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Tom Stoppard's work as a playwright and screenwriter has always been notable for mixing ideas with entertainment. From the early success of Rosencrantz and Guildenstern Are Dead to masterpieces like Arcadia, from radio plays about modern art to the Oscar-winning screenplay for Shakespeare in Love, Stoppard has challenged and delighted audiences with the intellectual and cultural richness of his writing. Tom Stoppard in Context provides multiple perspectives on both the life and works of one of the most important modern playwrights. This collection covers biographical and historical topics, as well as the broad array of intellectual, aesthetic, and political concerns with which Stoppard has engaged. More than thirty essays on subjects ranging from science to screenwriting help illuminate Stoppard's rich body of work.
Post-tonsillectomy bleeding is the most frequent complication of tonsillectomy. Inherited platelet function disorders have an estimated prevalence of 1 per cent. Any association between post-tonsillectomy bleeds and undiagnosed inherited platelet function disorders has not been investigated before.
To assess the prevalence of inherited platelet function disorders in a cohort of post-tonsillectomy bleed patients.
An observational cohort study was conducted using hospital digital records. Platelet function analyser 100 (‘PFA-100’) closure time was tested on post-tonsillectomy bleed patients who presented to hospital.
Between 2013 and 2017, 9 of 91 post-tonsillectomy bleed patients who underwent platelet function analyser 100 testing (9.89 per cent) had positive results. Five patients (5.49 per cent) had undiagnosed inherited platelet function disorders. Four patients had false positive results secondary to a non-steroidal anti-inflammatory drug effect (specificity of 95.3 per cent) proven by repeat testing six weeks later, off medication. The false negative rate was 0 per cent.
The prevalence of inherited platelet function disorders in our post-tonsillectomy bleed cohort is five-fold higher than in the general population. Platelet function analyser 100 testing when patients present with a post-tonsillectomy bleed allows management of their inherited platelet function disorder.
School psychologists play a vital role in the mental health and well-being of students and are often tasked with establishing the assessment and intervention plans for reducing the severity of mental health difficulties, including suicidal behavior. With suicide the second-leading cause of death for middle and high school students, school psychologists need to be familiar with what their role is in recommending and providing suicide prevention and intervention programs within a multitiered systems of support (MTSS) framework. This chapter provides an overview of the problem of adolescent suicidal behavior (“what to know”), while also providing specific recommendations (“what to do”) for suicide prevention/intervention programs within each tier of the MTSS. Finally, this chapter includes specific guidelines for implementing “suicide postvention” (after a death due to suicide) procedures, in hopes of reducing the likelihood of another death due to suicide.
This article provides an overview of selected ongoing international efforts that have been inspired by Edward Zigler's vision to improve programs and policies for young children and families in the United States. The efforts presented are in close alignment with three strategies articulated by Edward Zigler: (a) conduct research that will inform policy advocacy; (b) design, implement, and revise quality early childhood development (ECD) programs; and (c) invest in building the next generation of scholars and advocates in child development. The intergenerational legacy left by Edward Zigler has had an impact on young children not only in the United States, but also across the globe. More needs to be done. We need to work together with a full commitment to ensure the optimal development of each child.
Affective polarization – partisans’ dislike and distrust of those from the other party – has reached historically high levels in the United States. While numerous studies estimate its effect on apolitical outcomes (e.g., dating and economic transactions), we know much less about its effects on political beliefs. We argue that those who exhibit high levels of affective polarization politicize ostensibly apolitical issues and actors. An experiment focused on responses to COVID-19 that relies on pre-pandemic, exogenous measures of affective polarization supports our expectations. Partisans who harbor high levels of animus towards the other party do not differentiate the “United States’” response to COVID-19 from that of the Trump administration. Less affectively polarized partisans, in contrast, do not politicize evaluations of the country’s response. Our results provide evidence of how affective polarization, apart from partisanship itself, shapes substantive beliefs. Affective polarization has political consequences and political beliefs stem, in part, from partisan animus.
We report an approach to expand the effective number of pixels available to small, two-dimensional electron detectors. To do so, we acquire subsections of a diffraction pattern that are then accurately stitched together in post-processing. Using an electron microscopy pixel array detector (EMPAD) that has only 128 × 128 pixels, we show that the field of view can be expanded while achieving high reciprocal-space sampling. Further, we highlight the need to properly account for the detector position (rotation) and the non-orthonormal diffraction shift axes to achieve an accurate reconstruction. Applying the method, we provide examples of spot and convergent beam diffraction patterns acquired with a pixelated detector.
