however, DaTscan SPECT imaging clarified the diagnosis as DIP. As the daily lithium dosage was reduced, the patient's motor symptoms improved. This report emphasizes close monitoring of lithium levels in geriatric populations and the need to consider lithium-induced parkinsonism when PD symptoms appear in chronic lithium users.
The obligate intracellular pathogen Coxiella burnetii has long been considered the most heat resistant pathogen in raw milk, making it the reference pathogen for determining pasteurisation conditions for milk products. New milk formulations and novel non-thermal processes require validation of effectiveness which requires a more practical method for analysis than using the currently used animal model for assessing Coxiella survival. Also, there is an interest in better characterising thermal inactivation of Coxiella in various milk formulations. To avoid the use of the guinea pig model for evaluating Coxiella survival, an Integrated Cell Culture-PCR (ICC-PCR) method was developed for determining Coxiella viability in milk. Vero cell cultures were directly infected from Coxiella-contaminated milk in duplicate 24-well plates. Viability of the Coxiella in milk was shown by a ≥0·5 log genome equivalent (ge)/ml increase in the quantity of IS111a gene from the baseline post-infection (day 0) level after 9–11 d propagation. Coxiella in skim, 2%, and whole milk, and half and half successfully infected Vero cells and increased in number by at least 2 logs using a 48-h infection period followed by 9-d propagation time. As few as 125 Coxiella ge/ml in whole milk was shown to infect and propagate at least 2 logs in the optimised ICC-PCR assay, though variable confirmation of propagation was shown for as low as 25 Coxiella ge/ml. Applicability of the ICC-PCR method was further proven in an MPN format to quantitate the number of viable Coxiella remaining in whole milk after 60 °C thermal treatment at 0, 20, 40, 60 and 90 min.
In the past 15 years in Canada, as in other nations, the mental health of veterans has emerged as a key concern for both government and the public. As mental health service enhancement unfolded, the need for wider population studies became apparent. This paper describes the renewal of services and key findings from national surveys of serving personnel and veterans.
There are conflicting data on the role of anxiety in predicting mortality.
To evaluate the 10-year mortality risk associated with anxiety in community-dwelling elderly people.
Using data from 718 men and 1046 women aged 65 years and over, gender-stratified associations of anxiety symptoms (Spielberger State–Trait Anxiety Inventory, third tertile) and current DSM-IV anxiety disorder including generalised anxiety disorder (GAD) and phobia with all-cause and cardiovascular mortality were determined.
In women, mortality risk was increased for anxiety disorder and GAD in multivariate Cox models (hazard ratio (HR) = 1.53, 95% Cl 1.02-2.27 and HR = 2.04, 95% Cl 1.08-3.86 respectively), whereas for phobia it was nearly significant (HR= 1.52, 95% Cl 0.94-2.47). Anxiety trait symptoms became non-significant as a result of the confounding effect of depressive symptoms. Anxiety disorder was associated with cardiovascular mortality in univariate analysis (HR = 2.42, 95% Cl 1.16-5.07). No significant associations were found in men.
Our study suggests a gender-specific association of anxiety and mortality.
The spatially uneven nature of the impacts of the Irish Famine have been recognised by both historians and geographers and research that has examined the Famine at various spatial scales has shed much light on its uneven impact on the human landscape of mid-1840s Ireland. However, the regionally varied nature of the event makes it difficult to understand its impacts at the national scale. This is because of the difficulty of assessing the extent to which local processes that may have contributed to the worsening of conditions for people in different areas operated at the national scale. The emphasis on local areas that characterises much of the literature on the Irish Famine in part contributes to this difficulty. We have much detailed research for particular villages, parishes, poor law unions and counties, but little comparative or national analysis. Recent research has attempted to bridge the gap between local and national perspectives on the Famine by constructing a geographical information systems (GIS) database of local attributes at electoral division (ED) level for the entire island. Electoral divisions are administrative units first introduced to Ireland in the mid-1840s for the purposes of rate collection and were also used as the unit for census data collection. There were 3,439 such divisions in Ireland at this time.
We analyze historical data to conduct an exploratory structural investigation into the process that Harriet Tubman used to free her family and friends as a member of the New York State Underground Railroad (UGRR). We suggest that she accomplished this feat because of her ability to rely on embedded (Granovetter 1985; Uzzi 1996) network contacts that allowed her to bridge structural holes (Burt 1992) and link with people with whom she was not previously linked (Lin et al., 2001). We conclude by discussing the importance of network analysis for providing empirical meaning to historical events and episodes.
Depression may increase the risk of mortality among certain subgroups of
older people, but the part played by antidepressants in this association
has not been thoroughly explored.
To identify the characteristics of older populations who are most at risk
of dying, as a function of depressive symptoms, gender and antidepressant
Adjusted Cox proportional hazards models were used to determine the
association between depression and/or antidepressant use and 4-year
survival of 7363 community-dwelling elderly people. Major depressive
disorder was evaluated using a standardised psychiatric examination based
on DSM-IV criteria and depressive symptoms were assessed using the Center
for Epidemiological Studies Depression scale.
Depressed men using antidepressants had the greatest risk of dying, with
increasing depression severity corresponding to a higher hazard risk.
Among women, only severe depression in the absence of treatment was
significantly associated with mortality.
The association between depression and mortality is gender-dependent and
varies according to symptom load and antidepressant use.
This article examines the phonological status of schwa in clitics, in particular whether or not schwa should be included in their lexical representation. Several distributional and experimental arguments pointing to the lexical status of clitic schwas are reviewed and are shown to be inconclusive, due to the existence of additional data that suggest a different interpretation not involving underlying schwas. The discussion includes experimental results that fail to show residual lip rounding in the vicinity of an omitted schwa at clitic boundaries, contra Barnes and Kavitskaya's (2002) previous claim. In the absence of evidence to the contrary, the non-contrastive nature of clitic schwas militates against their underlying status.
