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Three complementary points to Jaswal & Akhtar are raised: (1) As a person with autism, I desire sociality despite vulnerability to others’ antisocial behaviour; (2) Asperger's conflation of autism with psychopathy (Czech 2018) likely caused clinicians to disregard social motivation among those with autism; and (3) adverse experiences cause social-engagement diversity to develop in all people, not just those on the spectrum.
Mass gatherings are growing in frequency. Religious, or in this case, “mass” mass gatherings are also growing in complexity, requiring considerable effort from nations hosting a Papal Mass. Ireland hosted a papal mass in 1979 when the prospect of terrorism at such events was significantly lower. Large high-profile events such as a Papal Mass offer a platform via the media and social media to gain widespread coverage of adverse events. In 2018, a predicted 500,000 guests were scheduled to attend a Papal Mass gathering in Phoenix Park, Dublin, a bounded 1,700-hectare park in the center of Dublin.
To develop a medical plan estimating numbers of people requiring medical attention at a Papal Mass held in Ireland late August 2018, and compare same with actual numbers treated post-event. This study aims to reduce the medical impact of such an event on local receiving hospitals through plans that effectively manage medical- and trauma-related presentations on site.
A literature review of medical reports regarding medical care at Papal Mass gatherings worldwide found a range of predicted medical attendance from 21-61 per 10,000 attendees. On that basis we had prepared on-site facilities, facilities on travel routes and access point system for medical care for a crowd of 500,000 were selected.
One of 6 receiving hospitals in Dublin had an increase in average presentations on the day. Attendance was reduced significantly due to weather. 261 patients were treated on site, falling in line with lower rate predicted of 31 patients treated in hospital on site and 17 transports off-site.
A predictable number of patients presented for medical care. On-site medical services reduced transports to hospital. Reduced attendance ensured facilities were sufficient, but could have been under the pressure of the predicted attendance of 500,000.
During mass gatherings, such as marathons, the provision of timely access to health care services is required for the mass gathering population as well as the local community. However, effective provision of health care during sporting mass gatherings is not well understood.
To describe the structures and processes developed for an emergency team to operate an in-event acute health care facility during one of the largest mass sporting participation events in the southern hemisphere, the Gold Coast marathon.
A pragmatic qualitative methodology was used to describe the structures and processes required to operate an in-event acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with Emergency Department (ED) clinical staff working during the two-day event was undertaken in 2016.
Structural elements that underpinned the in-event health care facility included: physical spaces such as the clinical zones in the marathon health tent, tent access, and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms. Critical processes included: clear communication pathways, interprofessional care coordination, and engagement involving shared knowledge of and access to resources. Distinct but overlapping clinical scope between nurses and doctors was also noted as important for timely care provision and appropriate case management. Staff outlined many perceived benefits and opportunities of in-event health care delivery including ED avoidance and disaster training.
This in-event model of emergency care delivery enabled acute out-of-hospital health care to be delivered in a portable and transportable facility. Clinical staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.
Although the thermal evolution of the mantle before c. 3.0 Ga remains unclear, since c. 3.0 Ga secular cooling has dominated over heat production—this is time's arrow. By contrast, the thermal history of the crust, which is preserved in the record of metamorphism, is more complex. Heat to drive metamorphism is generated by radioactive decay and viscous dissipation, and is augmented by the influx of heat from the mantle. Notwithstanding that reliable data are sparse before the Neoarchean, we use a dataset of temperature (T), pressure (P) and thermobaric ratio (T/P at the metamorphic ‘peak’), and age of metamorphism (t, the timing of the metamorphic ‘peak’) for rocks from 564 localities ranging in age from the Cenozoic to the Eoarchean eras to interrogate the crustal record of metamorphism as a proxy for the heat budget of the crust through time. On the basis of T/P, metamorphic rocks are classified into three natural groups: high T/P type (T/P >775°C/GPa, mean T/P ~1105°C/GPa), including common and ultrahigh-temperature granulites, intermediate T/P type (T/P between 775 and 375°C/GPa, mean T/P ~575°C/GPa), including high-pressure granulites and medium- and high-temperature eclogites, and low T/P type (T/P <375°C/GPa, mean T/P ~255°C/GPa), including blueschists, low-temperature eclogites and ultrahigh-pressure metamorphic rocks. A monotonic increase in the P of intermediate T/P metamorphism from the Neoarchean to the Neoproterozoic reflects strengthening of the lithosphere during secular cooling of the mantle—this is also time's arrow. However, temporal variation in the P of intermediate T/P metamorphism and in the moving means of T and T/P of high T/P metamorphism, combined with the clustered age distribution, demonstrate the cyclicity of collisional orogenesis and cyclic variations in the heat budget of the crust superimposed on secular cooling since c. 3.0 Ga—this is time's cycle. A first cycle began