The co-occurrence of the 2020 Atlantic hurricane season and the ongoing coronavirus disease 2019 (COVID-19) pandemic creates complex dilemmas for protecting populations from these intersecting threats. Climate change is likely contributing to stronger, wetter, slower-moving, and more dangerous hurricanes. Climate-driven hazards underscore the imperative for timely warning, evacuation, and sheltering of storm-threatened populations – proven life-saving protective measures that gather evacuees together inside durable, enclosed spaces when a hurricane approaches. Meanwhile, the rapid acquisition of scientific knowledge regarding how COVID-19 spreads has guided mass anti-contagion strategies, including lockdowns, sheltering at home, physical distancing, donning personal protective equipment, conscientious handwashing, and hygiene practices. These life-saving strategies, credited with preventing millions of COVID-19 cases, separate and move people apart. Enforcement coupled with fear of contracting COVID-19 have motivated high levels of adherence to these stringent regulations. How will populations react when warned to shelter from an oncoming Atlantic hurricane while COVID-19 is actively circulating in the community? Emergency managers, health care providers, and public health preparedness professionals must create viable solutions to confront these potential scenarios: elevated rates of hurricane-related injury and mortality among persons who refuse to evacuate due to fear of COVID-19, and the resurgence of COVID-19 cases among hurricane evacuees who shelter together.
A central function of democratic institutions is to protect vulnerable populations. The stability and success of these institutions depends, in part, on popular support. Times of crisis can introduce novel dynamics that alter popular support for protective institutions, particularly among those who do not benefit from those protections. We explore this possibility in the context of Title IX's gender equality requirements and infrastructure to address sexual harassment in college sports. We conduct a large survey of college student-athletes to study their attitudes on these issues in response to the COVID-19 pandemic and concomitant financial challenges affecting college sports. We find that male student-athletes and those with sexist attitudes exhibit alarmingly low levels of support for ensuring the maintenance of equality and sexual harassment policy under Title IX during the COVID-19 crisis and eventual recovery. The results accentuate the vulnerability of certain populations during crises and the importance of maintaining strong institutional policy support during such times.
We evaluated the impact of reflex urine culture screen results on antibiotic initiation. More patients with positive urine screen but negative culture received antibiotics than those with a negative screen (30.5 vs 7.1%). Urine screen results may inappropriately influence antibiotic initiation in patients with a low likelihood of infection.
We describe 14 yr of public data from the Parkes Pulsar Timing Array (PPTA), an ongoing project that is producing precise measurements of pulse times of arrival from 26 millisecond pulsars using the 64-m Parkes radio telescope with a cadence of approximately 3 weeks in three observing bands. A comprehensive description of the pulsar observing systems employed at the telescope since 2004 is provided, including the calibration methodology and an analysis of the stability of system components. We attempt to provide full accounting of the reduction from the raw measured Stokes parameters to pulse times of arrival to aid third parties in reproducing our results. This conversion is encapsulated in a processing pipeline designed to track provenance. Our data products include pulse times of arrival for each of the pulsars along with an initial set of pulsar parameters and noise models. The calibrated pulse profiles and timing template profiles are also available. These data represent almost 21 000 h of recorded data spanning over 14 yr. After accounting for processes that induce time-correlated noise, 22 of the pulsars have weighted root-mean-square timing residuals of
in at least one radio band. The data should allow end users to quickly undertake their own gravitational wave analyses, for example, without having to understand the intricacies of pulsar polarisation calibration or attain a mastery of radio frequency interference mitigation as is required when analysing raw data files.
The crystal structure of oseltamivir phosphate has been refined using synchrotron X-ray powder diffraction data and optimized using density functional techniques. Oseltamivir phosphate crystallizes in space group P21212 (#18) with a = 24.0079(3), b = 24.6716(2), c = 7.45254(5) Å, V = 4414.24(5) Å3 at 295 K, and Z = 8. Prominent in the crystal structure are hydrogen bonds between the phosphate groups and the ammonium groups of the oseltamivir cations. The strong hydrogen bonds link the cations and the anions into columns parallel to the c-axis, with van der Waals interactions between the columns. Thermal expansion between 120 and 295 K is anisotropic. The powder pattern is included in the Powder Diffraction File™ as entry 00-068-1107.