Toxic anterior segment syndrome (TASS), a complication of cataract surgery, is a sterile inflammation of the anterior chamber of the eye. An outbreak of TASS was recognized at an outpatient surgical center and its affiliated hospital in December 2002.
Medical records of patients who underwent cataract surgery during the outbreak were reviewed, and surgical team members who participated in the operations were interviewed. Potential causes of TASS were identified and eliminated. Feedwater from autoclave steam generators and steam condensates were analyzed by use of spectroscopy and ion chromatography.
During the outbreak, 8 (38%) of 21 cataract operations were complicated by TASS, compared with 2 (0.07%) of 2,713 operations performed from January 1996 through November 2002. Results of an initial investigation suggested that cataract surgical equipment may have been contaminated by suboptimal equipment reprocessing or as a result of personnel changes. The frequency of TASS decreased (1 of 44 cataract operations) after reassignment of personnel and revision of equipment reprocessing procedures. Further investigation identified the presence of impurities (eg, sulfates, copper, zinc, nickel, and silica) in autoclave steam moisture, which was attributed to improper maintenance of the autoclave steam generator in the outpatient surgical center. When impurities in autoclave steam moisture were eliminated, no cases of TASS were observed after more than 1,000 cataract operations.
Suboptimal reprocessing of cataract surgical equipment may evolve over time in busy, multidisciplinary surgical centers. Clinically significant contamination of surgical equipment may result from inappropriate maintenance of steam sterilization systems. Standardization of protocols for reprocessing of cataract surgical equipment may prevent outbreaks of TASS and may be of assistance during outbreak investigations.
To assess the prevalence of HIV antiretroviral resistance among source patients for occupational HIV exposures.
Blood and data (eg, stage of HIV, previous antiretroviral drug therapy, and HIV RNA viral load) were collected from HIV-infected patients who were source patients for occupational exposures.
Seven tertiary-care medical centers in five U.S. cities (San Diego, California; Miami, Florida; Boston, Massachusetts; Albany, New York; and New York, New York [three sites]) during 1998 to 1999.
Sixty-four HIV-infected patients who were source patients for occupational exposures.
Virus from 50 patients was sequenced; virus from 14 patients with an undetectable (ie, < 400 RNA copies/mL) viral load could not be sequenced. Overall, 19 (38%) of the 50 patients had primary eenotypic mutations associated with resistance to reverse transcriptase or protease inhibitors. Eighteen of the 19 viruses with primary mutations and 13 wild type viruses were phenotyped by recombinant assays; 19 had phenotypic resistance to at least one antiretroviral agent. Of the 50 source patients studied, 26 had taken antiretroviral agents in the 3 months before the occupational exposure incident. Sixteen (62%) of the 26 drug-treated patients had virus that was phenotypically resistant to at least one drug. Four (17%) of 23 untreated patients had phenotypically resistant virus. No episodes of HIV transmission were observed among the exposed HCWs.
There was a high prevalence of drug-resistant HIV among source patients for occupational HIV exposures. Healthcare providers should use the drug treatment information of source patients when making decisions about postexposure prophylaxis.
Ana Mari Cauce, Department of Psychology, University of Washington, Seattle, WA,
Angela Stewart, Department of Psychology, University of Washington, Seattle, WA,
Melanie Domenech Rodriguez, Department of Psychology, University of Washington, Seattle, WA,
Bryan Cochran, Department of Psychology, University of Washington, Seattle, WA,
Joshua Ginzler, Department of Psychology, University of Washington, Seattle, WA
Adolescence, a time of rapid biological, emotional, and social changes, brings with it a heightened developmental risk (McCord, 1997). This risk may be highest for adolescents growing up in poverty within our country's inner cities. In addition to the normative stress of adolescence, poor inner-city youth face multiple stressors and adversities including crowded housing, poor-quality schools, inadequate nutrition, and the presence of violence and drugs in their neighborhoods (Sampson, Morenoff, & Earls, 1999). These factors, in turn, have been linked to a host of negative outcomes (Brooks-Gunn & Duncan, 1997; Gorman-Smith & Tolan, this volume). Nonetheless, some inner-city youth survive these circumstances, overcoming adversity to become productive members of society. This chapter will highlight research that helps us understand the dynamic process of risk and resilience during this difficult transition in an even more difficult context.
We begin this chapter with a definition of adolescence and urban poverty and then lay out a rationale for focusing on two outcomes, school achievement and dropout and behavior problems of an internalizing or externalizing nature. We then identify salient factors that increase vulnerability or protective processes for youth growing up in urban poverty. We end with a discussion of resilience, emphasizing the limits of resilient adaptation and implications of this for theory and research on resilience, as well as for interventions that may better the lives of these vulnerable youth.
Acute tryptophan depletion (ATD) results in a transient lowering of mood in patients recovered from depression and in healthy volunteers with a family history of affective disorders. The personality trait of neuroticism is strongly associated with depression.
To assess whether neuroticism predicts mood change in response to ATD in healthy volunteers.
Healthy volunteers who scored at the top and bottom fifth percentiles of neuroticism scores (17 and 15 respectively) were selected. In a double-blind, crossover study they received a tryptophan-free or a control drink. Mood and cognition were assessed.
Neuroticism did not predict the amount of mood change following ATD but did moderate performance on the verbal fluency test. A family history of affective disorder (n=5) predicted mood change but not cognitive function following ATD.
Neuroticism moderates aspects of cognitive function, but in this study it was not strongly related with mood change via serotonin.