with the widespread appearance/survival of intermediate T/P and high T/P metamorphism in the Neoarchean rock record coeval with amalgamation of dispersed blocks of lithosphere to form protocontinents. This cycle was terminated by the fragmentation of the protocontinents into cratons in the early Paleoproterozoic, which signalled the start of a new cycle. The second cycle continued with the progressive amalgamation of the cratons into the supercontinent Columbia and extended until the breakup of the supercontinent Rodinia in the Neoproterozoic. This cycle represented a period of relative tectonic and environmental stability, and perhaps reduced subduction during at least part of the cycle. During most of the Proterozoic the moving means for both T and T/P of high T/P metamorphism exceeded the arithmetic means, reflecting insulation of the mantle beneath the quasi-integrated lithosphere of Columbia and, after a limited reorganisation, Rodinia. The third cycle began with the steep decline in thermobaric ratios of high T/P metamorphism to their lowest value, synchronous with the breakup of Rodinia and the formation of Pannotia, and the widespread appearance/preservation of low T/P metamorphism in the rock record. The thermobaric ratios for high T/P metamorphism rise to another peak associated with the Pan-African event, again reflecting insulation of the mantle. The subsequent steep decline in thermobaric ratios of high T/P metamorphism associated with the breakup of Pangea at c. 0.175 Ga may indicate the start of a fourth cycle. The limited occurrence of high and intermediate T/P metamorphism before the Neoarchean suggests either that suitable tectonic environments to generate these types of metamorphism were not widely available before then or that the rate of survival was low. We interpret the first cycle to record stabilisation of subduction and the emergence of a network of plate boundaries in a plate tectonics regime once the balance between heat production and heat loss changed in favour of secular cooling, possibly as early as c. 3.0 Ga in some areas. This is inferred to have been a globally linked system by the early Paleoproterozoic, but whether it remained continuous to the present is unclear. The second cycle was characterised by stability from the formation of Columbia to the breakup of Rodinia, generating higher than average T and T/P of high T/P metamorphism. The third cycle reflects colder collisional orogenesis and deep subduction of the continental crust, features that are characteristic of modern plate tectonics, which became possible once the average temperature of the asthenospheric mantle had declined to <100°C warmer than the present day after c. 1.0 Ga.
We measure the cosmic star formation history out to z = 1.3 using a sample of 918 radio-selected star-forming galaxies within the 2-deg2 COSMOS field. To increase our sample size, we combine 1.4-GHz flux densities from the VLA-COSMOS catalogue with flux densities measured from the VLA-COSMOS radio continuum image at the positions of I < 26.5 galaxies, enabling us to detect 1.4-GHz sources as faint as 40 μJy. We find that radio measurements of the cosmic star formation history are highly dependent on sample completeness and models used to extrapolate the faint end of the radio luminosity function. For our preferred model of the luminosity function, we find the star formation rate density increases from 0.017 M⊙ yr−1 Mpc−3 at z ∼ 0.225 to 0.092 M⊙ yr−1 Mpc−3 at z ∼ 1.1, which agrees to within 40% of recent UV, IR and 3-GHz measurements of the cosmic star formation history.
Laboratory identification of carbapenem-resistant Enterobacteriaceae (CRE) is a key step in controlling its spread. Our survey showed that most Veterans Affairs laboratories follow VA guidelines for initial CRE identification, whereas 55.0% use PCR to confirm carbapenemase production. Most respondents were knowledgeable about CRE guidelines. Barriers included staffing, training, and financial resources.
In Scotland, the base of the Ballagan Formation has traditionally been placed at the first grey mudstone within a contiguous Late Devonian to Carboniferous succession. This convention places the Devonian–Carboniferous boundary within the Old Red Sandstone (ORS) Kinnesswood Formation. The consequences of this placement are that tetrapods from the Ballagan Formation were dated as late Tournaisian in age and that the ranges of typically Devonian fish found in the Kinnesswood Formation continued into the Carboniferous. The Pease Bay specimen of the fish Remigolepis is from the Kinnesswood Formation. Comparisons with its range in Greenland, calibrated against spores, show it was Famennian in age. Detailed palynological sampling at Burnmouth from the base of the Ballagan Formation proves that the early Tournaisian spore zones (VI and HD plus Cl 1) are present. The Schopfites species that occurs through most of the succession is Schopfites delicatus rather than Schopfites claviger. The latter species defines the late Tournaisian CM spore zone. The first spore assemblage that has been found in Upper ‘ORS' strata underlying the Ballagan Formation (Preston, Whiteadder Water), contains Retispora lepidophyta and is from the early latest Famennian LL spore zone. The spore samples are interbedded with volcaniclastic debris, which shows that the Kelso Volcanic Formation is, in part, early latest Famennian in age. These findings demonstrate that the Ballagan Formation includes most of the Tournaisian with the Devonian–Carboniferous boundary positioned close to the top of the Kinnesswood Formation. The Stage 6 calcrete at Pease Bay can be correlated to the equivalent section at Carham, showing that it represents a time gap equivalent to the latest Famennian glaciation(s). Importantly, some of the recently described Ballagan Formation tetrapods are older than previously dated and now fill the key early part of Romer's Gap.