A detailed assessment of the inter-scale energy budget of the turbulent flow in a von Kármán mixing tank has been performed based on two extensive experimental data sets. Measurements were performed at a Taylor microscale Reynolds number of
in the central region of the tank, using scanning particle image velocimetry (PIV) to fully resolve the velocity gradient tensor (VGT), and stereoscopic PIV for an expanded field of view. Following a basic flow characterisation, the Kármán–Howarth–Monin–Hill equation was used to investigate the inter-scale energy transfer. Access to the full VGT enabled the contribution of the different terms of the energy budget to be evaluated without any assumptions or approximations. The scale-space distribution of the dominant terms was also reported to assess the isotropy of the energy transfer. The results show a highly anisotropic distribution of energy transfer in scale space. Energy transfer was shown in a spherically averaged sense to be dominated at the small scales by the nonlinear inter-scale transfer term. However, in contrast to flows considered in previous studies, the local energy transfer is found to depend heavily on the linear contribution associated with the mean flow. Analysis of the scale-to-scale transfer of energy also allowed direct assessment of the classical picture of the energy cascade. It was found that while the inter-scale energy cascade driven by the turbulent fluctuations always proceeds in the forward direction, the total energy cascade driven by both the turbulent fluctuations and the mean flow exhibits significant inverse cascade regions, where energy is transferred from smaller to larger scales.
This study examined the relationship between patient performance on multiple memory measures and regional brain volumes using an FDA-cleared quantitative volumetric analysis program – Neuroreader™.
Ninety-two patients diagnosed with mild cognitive impairment (MCI) by a clinical neuropsychologist completed cognitive evaluations and underwent MR Neuroreader™ within 1 year of testing. Select brain regions were correlated with three widely used memory tests. Regression analyses were conducted to determine if using more than one memory measures would better predict hippocampal z-scores and to explore the added value of recognition memory to prediction models.
Memory performances were most strongly correlated with hippocampal volumes than other brain regions. After controlling for encoding/Immediate Recall standard scores, statistically significant correlations emerged between Delayed Recall and hippocampal volumes (rs ranging from .348 to .490). Regression analysis revealed that evaluating memory performance across multiple memory measures is a better predictor of hippocampal volume than individual memory performances. Recognition memory did not add further predictive utility to regression analyses.
This study provides support for use of MR Neuroreader™ hippocampal volumes as a clinically informative biomarker associated with memory performance, which is a critical diagnostic feature of MCI phenotype.
To highlight significant increase in serum creatine kinase(CK) without occurrence of Neuroleptic Malignant Syndrome (NMS), during treatment with atypical antipsychotics (Olanzapine and/or Quetiapine) in a patient with paranoid schizophrenia and the absence of recurrence on treatment with Clozapine.
Clinical biochemistry data was collected at regular intervals to monitor the relevant changes in serum CK levels,of a patient with paranoid schizophrenia who was an inpatient in our low secure forensic psychiatric ward in 2008-09. We also did a literature search in Pubmed and Google with the key words ‘Increase in serum Creatine Kinase’ and ‘antipsychotics’.
Our patient developed a significant increase in serum CK levels with Olanzapine and also Quetiapine without the occurence of NMS. The CK levels came back to normal on stopping these medications.Following this he was initiated on Clozapine and has remained stable for almost a year without a significant increase in serum CKlevels. There have been previous case reports on the use of Clozapine in patients with significant increase in CK secondary to other antipsychotics, without recurrence in elevation of creatine kinase.
Clinicians should be aware that Clozapine can be considered as a treatment option in patients presenting with (non NMS) significant increase in CK due to other antipsychotics. Clozapine has been known to cause Neuroleptic Malignant Syndrome and previous literature suggests Clozapine-induced NMS may present with fewer extrapyramidal side effects and a lower rise in Creatine Kinase levels.
Advance statements are expressions of wishes made by an individual anticipating future mental incapacity to express treatment choices, spiritual or cultural needs and to nominate someone to be consulted in the event of future incapacity.Advance statements about medical treatment are usually positively-framed treatment choices or requests. An advance statement could also inform the process of determining a person's best interests under the Mental Capacity Act 2005 procedure. Advance Directives project was initiated at Langdon Hospital(Regional Secure Unit with medium and low secure as well as open Forensic wards) in early 2011 and rolled out across site by late 2011.