Mass gatherings such as marathons are increasingly frequent. During mass gatherings, the provision of timely access to health care services is required for the mass-gathering population, as well as for the local community. However, the nature and impact of health care provision during sporting mass gatherings is not well-understood.
The aim of this study was to describe the structures and processes developed for an emergency health team to operate an in-event, acute health care facility during one of the largest mass-sporting participation events in the southern hemisphere, the Gold Coast Marathon (Queensland, Australia).
A pragmatic, qualitative methodology was used to describe the structures and processes required to operate an in-event, acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with emergency department (ED) clinical staff working during the two-day event was undertaken in 2016.
Important structural elements of the in-event health care facility included: physical spaces, such as the clinical zones in the marathon health tent and surrounding area, and access and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms (ECGs) and intravenous fluids. Process elements of the in-event health care facility included clear communication pathways, as well as inter-professional care coordination and engagement involving shared knowledge of and access to resources, and distinct but overlapping clinical scope between nurses and doctors. This was seen to be critical for timely care provision and appropriate case management. Staff reported many perceived benefits and opportunities of in-event health care delivery, including ED avoidance and disaster training.
This in-event model of emergency care delivery, established in an out-of-hospital location, enabled the delivery of acute health care that could be clearly described and defined. Staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.
JohnstonANB, WadhamJ, Polong-BrownJ, AitkenM, RanseJ, HuttonA, RichardsB, CrillyJ.Health Care Provision During a Sporting Mass Gathering: A Structure and Process Description of On-Site Care Delivery. Prehosp Disaster Med. 2019;34(1):62–71.
Optimising short- and long-term outcomes for children and patients with CHD depends on continued scientific discovery and translation to clinical improvements in a coordinated effort by multiple stakeholders. Several challenges remain for clinicians, researchers, administrators, patients, and families seeking continuous scientific and clinical advancements in the field. We describe a new integrated research and improvement network – Cardiac Networks United – that seeks to build upon the experience and success achieved to-date to create a new infrastructure for research and quality improvement that will serve the needs of the paediatric and congenital heart community in the future. Existing gaps in data integration and barriers to improvement are described, along with the mission and vision, organisational structure, and early objectives of Cardiac Networks United. Finally, representatives of key stakeholder groups – heart centre executives, research leaders, learning health system experts, and parent advocates – offer their perspectives on the need for this new collaborative effort.
The lower Mississippian Ballagan Formation of northern Britain is one of only two successions worldwide to yield the earliest known tetrapods with terrestrial capability following the end-Devonian mass extinction event. Studies of the sedimentary environments and habitats in which these beasts lived have been an integral part of a major research project into how, why and under what circumstances this profound step in the evolution of life on Earth occurred. Here, a new palaeogeographic map is constructed from outcrop data integrated with new and archived borehole material. The map shows the extent of a very low-relief coastal wetland developed along the tropical southern continental margin of Laurussia. Coastal floodplains in the Midland Valley and Tweed basins were separated from the marginal marine seaway of the Northumberland–Solway Basin to the south by an archipelago of more elevated areas. A complex mosaic of sedimentary environments was juxtaposed, and included fresh and brackish to saline and hypersaline lakes, a diverse suite of floodplain palaeosols and a persistent fluvial system in the east of the region. The strongly seasonal climate led to the formation of evaporite deposits alternating with flooding events, both meteoric and marine. Storm surges drove marine floods from the SW into both the western Midland Valley and Northumberland–Solway Basin; marine water also flooded into the Tweed Basin and Tayside in the east. The Ballagan Formation is a rare example in the geological record of a tropical, seasonal coastal wetland that contains abundant, small-scale evaporite deposits. The diverse sedimentary environments and palaeosol types indicate a network of different terrestrial and aquatic habitats in which the tetrapods lived.
This study investigated the characteristics of subjective memory complaints (SMCs) and their association with current and future cognitive functions.
A cohort of 209 community-dwelling individuals without dementia aged 47–90 years old was recruited for this 3-year study. Participants underwent neuropsychological and clinical assessments annually. Participants were divided into SMCs and non-memory complainers (NMCs) using a single question at baseline and a memory complaints questionnaire following baseline, to evaluate differential patterns of complaints. In addition, comprehensive assessment of memory complaints was undertaken to evaluate whether severity and consistency of complaints differentially predicted cognitive function.
SMC and NMC individuals were significantly different on various features of SMCs. Greater overall severity (but not consistency) of complaints was significantly associated with current and future cognitive functioning.
SMC individuals present distinctive features of memory complaints as compared to NMCs. Further, the severity of complaints was a significant predictor of future cognition. However, SMC did not significantly predict change over time in this sample. These findings warrant further research into the specific features of SMCs that may portend subsequent neuropathological and cognitive changes when screening individuals at increased future risk of dementia.
Each year, Emergency Medical Services (EMS) personnel respond to over 30 million calls for assistance in the United States alone. These EMS personnel have a rate of occupational fatality comparable to firefighters and police, and a rate of non-fatal injuries that is higher than the rates for police and firefighters and much higher than the national average for all workers. In Australia, no occupational group has a higher injury or fatality rate than EMS personnel. Emergency Medical Services personnel in the US have a rate of occupational violence injuries that is about 22-times higher than the average for all workers. On average, more than one EMS provider in the US is killed every year in an act of violence.
The objective of this epidemiological study was to identify the risks and factors associated with work-related physical violence against EMS personnel internationally.
An online survey, based on a tool developed by the World Health Organization (WHO; Geneva, Switzerland), collected responses from April through November 2016.
There were 1,778 EMS personnel respondents from 13 countries; 69% were male and 54% were married. Around 55% described their primary EMS work location as “urban.” Approximately 68% described their employer as a “public provider.” The majority of respondents were from the US.
When asked “Have you ever been physically attacked while on-duty?” 761 (65%) of the 1,172 who answered the question answered “Yes.” In almost 10% (67) of those incidents, the perpetrator used a weapon. Approximately 90% of the perpetrators were patients and around five percent were patient family members. The influence of alcohol and drugs was prevalent. Overall, men experienced more assaults than women, and younger workers experienced more assaults than older workers.
In order to develop and implement measures to increase safety, EMS personnel must be involved with the research and implementation process. Furthermore, EMS agencies must work with university researchers to quantify agency-level risks and to develop, test, and implement interventions in such a way that they can be reliably evaluated and the results published in peer-reviewed journals.
MaguireBJ, BrowneM, O’NeillBJ, DealyMT, ClareD, O’MearaP. International Survey of Violence Against EMS Personnel: Physical Violence Report. Prehosp Disaster Med. 2018;33(5):526–531.
We examine supervisor-subordinate (dis)agreement regarding perceptions of the supervisor’s ethical leadership and its relationship to organizational deviance. We find that, on average, supervisors rate themselves more favorably on ethical leadership compared to how followers rate them. In addition, polynomial regression results reveal that unit-level organizational deviance is higher when there is agreement about lower levels of ethical leadership, and disagreement when supervisors rate themselves higher on ethical leadership than subordinates’ ratings of the supervisors. Finally, drawing on social influence theories, we look at antecedents of (dis)agreement and find that supervisors’ beliefs about themselves (that they were “better-than-average” ethical leaders) and others (their assumptions about whether the morality of their subordinates is malleable or not) are associated with self-other (dis)agreement on ethical leadership.
This article presents detailed illustrations of two rock-reliefs from the neighbouring sites Rabana and Merquly, located on the flanks of Mt. Piramagrun in Iraqi Kurdistan. Both matching sculptures are aligned with perimeter fortifications that enclose substantial architectural remains. Based on numismatic parallels, supported by archaeological evidence, it is proposed that these depictions of near life-size figures represent an anonymous Arsacid King of Kings from the early first millennium (c. a.d. 50-150), who was credited with construction of the mountain fortresses. Rabana and Merquly together form an important landscape of settlement on the north-western frontier of the Parthian Empire.
We compared sepsis “time zero” and Centers for Medicare and Medicaid Services (CMS) SEP-1 pass rates among 3 abstractors in 3 hospitals. Abstractors agreed on time zero in 29 of 80 (36%) cases. Perceived pass rates ranged from 9 of 80 cases (11%) to 19 of 80 cases (23%). Variability in time zero and perceived pass rates limits the utility of SEP-1 for measuring quality.