Aims and objectives:
To audit the opportunity for patients at Langdon Hospital to have Advance Statements in place and its recording on Rio electronic system.To find out areas within the procedure that need improvement and changes.
Data was collected from Rio electronic records of all patients of all wards at Langdon Hospital during a 3 week period.
Results and conclusions:
Most wards had offered above 80% of patients a chance to make Advance Statements. 2 wards achieved 100%. The uptake by patients who were offered an opportunity was high at 70%. Most patients prefer to have a named advocate.In some cases patients specifically asked for a relative not to be involved.Improvement needed in using recommended format and uploading it to Rio. Some staff were concentrating mainly on physical health/end of life decisions. Improvement needed in including questions related to management of future aggression and violence.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
The crystal structure of atazanavir has been solved and refined using synchrotron X-ray powder diffraction data and optimized using density functional techniques. Atazanavir crystallizes in space group P21 (#4) with a = 15.33545(7), b = 5.90396(3), c = 21.56949(13) Å, β = 96.2923(4)°, V = 1941.134(11) Å3, and Z = 2. Despite being labeled as “atazanavir sulfate”, the commercial reagent sample consisted of atazanavir free base. The structure consists of an array of extended-conformation molecules parallel to the ac-plane. Although the atazanavir molecule contains only four classical hydrogen bond donors, hydrogen bonding is, surprisingly, important to the crystal energy. Both intra- and intermolecular hydrogen bonds are significant. The hydroxyl group forms bifurcated intramolecular hydrogen bonds to a carbonyl oxygen atom and an amide nitrogen. Several amide nitrogens act as donors to the hydroxyl group and carbonyl oxygen atoms. An amide nitrogen acts as a donor to another amide nitrogen. Several methyl, methylene, methyne, and phenyl hydrogens participate in hydrogen bonds to carbonyl oxygens, an amide nitrogen, and the pyridine nitrogen. The powder pattern is included in the Powder Diffraction File™ as entry 00-065-1426.
The crystal structure of atorvastatin calcium trihydrate (ACT) has been solved and refined using synchrotron X-ray powder diffraction data and optimized using density functional theory techniques. ACT crystallizes in space group P1 (#1) with a = 5.44731(4), b = 9.88858(16), c = 29.5925(10) Å, α = 95.859(3), β = 94.211(1), γ = 105.2790(1)°, V = 1521.277(10) Å3, and Z = 1. The most prominent feature of the crystal structure is a hydrophilic layer parallel to the ab-plane. The atorvastatin anions bond to each side of the hydrophilic layer, forming a triple layer. The calcium coordination is distorted octahedral, with the CaO6 coordination sphere being comprised of four carboxylate oxygens, one coordinated water molecule, and a hydroxyl group from one but not the second atorvastatin anion. Several O–H⋯O hydrogen bonds form a two-dimensional network parallel to the ab-plane. The powder pattern has been submitted to ICDD® for inclusion in the Powder Diffraction File™.
Baby’s breath (Gypsophila paniculata L.) is an invasive species in Michigan’s northern lower peninsula and is a problem in much of northern North America. It is of particular concern in coastal dune habitats of northwest Michigan, because the areas where it is most dense are also populated by several endemic and threatened species. Current removal methods include manual removal with a spade and directed spray-to-wet foliar application of glyphosate to individual plants using backpack sprayers. We assessed these methods by measuring G. paniculata density and presence–absence frequency before and after treatment using a point-intercept grid, establishing how type and timing of treatment within the growing season influences treatment efficacy and determining the proportion of plants that resprout after treatment. Our results show a consistent reduction in G. paniculata density after treatment with herbicide or manual removal (P < 0.001) but minimal impact on presence–absence frequency. These results indicate a need for quantitative data in the assessment of management efficacy to show a clearer picture of density reduction when extirpation is no longer a viable outcome of management. Through the assessment of treatment timing of manual removal and glyphosate treatments over time, we found no evidence that either treatment type was effective at reducing density when applied before plants flowered, but there was evidence that both treatments were effective when applied later in the growing season when plants were flowering. Resprouting of marked plants occurred in 14% of manually removed plants and 2% of herbicide-treated plants. Our results suggest that managers should treat G. paniculata infestations for consecutive years to remove regrowth and focus treatment during flowering for best control.